Integrative Management of Respiratory Illnesses, continued…
There have been several studies published on the antimicrobial effects of vitamin D. An excellent review article on the antimicrobial research behind the use of supplemental vitamin D was produced by Youssef et al. (2011), and describes the state of the literature to date. Those authors conclude that vitamin D boosts innate immunity through modulation of cytokines and antimicrobial peptides.91 B and T cell, monocyte, and macrophage activation are all increased by vitamin D.92,93 Moreover, the enhanced clearance of invading organisms exhibited by its use may help to minimize direct invasion of infectious agents at sites such as the respiratory tract.94-98
Goldenseal, Berberis species, mullein, St. John’s wort, olive leaf, osha, lomatium, horehound, and bee propolis are agents that we use routinely. Goldenseal (Hydrastis canadensis) shows some in vitro activity against the H1N1 strain of influenza A.99 The effects of Berberis species, and the isoquinoline alkaloid berberine in particular, have demonstrated in vitro effects against respiratory pathogens such as S. aureus, and K. pneumoniae, and C. albicans.100-103 It has also been shown to increase mucous production and may therefore be a soothing expectorant.104 Mullein (Verbascum thapsus) has demonstrated antibacterial activity against S. aureus, K. pneumoniae and has a rich traditional use as a soothing expectorant.105,106 St. John’s wort (Hypericum perforatum) has demonstrated excellent antimicrobial activity against MRSA and other gram-positive bacteria.107 Olive leaf (Olea europa), osha (Ligusticum porteri), and lomatium (Lomatium dissectium) all have a rich traditions of use in treatment of upper respiratory infections, especially viral infections, and olive leaf has shown some antiviral activity in vitro.38,108 Horehound (Marrubium vulgare) essential oil has shown antibacterial and antifungal properties.109,110 Bee propolis is another agent that we employ frequently; it has demonstrated repeated antimicrobial and anti-inflammatory properties in vitro.111-121
Supportive Natural Therapies
Supportive therapies take many forms and may be immunomodulatory, hydrating, nutritional, or any of several others. In this instance, we will also use the term to refer to those treatments that are traditional or rationally expected to be physiologically helpful in spite of the fact that evidence surrounding their use may be conflicting or absent.
Two clinical trials have shown the importance of supplemental zinc in the treatment of childhood pneumonia. The first of these demonstrated that 20 mg/day of zinc supplementation in 270 children aged 2 to 23 months hospitalized for pneumonia accelerated the rate of recovery and reduced the number of days spent in hospital.122 The second trial demonstrated no effect of zinc supplementation on the amount of time to normalization of respiratory rate, oxygen saturation, or body temperature in 352 children aged 6 to 59 months with severe pneumonia; however, there was a significant reduction in mortality in the treated group compared with the placebo group.123
The use of vitamin C in the treatment and prophylaxis of pneumonia has been the subject of literature review and authors conclude that the present evidence is insufficient and contradictory, but promising, especially in those with low plasma level of vitamin C.124
Vitamin E has been demonstrated to significantly enhance immune function in the elderly in several investigations.125
In our practice, we routinely recommend postural drainage, contrast hydrotherapy, short wave diathermy, and at-home mustard plasters in the supportive treatment of respiratory infections. The Cochrane Database has reviewed chest physiotherapy treatments for pneumonia in adults and concludes that they may not be warranted as routine adjunctive treatment, but conceded that the review is hampered by limited evidence.126 Unfortunately, none of these other treatments have been reported in recent medical literature; yet anecdotally we find them helpful enough to continue recommending them.
Perhaps our favorite routine supportive treatment recommendation to patients with acute infections is a blend of herbs affectionately referred to as “Chinese chicken soup.” It contains lotus seed, Lycium fruit, Dioscorea rhizome, Polygonatum rhizome, black fungus, Codonopsis root, astragalus root, and longan fruit. Patients are instructed to cook the herbs in water with vegetables and chicken or tofu. Other than the astragalus root, all of the herbs are edible after cooking. Several demonstrate nonspecific immunomodualtory properties and one in particular demonstrates antiviral activity.127-131
The best existing evidence base for any natural treatment in respiratory infections appears to be use of the botanical medicine andrographis (Andrographis paniculata). Several excellent reviews of this botanical medicine are available and demonstrate effects on symptom alleviation and prevention of upper respiratory tract infection.132-135 We have not used it extensively in our practice before now, but we certainly intend to consider it as an option in all appropriate cases from here forward. Current evidence appears to indicate that 400 mg, three times daily, demonstrates the best effects in acute illness.133
Conclusion
Scrupulous scrutiny for contraindications and potential interactions is demanded when constructing a natural medicine treatment plan that is adjunct or alternative to the standard of care in the treatment of any condition. Many of the treatments mentioned in this article are contraindicated in pregnancy or have other important potential adverse interactions. Excellent resources are available for the purpose of contraindication screening, including the online databases Natural Standard and Natural Medicines Comprehensive Database and the texts Herb Contraindications and Drug Interactions by Brinker and Herb, Drug, Nutrient Interactions by Stargrove, Treasure, and McKee. It also bears noting that respiratory conditions always have the potential to become critical or life-threatening at a moment’s notice, even when previously stable.
Unfortunately, as is so often the case, there is a dearth of evidence regarding the safety and efficacy of many natural treatments that we routinely recommend for respiratory infections. This should ring loud and clear as a general call to increase the amount and the rigor of the research that we do in the disciplines of natural medicine. Every clinician has a part to play and can contribute to the evidence base of natural medicine; even a single case report is one more piece of evidence than currently exists.
Respiratory conditions, infectious and otherwise, are highly amenable to natural medicine treatments in our experience. There are many combinations of therapies that can improve patient outcomes and satisfaction. Appropriate decision-making regarding diagnosis and context of care in respiratory illnesses is our responsibility as physicians; the application of natural therapies in their management is the art and science of natural medicine.
The authors have no financial conflicts of interest to declare.
