asthmatic bronchitis
Introduction:
Bronchitis is due to inflammation of the large air passageways of the lungs. Acute bronchitis is a short term illness usually caused by an upper respiratory viral or bacterial pathogen that has spread downward from the sinuses or throat into the lungs. The progression of the common cold may often precipitate acute bronchitis in this fashion. Symptoms of acute bronchitis include cough, shortness of breath, sputum production, fatigue, fevers, chest pain with cough, and wheezing. Many patients become concerned about cough which has persisted for a up to a month after the acute phase. In general, the cough should slowly resolve over the course of a month to resolution after the acute phase. As opposed to acute bronchitis, chronic bronchitis is characterized by bronchial inflammation and a lower grade illness characterized by sputum production most days of the month for at least 3 months of the year for 2 consecutive years. Pneumonia may cause similar symptoms as bronchitis, but generally is a more severe illness than bronchitis with high fevers, chills, and severe shortness of breath.
Overview of bronchitis course and treatment:
Aside from antibiotics which are usually prescribed and many times necessary for acute bronchitis, there are overall few options available to treat this condition directly in the acute phase. Most episodes of bronchitis will resolve without any specific treatment. Most of the treatment has been directed toward the symptoms as the illness continues to run its course. Over the counter expectorants, decongestants, and cough suppressants treat symptoms but do not reduce the duration of bronchitis. By taking measures to prevent the common cold, in turn bronchitis may also be prevented since it often occurs as progression of viral infection or secondary bacterial infection after viral illness. Please see the section on prevention and treatment of “common cold”.
Natural therapy for acute bronchitis in adults:
One of the natural treatment options for acute bronchitis with evidence-based effectiveness is Pelargonium sidoides herbal extract. Pelargonium sidoides in the form of an herbal extract also known as South African Geranium, Umckaloabo, Kaloba, Umcka, and Zucol has produced good results in several trials as a treatment for acute bronchitis. It is currently widely available but as a general consensus by most physicians, it is felt more research is needed before it is recommended routinely. Of note, minor side effects have been reported with this herbal preparation Several studies are represented below.
A randomized, double-blind, placebo-controlled trial by Chuchalin AG et al enrolled 124 adults with acute bronchitis present for 48 hours or less, with symptoms greater than 5 points on the Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea). Participants received Pelargonium sidoides (30 drops [1.5 mL]) (n=64) or placebo (n=60) 3 times daily for 7 days. From baseline to day 7, decrease in the BSS in the treatment group was 7.2 points versus 4.9 points for placebo. In the treatment group, at day four onset of treatment effect was reported for 68.8% versus 33.3% for placebo. Patients on pelargonium reported a greater improvement in quality of life status. No serious side effects were reported. (1)
A randomized, double-blind, placebo-controlled, multicenter study evaluated 217 adults aged 18 to 66 years with acute bronchitis. Participants in the active arm (n=108) received Pelargonium sidoides, 30 drops (1.5 mL) or placebo 3 times daily, for 7 days. Changes in bronchitis severity score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea) were assessed. At the end of treatment, the BSS decreased by 7.6 points in the active treatment group and by 5.3 points in the placebo group. The following signs and symptoms were reported as better in the Pelargonium sidoides group over placebo: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea, hoarseness, fatigue, fever, headache, and limb pain. A higher rate of minor adverse effects were reported in the placebo group compared to the treatment group and no serious adverse events occurred. (3)
Pelargonium sidoides (EPs 7630) was reported to benefit both adults and children with acute bronchitis without indication for treatment with antibiotics. A total of 2099 patients aged 0-93 years were included in this study. Participants received EPs 7630 for 14 days at a dose determined by a participant\’s age. The doses provided included the following. The dose was given 30 minutes before meals. Adults and children over 12 years were given a dose of 30 drops, children over 6 up to 12 years old were provided a dose of 20 drops, and children under 6 years old were given 10 drops per dose. During treatment, the average Bronchitis Severity Score (BSS: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea) of all patients decreased from 7.1 points at baseline to 1.0 points at last visit. For children, average BSS decreased from 6.3 points to 0.9 points. For children aged 3 years or less, average mean BSS decresed from 5.2 points to 1.2 points. No serious side-effects were reported. (2)
Adverse reactions of Pelargonium sidoides:
The active compound in umckaloabo or Pelargonium sidoides showed few adverse effects, and those that occurred were at similar rates in both treatment and placebo groups in the above mentioned studies (1-3). Polyphenols and coumarins present in the supplement were studied for increased risk of bleeding. There was no change seen in thromboplastin time (TPT), partial TPT (PTPT) or thrombin time (TT) in rats given extremely large doses of EPs 7630. Also, the supplement added to warfarin treatment did not affect the lab values either. Hemorrhage caused by this agent was felt to be unlikely by the author of the study. (4)
An option for natural cough suppression:
Theobromine is a natural compound present in dark chocolate. In 10 human subjects, theobromine (a bitter compound closely related to caffeine) at a dose of 1000 mg stopped capsaicin-induced cough better than 60 mg of codeine. In clinical research, capsaicin is also used to determine the cough threshold. Compared to placebo, theobromine significantly increased the amount of capsaicin needed to produce five coughs. Capsaicin is used to help relieve minor pain associated with rheumatoid arthritis or muscle sprains and strains. (5)
Duration of theobromine effect:
According to Simons FE et al, the effect of theobromine peaked at 2 hours and lasted for 6 hours which was comparable to the duration and bronchodilation action of theophylline currently used as a pharmaceutical therapy for asthma (6).
Assessment and Plan: Acute Bronchitis
By taking measures to prevent the common cold, in turn bronchitis may also be prevented since it often occurs as progression of viral infection or secondary bacterial infection after viral illness. It is important to stay hydrated by consuming adequate fluids. Please see the section on prevention and treatment of “common cold”.
An herbal extract, Pelargonium sidoides, (also known as South African Geranium, Umckaloabo, Kaloba, Umcka, and Zucol) has been studied in both adults and children. It produced good results in several trials as a treatment for acute bronchitis. The following signs and symptoms were reported as better in the Pelargonium sidoides group over placebo: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea, hoarseness, fatigue, fever, headache, and limb pain. The dose in the studies most commonly used was 30 drops or 1.5 mL, 3 times per day given before meals. Adults and children over 12 years were given a dose of 30 drops, children over 6 up to 12 years old were provided a dose of 20 drops, and children under 6 years old were given 10 drops per dose for duration of either 7 or 14 days. There were few adverse effects occurring at similar rates in both treatment and placebo groups (1-3), and another study showed that an adverse reaction of bleeding was felt unlikely (4). It is currently widely available but the use of this agent should be overseen by a physician.
Patients should not take Pelargonium sidoides if they have an allergy to this herbal preparation or allergy to a similar plant family.
For more specific information on Pelargonium sidoides, (also known as South African Geranium, Umckaloabo, Kaloba, Umcka, and Zucol) please see that section.
A small study with10 human subjects showed that theobromine (a bitter compound closely related to caffeine available in dark chocolate) at a dose of 1000 mg stopped capsaicin-induced cough better than 60 mg of codeine (5). According to Simons FE et al, the effect of theobromine peaked at 2 hours and lasted for 6 hours which was comparable to the duration and bronchodilation action of theophylline currently used as a pharmaceutical therapy for asthma (6).
References:
1.Chuchalin AG, Berman B, Lehmacher W. Treatment of acute bronchitis in adults with a Pelargonium sidoides preparation (EPs 7630): a randomized, double-blind, placebo-controlled trial. Explore (NY). 2005 Nov;1(6):437-445. http://www.ncbi.nlm.nih.gov/pubmed/16781588
2.Matthys H, Kamin W, Funk P, Heger M. Pelargonium sidoides preparation (EPs 7630) in the treatment of acute bronchitis in adults and children. Phytomedicine. 2003;14 Suppl 6:69-73. http://www.ncbi.nlm.nih.gov/pubmed/17184981
3.Matthys H, Heger M. Treatment of acute bronchitis with a liquid herbal drug preparation from Pelargonium sidoides (EPs 7630): a randomised, double-blind, placebo-controlled, multicentre study. Curr Med Res Opin . 2007;23:323-331. http://www.ncbi.nlm.nih.gov/pubmed/17288687
4.Koch E, Biber A. Treatment of rats with the Pelargonium sidoides extract EPs 7630 has no effect on blood coagulation parameters or on the pharmacokinetics of warfarin. Phytomedicine. 2007;14 Suppl 6:40-5. Epub 2006 Dec 22. http://www.ncbi.nlm.nih.gov/pubmed/17188479
5.Usmani OS, Belvisi MG, Patel HJ, Crispino N, Birrell MA, Korbonits M, Korbonits D, Barnes PJ. Theobromine inhibits sensory nerve activation and cough. FASEB J. 2005 Feb;19(2):231-3. http://www.ncbi.nlm.nih.gov/pubmed/15548587
6.Simons FE, Becker AB, Simons KJ, Gillespie CA. The bronchodilator effect and pharmacokinetics of theobromine in young patients with asthma. J Allergy Clin Immunol. 1985 Nov;76(5):703-7. http://www.ncbi.nlm.nih.gov/pubmed/4056254