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INTRODUCTION
Chronic Obstructive Pulmonary Disease (COPD) ranked as the fifth leading cause of death in high-income countries, contributing to 3.8% of all deaths. In low and middle-income countries, it was the sixth leading cause, responsible for 4.9% of total mortality (Mannino & Buist, 2007). In India, COPD is the second most prevalent lung disease after pulmonary tuberculosis, with a prevalence ranging from 6.5% to 7.7% (McKay et al., 2012). Chronic Obstructive Pulmonary Disease (COPD) is characterized by inflammation and structural changes in the lower airways and lung tissue, along with the activation of inflammatory and immune responses. Current treatments often fail to halt disease progression or address many key features of COPD, which may be due to the absence of reliable biomarkers needed to identify the diverse clinical and molecular variations of the disease (Uwagboe et al., 2022). Diagnosing COPD requires a thorough approach that includes evaluating symptoms, risk factors and conducting spirometry testing. The prevalence of COPD is often underestimated because many symptoms, like cough and dyspnea, are overlooked by patients until they become more severe and cannot be confirmed through objective lung function tests (Daniel et al.,, 2021). This report presents a unique clinical case demonstrating a synergistic therapeutic approach for managing COPD by integrating classical Ayurvedic formulations with advanced nanomedicine. The rationale for this integrated strategy rests upon the premise that nanomedicine can significantly increase treatment effectiveness by improving the delivery and bioavailability of medicinal compounds at the cellular level, particularly beneficial for respiratory disorders.
CASE DESCRIPTION
Patient information
A 69-year-old male patient presented to the Panchakarma Outpatient Department (OPD) at the Mahatma Gandhi Ayurved Hospital and Research Centre, Wardha, India with complaints of an intermittent dry and wet cough and a persistent loss of appetite, symptoms that had been present for an extensive period of eight months. More recently, over the preceding month, the patient had developed associated acute complaints, including abdominal distension, palpitations and dyspnea occurring intermittently (on and off). Further complaints associated with the acute phase included generalized restlessness and disturbed sleep, also persisting for one month.
Past medical history
The patient had Ischemic Heart Disease (IHD) for 10 years. However, at the time of presentation, the patient was asymptomatic regarding IHD and was not taking any medications specifically related to that condition.
Relevant past interventions and their outcomes
The patient took doxiphylline, azithromycin, prednisolone and nebulization of ipratropium bromide and levosalbutamol. It is crucial to note that the patient reported that these conventional treatments failed to provide meaningful or sustained relief. The persistent failure of standard symptomatic relief measures strongly necessitated the exploration of an alternative, integrated treatment protocol.
Clinical findings
Upon initial clinical examination, the patient's vital signs were observed to be within normal established limits. Despite normal vital signs, the severity of the clinical manifestations was considerable. Based on standardized assessments, the patient's cough was graded as Severe (Irwin et al., 2018). Abdominal distension and palpitations were classified as Moderate. The dyspnea was rated as Grade 1 (Mild) according to the American Thoracic Society (ATS) Scale. The overall impact of the condition on the patient’s health status was evaluated using the COPD Assessment Test (CAT), which indicated Stage 2 (Moderate) COPD severity.
Diagnostic methodology
The confirmation of the final diagnosis of COPD required a meticulous approach utilizing objective clinical and imaging modalities, including spirometry, High-Resolution Computed Tomography (HRCT) and routine blood investigations.
Spirometry results were critical in objectively confirming the diagnosis and staging the disease, showing a predicted Forced Expiratory Volume in 1 sec (FEV₁) of 68%, a measurement consistent with Stage 2 (Moderate) COPD. Furthermore, laboratory assessment revealed an elevated C-Reactive Protein (CRP) level of 27.5 mg/dL. This elevated level served as an objective biomarker, indicating significant, underlying systemic inflammation, which is a key pathological component of COPD.
The HRCT imaging provided additional structural context, revealing small patchy consolidations, peribroncho-vascular nodular thickening and ground-glass attenuation present in the bilateral lower lobes, inferior lingula and middle lobe. These specific features were suggestive of an infective etiology contributing to the patient's current presentation. The imaging also noted a few enlarged lower paratracheal and right hilar lymph nodes, while confirming the absence of pleural effusion or pleural thickening on either side.
Before the objective confirmation using spirometry and HRCT, bronchitis or emphysema remained alternative possible diagnoses. The combined results established the final diagnosis as COPD.
The case was diagnosed and clerked by Dr. Punam Sawarkar, Professor and Head, Dept. of Panchakarma, MGACH & RC, who supervised diagnosis and treatment planning.
Diagnostic challenges
The initial presentation shared features with bronchitis and emphysema, which were ruled out post-spirometry and HRCT.
Timeline of Intervention and Outcomes
It emphasizes the sequence from symptom onset through intervention phases to final outcomes. This approach allows for a transparent assessment of therapeutic correlation and efficacy. Timeline of Clinical Presentation with Intervention and Outcomes explained in Table 1.
| Date/Period | Event/Phase | Key Clinical Status | Diagnostic/Assessment Data |
|---|---|---|---|
| 8 Months Prior (approx.) | Initial Symptom Onset (Chronic) | Intermittent dry/wet cough, appetite loss. History of IHD (10 years prior, now asymptomatic). | N/A |
| 1 Month Prior (approx.) | Acute Exacerbation & Baseline Visit | Abdominal distension, palpitations, dyspnea (on/off), disturbed sleep. Failure of previous conventional treatment. | Initial presentation: ATS Grade 1 Dyspnea; CAT Stage 2 (Moderate). CRP: 27.5 mg/dL (Elevated). |
| Time 0 (Day 1) | Diagnosis Confirmed & Intervention Start | COPD Stage 2 confirmed. Initiation of personalized Ayurvedic protocol + Nanomedicine. | FEV₁ 68%, HRCT findings noted (consolidation, nodular thickening). |
| Day 1 - Day 30 | Treatment Phase 1 (1 Month) | Core pulmonary agents continued. Focused digestive support: Hingwashtak Churna and Gandharva Haritaki Churna administered. | Monitoring of digestive function, adherence and tolerability (strict adherence noted). |
| Day 30 - Day 45 | Treatment Phase 2 (Continued Core Agents) | Sukshma Vasa Globules and Dashamoola Katuthrayam Kashaya continued for sustained pulmonary action. | Monitoring of respiratory function and overall well-being. |
| Post-Intervention (Follow-up) | Outcome Assessment | Significant symptomatic improvement, including resolution of digestive and respiratory distress. Everyday activities improved. | ATS Grade 0 (None); CAT Stage 1 (Mild). CRP: 4.32 mg/dL (Normal). |
Therapeutic intervention
The therapeutic protocol was individualized and comprised a synergistic combination of classical internal Ayurvedic medications and a nanomedicine-based formulation. The strategic inclusion of diverse formulations aimed not only at the primary respiratory ailment but also at underlying systemic and digestive imbalances. Internal Ayurvedic medications, including Sukshma Vasa globules as a nanomedicine, Dashamoola Katuthrayam Kashaya for 45 days and Hingwashtak Churna and Gandharva Haritaki Churna for 1 month, were prescribed.
Administration of therapeutic intervention
Sukshma Vasa globules 5 globules thrice a day, Dashamoola Katuthrayam Kashaya 15 mL twice daily after food with warm water for 45 days. Hingwashtak Churna 5 gm before meal with warm water and Gandharva Haritaki Churna 10 gm at night after food with warm water given for 1 month. The therapeutic intervention remained rigorously consistent throughout the entire stipulated course of treatment, providing a stable basis for outcome evaluation.
Follow-up and outcomes
The post-intervention evaluation confirmed a marked and sustained improvement across both objective and clinician- and patient-assessed outcomes.
Clinician- and patient-assessed outcomes
The patient's cough significantly improved, reducing from Severe to Mild. Appetite improved and abdominal distension and palpitations became milder. The American Thoracic Society (ATS) scale decreased from 1 (Mild) to 0 (None) and the COPD Assessment Test (CAT) score improved to Stage 1(Mild) following treatment.
Follow-up diagnostic and other test results
Following the intervention, the patient's everyday activities were evaluated through clinical follow-up and elevated C-Reactive Protein (CRP) became in the normal range (4.32mg/dL).
Intervention adherence and tolerability
The patient reported no adverse effects from the medication and adhered strictly to the treatment plan. Follow-up assessments confirmed good tolerability.
Adverse and unanticipated events
No adverse events occurred during the course of treatment.
DISCUSSION
Nanomedicine is designed to increase the effectiveness of treatment by improving medicine delivery to the body's cells. Vasa (Adhatoda vasica) is a well-known herb used to treat respiratory disorders and fevers; almost all Ayurvedic seers agree that it is important for respiratory ailments (Claeson et al., 2000). Sukshma Vasa Globules is potent bronchodilator and mucus-clearing properties, targeting the respiratory symptoms of COPD effectively through enhanced delivery at the cellular level due to its nano size and micro-sized therapeutic particles that have immense potential in reducing both the frequency and severity of the cough, whether dry or wet and help clear the sticky mucus, leading to better respiratory function and less breathing difficulty. Dashamoola Katuthrayam Kashaya is tridosha shamak that shows anti-oxidant and anti-inflammatory effects, helps to reduce parenchymal inflammation and relax the muscle airways, also reduces abdominal distension and eases the discomfort from palpitations (Parekar et al., 2015). Hingwashtak churna possesses deepana (digestive stimulation) and pachana (metabolism) properties therefore used in indigestion, flatulence and other conditions involving compromised digestive tract metabolism (Shirwaikar et al., 2006). Gandharva haritaki churna promotes regular and easy stool removal without vitiating vata, which supports healthy bowel habits (Nair, Holla and Yoganarasimhan, 1988). Integrating nanomedicine into classical ayurvedic formulations can enhance their effectiveness, ensuring that the medicinal compounds are delivered more efficiently and significantly impact the management of COPD.
CONCLUSION
This case demonstrates the potential benefits of combining classical Ayurvedic formulations with nanomedicine in managing Chronic Obstructive Pulmonary Disease (COPD). Sukshma Vasa Globules significantly reduced cough frequency and severity, improving respiratory function and reducing mucus build-up. The patient's overall well-being improved with no adverse effects, suggesting that this collaborative approach is effective and safe for managing COPD symptoms. This approach may offer a promising alternative or adjunct to conventional treatments for COPD. Clinical studies with large sample sizes can be planned to embark on this conclusion.