30-Year-Old Male Patient Recovered from Allergic Bronchopulmonary Aspergillosis (ABPA)

Abstract

Background: Allergic Bronchopulmonary Aspergillosis (ABPA) is a chronic respiratory hypersensitivity condition characterized by recurrent cough, dyspnea, fever, and mucus plugging. Ayurveda describes comparable presentations under Shwasa Roga, where Kapha obstruction of Vata in the respiratory channels, i.e., Pranavaha Strotas, leads to impaired breathing and reduced functional capacity.

Objective: To evaluate the effect of an Ayurvedic treatment protocol in a case of ABPA correlating with Shwasa Roga (Kapha-Vata Pradhana).

Materials and Methods: A 30-year-old male with symptoms of ABPA received Ayurvedic therapy including Pratimarsha Nasya, i.e., Nasa Yoga Grutham and IAFA Nasal All Clear X Drops, Internal therapy including Swarasa, i.e., Total Care 3X Ras, Chhoti Dudhi Swaras, Shirish Swaras, and herbo-mineral formulations, i.e., AF-7 Tablet, IAFA Respiro Detox Formula, IAFA Curcumin, Sitopaladi Tablet, Shwaskuthar Ras, Laxmivilas Ras Nareedya, Rasasindoor Sahastraputi. Dietary regulation and Yoga-Pranayama were also advised. Follow-ups were recorded on 03/08/2021, 04/11/2021, 03/02/2022, 05/04/2022, and 03/06/2022. Symptom scores and functional changes were monitored over 10 months.

Results: Progressive clinical improvement was observed with a reduction in dyspnea from Grade III to Grade I, approximately 70% decrease in cough frequency, and complete resolution of hemoptysis. Appetite and sleep normalized, functional tolerance improved to independent routine activities, and body weight increased from 49 kg to 53.5 kg. No respiratory exacerbations or hospital visits occurred during the treatment period.

Conclusion: Ayurvedic management targeting Kapha-Vata imbalance in Shwasa Roga contributed to sustained respiratory improvement and better quality of life in this ABPA case. Further controlled studies are recommended to validate these findings.

Introduction

Allergic Bronchopulmonary Aspergillosis (ABPA) is a chronic pulmonary disorder caused by an exaggerated immune response to Aspergillus fumigatus antigens. It commonly occurs in individuals with underlying airway hypersensitivity and presents with recurrent cough, dyspnea, mucus plugging, wheezing, and occasional hemoptysis.

If inadequately managed, ABPA may progress toward airway remodeling and compromised respiratory function. In Ayurveda, similar manifestations are described under Shwasa Roga in various classical literatures, a condition originating from the vitiation of Vata being obstructed by Kapha in the chest region (Uras).

This obstruction disrupts the normal movement of Vata in the Pranavaha Strotas, leading to breathlessness, chest tightness, frequent cough, expectoration, and reduced strength and appetite. Among different types of Shwasa Roga, Kapha-Vata Pradhana involvement aligns closely with clinical symptoms of mucus accumulation, heaviness in the chest, recurrent attacks, and respiratory distress.

From this dual perspective, ABPA can be correlated with a Kapha-Vata dominant Shwasa Roga presentation, where aggravated Kapha obstructs the channels of respiration, while Vata contributes to the episodic shortness of breath and cough reflex. The therapeutic goal in such cases includes Kapha-Shamana (reducing obstruction), Vata-Anulomana (normalizing respiratory movement), Strotoshodhana (clearing channels, mainly Pranavaha Strotas), Agni-Deepana (enhancing digestion and metabolism), and strengthening of lung function.

This case report presents the clinical outcomes of a structured Ayurvedic intervention in a diagnosed case of ABPA, focusing on symptom control, functional improvement, and overall quality of life during long-term follow-up.

Keywords: ABPA, Ayurveda, Shwasa Roga, Nasya, Aspergillosis, Respiratory Allergy, Bronchopulmonary Diseases, Dyspnea

Case Presentation

A 30-year-old male presented with a history of recurrent respiratory symptoms suggestive of chronic allergic airway disease. He complained of a persistent cough with occasional mucus expulsion, exertional shortness of breath, episodic fever, chest pain, headache, reduced appetite, generalized weakness, and unintended weight loss.

He also reported episodes of hemoptysis, causing significant anxiety. The symptoms were chronic with fluctuating severity, affecting his routine physical activity and nutritional status. Based on clinical history and assessment, the case correlated with Shwasa Roga, i.e., Kapha-Vata Pradhana, and may be interpreted in modern terms as Allergic Bronchopulmonary Aspergillosis (ABPA).

No notable comorbidities or hospitalizations were reported at the time of the first consultation. Ayurvedic therapy plan was initiated, and follow-up assessments on 04/11/2021, 03/02/2022, 05/04/2022, and 03/06/2022 documented progressive improvement during treatment.

1) Patient Details

Age/Sex: 30-year-old / Male

Date of First Visit: 03/08/2021

2) Chief Complaints

Recurrent fever
Difficulty in breathing
Recurrent cough
Hemoptysis
Headache
Chest pain
Loss of appetite
Underweight
Joint pain
Weaknesses

3) Diagnosis

System	Diagnosis	Clinical Basis
Modern	Allergic Bronchopulmonary Aspergillosis (ABPA)	History of recurrent respiratory symptoms, cough with mucus, hemoptysis, and allergic airway sensitivity
Ayurveda	Shwasa Roga, i.e., Kapha-Vata Pradhana	Kapha obstruction in Pranavaha Strotas, causing Vata impairment, results in dyspnea, cough, chest tightness, and anorexia

4) Triggers and Exacerbating Factors

Dust and environmental allergens increased cough and respiratory distress
Cold exposure worsens breathlessness and chest tightness
Seasonal changes, especially winter and humid climates, result in symptom flare-ups
Poor digestion and a Kapha-aggravating diet result in heaviness in the chest, mucus formation
Physical exertion during the symptomatic phase increased dyspnea and fatigue
Inadequate nutrition and low body mass reduced stamina and recovery rate

Materials and Methods

This section describes clinical intervention, Ayurvedic diagnosis, treatment strategy, monitoring plan, and supportive lifestyle measures applied throughout the treatment.

1) Intervention Protocol

Ayurvedic treatment was initiated after baseline consultation on 03/08/2021, focusing on correction of Kapha-Vata vitiation, Strotoshodhana (clearing airway obstruction), Agnideepana, and Rasayana to improve nutrition and immunity, local airway therapies to reduce Kapha accumulation.

2) Ayurvedic Diagnostic Framework

Table 1. Samprapti Ghatak (Ayurvedic Diagnostic Analysis)

Samprapti Ghataka	Analysis
Dosha	Kapha-Vata Pradhana
Dushya	Rasa Dhatu (reduced nourishment and recurrent fever), Mamsa Dhatu (lung tissue involvement and structural changes)
Strotas	Pranavaha Strotas (primary), Annavaha and Udakavaha Srotas (secondary)
Srotodushti	Sanga (obstruction), Vimargagamana (improper movement of Vata)
Udbhava Sthana	Aamashaya (due to impaired digestion and mucus formation)
Vyaktasthana	Uras (lungs and thoracic region)
Agni	Mandagni indicated by anorexia, low weight
Aama	Present (congestion, heaviness, weakness)
Roga Marga	Abhyantara (inner pathway)
Adhishthana	Pranavaha Strotas affected by Kapha obstruction

3) Ayurvedic Treatment Protocol

The treatment approach was focused on relieving Kapha obstruction and restoring normal Vata movement in the Pranavaha Strotas. External therapy included Pratimarsha Nasya with Nasa Yoga Grutham and IAFA Nasal All Clear X Drops, administered twice daily to liquefy and expel Kapha from the upper airway, enhance nasal patency, and support respiratory function.

Additionally, Nasal Dhumapana was incorporated in the later stage to further facilitate mucolysis and reduce airway inflammation. Internal therapy primarily utilized various Swarasa, i.e., Total Care 3X Ras, Chhoti Dudhi Swaras, and later Shirish Swaras, ensuring rapid systemic absorption and efficient clearing of Kapha while enhancing Agni and immunity.

This was supported with herbo-mineral formulations, including AF-7 Tablet, IAFA Respiro Detox Formula, Sitopaladi Tablet, Shwaskuthar Ras, Laxmivilas Ras (Nardiya), and later Rasasindoor Sahastraputi for deeper detoxification and improved pulmonary strength. Curcumin with Piperine Extract was provided throughout due to its anti-inflammatory and immunomodulatory properties. Together, these treatments aimed to normalize breathing effort, improve digestive and immune strength, prevent recurrence, and stabilize long-term respiratory function while avoiding adverse effects.

4) Treatment Progression Across Follow-Ups

Table 2. Formulations Used with Dose, Frequency, Route, and Duration

Formulations used	Dose	Frequency	Route	Duration and Follow-up
Nasa Yoga Grutham	4-6 drops	Twice daily	Intranasal	Throughout all follow-ups.
IAFA Nasal All Clear X Drops	2-6 drops	Twice daily	Intranasal	All follow-ups, dose adjusted.
Total Care 3X Ras	30 ml with an equal amount of water	Twice daily	Oral	Initial phase till Nov 2021.
Chhoti Dudhi Swaras	30 ml with an equal amount of water	Twice daily	Oral	Throughout treatment.
Shirish Swaras	30 ml with an equal amount of water	Twice daily	Oral	Added 03/02/2022 onwards.
IAFA AF-7 Tablet	2 tablets	Twice daily	Oral	Entire treatment period.
IAFA Respiro Detox Formula	3 g	Twice daily	Oral	All follow-ups.
Sitopaladi Tablet	2 tablets	Twice daily	Oral	Initial phase.
Laxmivilas Ras (Nardiya)	1 tablet	Twice daily	Oral	Added 03/02/2022.
Shwaskuthar Ras	2 tablets	Twice daily	Oral	Added 03/02/2022.
Rasasindoor Sahastraputi	1 tsp mixture	Twice daily	Oral	Added 03/06/2022.
Curcumin with Piperine Extract	1–2 capsules	Twice daily	Oral	Entire treatment period.
Nasal Dhumapana	Once daily	Inhalation	Nasal/Oral	Added 03/06/2022.

5) Phased Therapeutic Strategy

The treatment plan was structured in progressive phases as per the changing clinical needs. Initial management focused on Kapha liquefaction and airway clearance. Subsequent phases work on deeper respiratory strengthening and immune support to sustain recovery and prevent recurrences. Modifications were made at each follow-up based on symptom response and functional improvement.

Table 3. Phased Ayurvedic Treatment Strategy

Phase	Timeline	Key Ayurvedic Treatment Active in Phase	Therapeutic Objective	Clinical Outcomes Observed
Phase 1A: Acute Management and Kapha Clearance	03/08/2021 to 04/11/2021	Nasya (Nasa Yoga Grutham and IAFA Nasal All Clear X Drops), Total Care 3X Ras, Chhoti Dudhi Swaras, AF-7 Tablet, IAFA Respiro Detox Formula, Sitopaladi Tablet, Curcumin with Piperine extract	Reduce airway obstruction, relieve hemoptysis, decrease fever, and improve breathing.	Hemoptysis stopped, fever reduced, dyspnea improved from Grade III to Grade II, and appetite restored.
Phase 1B: Clinical Stabilization with Same Protocol	04/11/2021 to 03/02/2022	Same as Phase 1A	Maintain symptom control, enhance digestion and strength, and prevent relapses.	Cough frequency further lowered, physical tolerance improved, and weight gain continued.
Phase 2: Functional Enhancement and Relapse Prevention	03/02/2022 to 05/04/2022	Added new Shirish Swaras, Shwaskuthar Ras, Laxmivilas Ras (Nardiya) in Phase 1 components	Strengthen lungs, clear deeper Kapha, enhance immunity	Dyspnea is stable at Grade II, but with better stamina, weight approx. 52.5 kg, better exercise tolerance
Phase 3: Stabilization and Rasayana Support	03/06/2022 onward	Rasasindoor Sahastraputi was added to the Respiro Detox Formula, and Nasal Dhumapana was introduced with Phase 2 supports.	Prevent recurrence, promote long-term lung resilience, and normalize lifestyle activities.	Dyspnea Grade I, minimal cough, no hospital visits, improved sleep, and confidence

6) Monitoring and Evaluation Protocol

Evaluation was performed using clinical symptoms, functional capacity, and nutritional status across all follow-up visits. Dyspnea severity was objectively graded using the Modified Medical Research Council (mMRC) Dyspnea Scale, which demonstrated progressive improvement from Grade III at baseline to Grade I.

Table 4. Clinical Monitoring Approach

Parameter	Frequency of Assessment	Assessment Method	Response
Dyspnea Severity (mMRC Grade)	Each follow-up visit	Modified Medical Research Council scale	Improvement indicated by grade reduction: Grade III to Grade II to Grade I, which enhanced ventilatory efficiency and reduced breathlessness
Cough Frequency	Feedback on follow-up	Patient-reported episodes/day and clinical enquiry	Lower frequency indicates Kapha clearance and reduced airway irritation
Hemoptysis	Daily monitoring	Symptom observation and patient reporting	Absence of bleeding signifies airway mucosa recovery
Body Weight	Every follow-up	Standard digital weighing	Weight gain reflects improved nutrition, Agni, and systemic strength
Sleep Quality	Weekly review	Patient feedback on nocturnal awakening	Improved sleep continuity results in reduced nocturnal dyspnea and anxiety
Physical Endurance	Every follow-up	Activity tolerance and daily functioning assessment	Increased stamina and walking distance indicate normalized Vata movement in respiration
Exacerbations/ Hospital Visits	Continuously monitored	Patient self-reporting	No exacerbations indicate successful disease control and relapse prevention.

7) Dietary and Lifestyle Monitoring

Kapha-Vata has a pacifying diet, which is warm, light, and fiber-rich.
Avoid processed foods.
Avoid cold, sour, heavy, fermented, dairy-rich items that aggravate Kapha.
Regular lukewarm water sipping for mucolysis.
Daily Yoga and Pranayama like Sarvanga Asanam, Vajrasana, Savasana, Suryanamaskar.
Adequate rest and stress reduction.

Results

Table 5: Symptom Status Across Follow-up Visits

Visit Date	Dyspnea (mMRC Grade)	Cough Episodes/ Day	Hemoptysis	Weight	Functional Status
03/08/2021	Grade III	20-25	Present	49 kg	Unable to walk >50 m without breathlessness
04/11/2021	Grade II	12-14	Absent	50.5 kg	Able to perform light daily activities
03/02/2022	Grade II	8-10	Absent	51 kg	Improved stamina and confidence
05/04/2022	Grade II	6-8	Absent	52.5 kg	Routine tasks without chest discomfort
03/06/2022	Grade I	3-5	Absent	53.5 kg	Fully independent in daily activities

1) Major Clinical Improvements

Hemoptysis is completely resolved after the first follow-up.
Dyspnea improved from Grade III to Grade I over 10 months.
Cough reduced by nearly 70%.
Weight gain of 4.5 kg indicates improved Agni and nutrition.
No hospital visits or acute exacerbations throughout treatment.
Marked improvement in sleep and physical endurance.
Subjects regain routine functional capacity without limitations.

Table 6: Additional Clinical Response Indicators

Parameter	Baseline	Final Follow-Up	Clinical Significance
Night awakenings due to dyspnea	3-4 / week	0	Better nocturnal airway stability and anxiety reduction
Activity tolerance	< 50 m	Full household activities	Improved Vata function in respiration
Appetite	Poor	Normal	Agnideepana achieved
Recurrence pattern	Frequent exacerbations	None	Effective Kapha-Shamana and Strotoshodhana

2) Safety and Adverse Events

No adverse drug reactions reported
No new systemic complaints
Good clinical tolerance throughout treatment

Discussion

Allergic Bronchopulmonary Aspergillosis (ABPA) is a chronic immunological disorder resulting from hypersensitivity to Aspergillus fumigatus, characterized by recurrent cough, dyspnea, mucus plugging, and episodic inflammatory flares. Modern treatment often struggles with relapses and long-term airway damage. In Ayurveda, this condition is correlated with Shwasa Roga, particularly where Kapha obstruction and Vata dysfunction dominate respiratory pathology.

1) Pathophysiological Understanding of ABPA

Allergic Bronchopulmonary Aspergillosis (ABPA) develops as a hypersensitivity to Aspergillus fumigatus colonizing the airways. The inhaled fungal antigens trigger IgE-mediated and Th2-dominated immune responses, leading to eosinophilic inflammation, airway edema, and excessive mucus secretion. Repeated episodes of immune activation cause mucus plugging, airflow obstruction, and structural bronchial damage, eventually progressing to bronchiectasis if uncontrolled.

Clinically, this manifests as recurrent cough, exertional dyspnea, fever, chest discomfort, weight loss, and fatigue, which were consistently observed in this patient. Ayurveda interprets this as Shwasa Roga arising from simultaneous Kapha aggravation and Vata vitiation. Kapha, when excessively accumulated, i.e., Sanchita and Prakupita Kapha, obstructs the Pranavaha Strotas, leading to Sanga Strotodushti, i.e., blockage of air channels.

This results in Shleshma- Aadhikya (excessive phlegm), heaviness in the thorax, and a productive cough. The obstructed airflow disrupts normal movement of Prana Vaayu, causing Shwasa- Kricchta (breathing difficulty), Ucchavasa- Nirodha (restricted inhalation), reduced endurance, and disturbed sleep.

Further, Mandagni and Aama formation, which is symptomatically shown by anorexia, low weight, and recurrent fever, weaken the system’s metabolic and immune defense, increasing susceptibility to chronic allergic responses.

Persistent Kapha stagnation causes local inflammation and involvement of Rakta and Mamsa Dhatu, reflected clinically as hemoptysis and compromised lung parenchyma. The chronic nature of symptoms and allergic recurrences indicates Oja-Kshaya or instability of Vyadhi-Kshmatva (reduced disease resistance).

2) Phase-Wise Therapeutic Approach and Clinical Response

The treatment plan of this case was described as phases that correspond to a sequential breakdown of Ayurvedic Samprapti (pathogenesis). Each phase represented a targeted therapeutic milestone, which is shown by clinical improvements.

Phase 1: Removal of Kapha obstruction and Airway Relief

Time period: 03/08/2021 to 04/11/2021

Target: Remove Kapha obstruction in Pranavaha Strotas

Therapeutic Strategy: Nasya Chikitsa for draining and thinning of Kapha by Nasa Yoga Ghrutham, All Clear X drops. Use of Swarasa therapy, i.e., Total Care 3X Ras, Chhoti Dudhi for systemic Kapha- Shamana. Sitopaladi, AF-7, and Detox formulation to relieve cough and inflammatory heat.

Samprapti Vightana (Pathophysiological Reversal): Kapha Avarana decreases, resulting in improved Vata Gati and airway patency restored.

Clinical Response:

Hemoptysis resolved
Dyspnea downgrade: mMRC Grade III to II
Appetite increased, fever reduced
Body shifts to controlled respiratory function

Phase 1B: Disease Stabilization and Digestive Fire stimulation

Time period: 04/11/2021 to 03/02/2022

Target: Prevent relapses and sustain gains.

Therapeutic Strategy: Continuation of Phase-1 medicines to maintain the decrease of Kapha, and also focus on digestion-strengthening and sleep improvement.

Clinical Response:

Cough frequency significantly decreased
Night awakenings reduced
Mild weight gain continued

Phase 2: Functional Respiratory Strengthening

Time period: 03/02/2022 to 05/04/2022

Target: Deeper pulmonary restoration and control of allergies

Therapeutic Strategy:

Added Shirish Swaras for immunomodulation and airway cleansing
Shwaskuthar Ras and Laxmivilas Ras for Pranavaha Strotas stabilization by Strotoshodhana and Vata-Kapha harmonization.

Samprapti Vightana (Pathophysiological Reversal): Srotoshodhana results in decreased mucus load and Prana Vayu normalization, which increases lung compliance.

Clinical Response:

Dyspnea stabilized, better stamina, and reduced breathing effort. Weight increased to 52.5 kg, which resulted in restored nutrition.
Better daily physical capacity.

Phase 3: Rasayana Phase and Long-Term Disease Control

Time period: 03/06/2022 onward

Target: Immunity stabilization, relapse prevention, quality of life enhancement

Therapeutic Strategy: Rasasindoor Sahastraputi to elevate systemic Ojas. Dhumapana for ongoing mucolysis and sterile airway maintenance. Continuation of Curcumin-Piperine for immune regulation.

Clinical Response:

Dyspnea further improved: Grade II to Grade I
Minimal cough, no exacerbations
Fully independent in routine activities

3) Ayurvedic Pharmacological Correlation

Table 7. Ayurvedic Pharmacological Correlation of Interventions Used with Clinical Outcomes

Intervention	Ayurvedic Therapeutic Role	Clinical Correlation	Observed Outcome in Patient
Nasa Yoga Grutham	Clears Kapha from upper channels, improves nasal airflow	Reduces obstruction and post-nasal drip	Better airway patency, reduced cough triggers
IAFA Nasal All Clear X Drops	Kapha breakup and drainage	Mucolytic effect	Less nasal congestion and cough episodes decrease
Chhoti Dudhi Swaras	Kapha Nashaka and allergy-modulating	Anti-inflammatory, antihistamine-like behavior	Reduced mucus volume and fever relief
Shirish Swaras	Anti-allergic, anti-inflammatory	Down-regulates the allergic cascade	Fewer symptom flares and improved breath capacity
AF-7 Tablet	Systemic Kapha-Shamana and immunity support	Stabilizes immune response	No exacerbations recorded
Respiro Detox Formula	Srotoshodhana (airway cleansing)	Decreases airway reactivity	Dyspnea and cough intensity decrease
Sitopaladi Tablet	Relieves cough and bronchial irritation	Calms hyper-responsive airways	Faster recovery from acute symptoms
Shwaskuthar Rasa	Strengthens Pranavaha Strotas	Bronchodilator effect	Breath control improved
Laxmivilas Ras (Nardiya)	Digestion correction reduces Aama	Improves metabolism	Weight gain and stamina increase
Rasasindoor Sahastraputi	Act as Rasayana: enhances Ojas and lung strength	Immune resilience enhancement	No relapse and improved overall capacity
Curcumin with Piperine extract	Anti-inflammatory and Kapha-Vata balancing	Eosinophil and cytokine suppression	Less allergic irritation
Nasal Dhumapana	Maintains airway hygiene, mucolysis	Warm vapor clearing effect	Prevents mucus buildup and nocturnal cough
Follow of Pathya and Apathya, i.e., Kapha-Vata pacifying	Restores Agni and reduces Kapha	Improved nutrition and gut-lung axis	Weight and appetite improved
Yoga and Pranayama	Vata Anulomana supports lung expansion	Strengthens respiratory muscles	Healthy Respiratory System

Happy Note

Conclusion

This case shows that a planned and personalized Ayurvedic treatment approach can be useful in managing chronic respiratory conditions like ABPA. By reducing Kapha obstruction and improving the normal movement of Vata in the lungs, the therapy helped relieve breathlessness, reduce cough, and improve appetite and strength.

Consult Online with Dr. Sahil Gupta (B.A.M.S., M.H.A.)

The patient gained weight, regained routine activity, and did not experience any further flare-ups during the follow-up period. No side effects or complications were observed. These encouraging clinical improvements suggest that Ayurveda may offer a safe and supportive option for long-term management of ABPA and similar forms of Shwasa Roga. However, larger studies with standard investigations are needed to confirm these results.

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