From Smoke to Respiratory Relief: 
Development, Validation and Feasibility of 
Pranayama-based VRBT Module for Enhancing 
Pulmonary Function in Biomass Smoke 
Exposed Women.

Background: Prolonged exposure to biomass smoke is a leading cause of respiratory morbidity among women living in low and middle-income countries, resulting in progressive lung damage and increased risk for chronic respiratory diseases. Purpose: To develop, validate, and evaluate the feasibility of a Pranayama-based voluntarily regulated breathing technique (VRBT) module specifically tailored for women exposed to biomass smoke. Methods: The VRBT module was developed through a yoga literature review and scientific evidence, and then evaluated for content validity by 22 yoga experts using Lawshe's CVR method. One month pre-post feasibility trial of the module was conducted among 12 rural non-smoking women mean age of 50.42 ± 8.05 years; Biomass Exposure Index ≥ 60 hour-years. Pulmonary function was measured at baseline and post-intervention using Spirometer RMS Helios 401. Statistical analyses were conducted using paired t-tests (p < .05). Results: Fourteen practices met the CVR threshold of 0.45; the final module duration is 40 minutes. After one month, significant improvements were observed in FVC (1.43 ± 0.41 L to 1.94 ± 0.37 L, p < .001), FEV1 (1.31 ± 0.40 L to 1.57 ± 0.34 L, p = .037), FEV1/FVC ratio (91.7 ± 7.96 to 80.6 ± 1.63, p < .001), and PEFR (2.83 ± 0.97 to 3.60 ± 0.96 L/s, p = .040). FEF25-75% did not show any significant change (p = .554). Pranayama was found to be a safe intervention with no adverse effects observed. Conclusion: The module was designed for simplicity and ease of adoption by women, ensuring its accessibility. Hence, the VRBT module can be administered to the women exposed to biomass smoke.