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Group A: medication only, Group B: medication+ Spirulina, Group C: Spirulina only. ANOVA: significant at *p < .05, **p < .01, ***p < .001. a Baseline—2 months (p < .05). b 2-4 months (p < .01). c Baseline—4 months (p < .01). d 2-4 months (p < .001). e Baseline—4 months (p < .001). f 2-4 months (p < .05). g Baseline—4 months (p < .05). h Baseline—2 months (p < .001). 1 Baseline—2 months (p < .01).

anti-inflammatory drugs has helped to improve the pulmonary function in Group A patients, as evidenced by significant improvement in % FEV1 and % FEV1/FVC over a period of 4 months. However, the patients in Group A reported to experiencing certain side effects such as palpitation, weakness, and tremors on use of these medications. Literature has cited a few to more increasing side effects of drugs on prolonged use.41

The Group B patients (medication + Spirulina) showed a significant improvement in % FVC (72 ± 17 to 78 ± 16), % FEV1 (61 ± 14 to 67 ± 16) and % PEFR

values (43 ± 18 to 58 ± 18) over a period of 4 months (Table 4.8). It is interesting to note in this group that when the Spirulina supplements were withdrawn after a period of 2 months, the pulmonary function variables showed a decrease from 2 to 4 months. This indicates that Spirulina might be playing an important contributory role over and above the given medication. Spirulina could have probably contributed to improvement in pulmonary function owing to two reasons. First, it is a rich source of GLA, which might play a crucial role as an anti-inflammatory agent and second it has a good antioxidant profile that might help to counteract the detrimental exposure to oxidants.

Further, the role of Spirulina gets pronounced when a significant decrease in % FVC, % FEV1, and % FEV1/FVC was observed in the next 2 months when the Spirulina supplements were withdrawn while the medication was continued. Similar supplementation studies with GLA-rich agents or by altering the essential fatty acid content of the diet have been carried out, and these have shown a beneficial effect in patients with inflammatory diseases.42-44 Also, a study by Hayashi et al.45 reported that Spirulina may be beneficial in treating some forms of atopic bronchial asthma. Thus, the above-mentioned studies support our findings that supplementation with GLA rich agents (Spirulina) could possibly have helped to improve the pulmonary function in asthmatics.

The probable contributory factor in Spirulina is its rich antioxidant profile. Symptoms of ongoing asthma in adults appear to be increased by exposure to detrimental oxidants, which can be released endogenously in the lungs or can be exogenous in nature. It has been reported that inflammatory cells obtained from lungs of patients with asthma generate increased amounts of reactive oxygen species (ROS) and ROS can reproduce the key abnormalities of asthma.46-49

Thus, Spirulina with its good content of antioxidant nutrients such as j-carotene, vitamin E, selenium could possibly play a role in alleviating the pulmonary function abnormalities by scavenging endogenous and/or environmental oxidant sources. In the present study the intake of most nutrients (energy, protein, j -carotene) by the asthmatics was below the recommended dietary allowance (RDA). In particular, j-carotene contributed to only 52% of RDA in group B patients (Table 4.6). A marked fall in consumption of antioxidants and mineral cofactors in fresh fruit and vegetables, fish, and meat has produced a general reduction in the ability of lungs to counter inflammatory reactions due to inhalation of irritants or allergens.50

Spirulina, which contains antioxidant vitamins and minerals, could have possibly improved the overall antioxidant status of group B patients. This would have resulted in improving their pulmonary function efficacy as evidenced by significant improvement in all the pulmonary function variables in the first 2 months of supplementation followed by significant reduction observed in % FEV1, % FVC, and % FEV1/FVC in next 2 months on withdrawal of Spirulina. Also, Spirulina with its richest source of proteins of high biological value and a good content of phytonutrients might have helped to improve the immunocompetance in asthma patients.

In patients of Group C who were on continued Spirulina supplementation for a period of 4 months significant improvement was observed in % FEV1 values from 63 ± 14 to 80 ± 14 (Table 4.8). In addition to antioxidant vitamins and minerals, the

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