➤ General comments
– Acute bronchitis
• Usually caused by an ascending viral infection. Irritant bronchitis is due to the inhalation of toxic or allergic substances.
• The disease is marked by abnormal mucus production and impaired ejection of mucus from the bronchi. The bronchial passages become obstructed owing to the thick mucous secretions and inflammation. Coughing and phlegm production, the hallmark symptoms of bronchitis, ultimately occur.
• The initial symptoms are dry cough accompanied by a burning sensation in the chest. The cough gradually becomes productive and increasingly troublesome. The viscosity of the mucus starts to decrease over the course of time (2 to 3 weeks).
• Yellowish-green mucus is indicative of secondary bacterial infection.
Note: If there is severe coughing (especially with a presumed lung involvement), frequent relapsing, or persistent coughing with expectoration, the patient should consult a physician to assess the need for antibiotic treatment.
• Complications: The primary complication is chronic bronchitis, which can cause irreversible damage to the mucous membranes. The damaged membranes provide a foundation for further complications, such as pulmonary emphysema, bronchiectasis, and bronchopneumonia.
– Chronic bronchitis
• Smoking is usually responsible for the persistence of bronchitis. Chronic adenovirus infection may be another cause.
• Increased quantities of CD8+ T lymphocytes can be found in the larger airways (beneath the basal membrane). The bronchial glands are swollen, and large quantities of neutrophil granulocytes and macrophages are present, even in the alveolar fluid.
➤ Herbal and general treatment measures of bronchitis
– Increasing the fluid intake is essential. In mild cases, the patient should drink large quantities of tea made from herbs selected according to the type of cough.
– Herbal preparations with soothing effects are to be applied first. Expectorants, preferably those with antispasmodic or immunostimulatory effects, can be prescribed later if necessary.
➤ Clinical value of herbal medicine
– The objective of herbal treatment is to prevent complications. Treatment should therefore be initiated in the early stages of disease.
– Herbal medicinal products containing single or multiple ingredients can decrease the viscosity of mucus, counteract inflammation, ease bronchospasms, and stimulate the immune system.
– In chronic bronchitis, herbal remedies are used for adjunctive treatment.
Recommended bronchitis Herbal Remedies (Overview)
Demulcents
➤ Marshmallow root (Althaeae radix); mallow leaf and flower (Malvae folium cum flores); ribwort plantain (Plantaginis herba)Iceland moss (Lichen islandicus); mullein (Verbasci flos).
– Action: Antitussive.
– Contraindications: None known.
– Dosage and administration: Oral dosage forms should be used. For dosage
recommendations, see the application in question.
– Side effects: None known.
Secretolytics and Expectorants
➤ Aromatic herbs and pure essential oils: Aniseed (Anisi fructus); fennel seed (Foeniculi fructus); thyme (Thymi herba); eucalyptus oil (cineol); camphor tree Cinnamomum camphorae aetheroleum); peppermint oil (menthol); pine needle oil (Piniaetheroleum).
➤ Saponin-containing herbs: Primula root (Primulae radix); mulleinflower (Verbasci flos); licorice (Liquiritiae radix).
– Action: Mucolytic and expectorant.
– Contraindications: Peppermint oil and preparations containing menthol and camphor as well as eucalyptus, pine, and spruce needle oils should never be applied to the face, especially the nose, of infants.
– Dosage and administration: See instructions for the specific application in question.
– Side effects
• Eucalyptus oil: Internal administration of large quantities of eucalyptus oil can lead to the passage of gallstones or kidney stones or to stomach irritation, cramps, tachycardia, and cyanosis. Eating large amounts of eucalyptus candy can induce nausea and vomiting in children.
• Licorice: Aldosterone-like side effects such as edema and hypokalemia, when larger quantities are consumed.
• Saponin-containing herbs: The consumption of large quantities can irritate the stomach.
• Cineol activates the hepatic enzyme system that metabolizes foreign substances, possibly weakening and/or shortening the therapeutic action of other active principles.
• Although rare, contact eczema may occur.
Bronchospasmolytics
➤ Thyme (Thymi herba); ivy leaf (Hederae helicis folium); primula root (Primulae radix); licorice root (Liquiritiae radix).
– Action: Relieve bronchial muscle spasms.
– Contraindications: None known.
– Dosage and administration: See instructions for the specific disease in question.
– Side effects
• Licorice.
• Ivy leaf and primula root: Large quantities of saponin-bearing herbs can irritate the stomach.
Antiphlogistics
➤ Ivy leaf (Hederae helicis folium); primula root (Primulae radix); ribwort plantain (Plantaginis herba); licorice (Liquiritiae radix); Iceland moss (Lichen islandicus).
– Action: Anti-inflammatory.
– Contraindications: None known.
– Dosage and administration: See instructions for the specific application in question.
– Side effects: Described above.
Antibiotics and Immunomodulators
➤ Thyme (Thymi herba); ivy leaf (Hederae helicis folium);nasturium (Tropaeoli herba); horseradish root (Amoraciae radix).
– Action: Reduces the likelihood of a secondary bacterial infection.
– Contraindications: Horseradish should not be used by individuals with peptic ulcers or nephritis, and should not be administered to children under 4 years of age.
– Dosage and administration: See instructions for the specific disease in question.
– Side effects: Those of ivy leaf are described above. Horseradish root can cause isolated allergic side effects; higher doses of the herbal remedy can cause gastrointestinal upsets.
Antitussives
➤ Sundew herb (Droserae herba).
– Action: Relieves dry cough by reducing the cough reflex.
– Contraindications: None known.
– Dosage and administration: See instructions for the specific disease in question.
– Side effects: None known.
Range of Applications in Acute Bronchitis
Internal Remedies
➤ Chest tea, Rx: Standard license: Anisi fructus (chopped) 15.0, Liquiritiae radix 25.0, Althaeae radix 35.0, Malvae folium 25.0.
➤ Cough and bronchial tea Rx: Anisi fructus 10 g, Plantaginis herba 30 g, Liquiritiae radix 30 g, Thymi herba 30 g.
– Dosage and administration: One teaspoon of either tea mixture per cup, 3 to 4 times a day. Commercial preparations should be used as directed on the product label.
– Clinical value: When treatment is initiated early, the combined administration of oral herbal remedies with topical remedies and inhalants can be sufficient treatment in many cases.
External Remedies of bronchitis
➤ Thyme; eucalyptus oil; dwarf pine oil; peppermint oil; spruce needle oil; camphor.
– Dosage and administration: Apply to the skin or use for inhalation several times a day. Should be used as directed on the product label.
– Clinical value: See internal remedies.
Range of Applications in Chronic Bronchitis
Immunostimulants
➤ Purple echinacea herb (Echinaceae purpureae herba) and paleflowered echinacea root (E. pallida radix).
– Dosage and administration: Liquid tinctures, 1:4, 2–4 mL are added to a little water and taken orally, 4 to 5 times daily.
– Clinical value: No comparable synthetic drug preparations exist. Echinacea’s immunostimulatory action takes effect within 24 hours. These products are safe to use, even by patients on concomitant antibiotic treatment. Symptomatic Treatment
➤ The purpose of symptomatic treatment is to promote the ejection of mucus in subacute or chronic bronchitis and to counteract inflammation.
➤ Thyme herb; primula root; ribwort plantain herb; ivy leaf (use commercial products only); cineol. See overview on p. 155.
– Tea Rx: Primulae radix, Thymi herba, Plantaginis herba, aa ad 100 g.
– Dosage and administration: 1 teaspoon per cup, 3 to 4 times a day. Commercial preparations should be used as directed on the product label.
– Clinical value: The specified herbal remedies are generally well tolerated and useful for adjunctive treatment.
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