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Bronchitis (Acute)

Integrative Interventions

Life Extension’s Flu and Common Cold Program

Bronchitis represents a natural progression of the common cold or flu in most cases (Tackett, Atkins 2012; First Consult 2013). Therefore, taking aggressive action at the first signs of the flu or common cold is one of the best ways to prevent progression to acute bronchitis. The suggestions outlined in this section (and expanded upon in the Influenza and Common Cold protocols) represent interventions aimed at stopping a cold or the flu from progressing to acute bronchitis. At the first sign of infection, consider taking the following supplements. This program is not intended for long-term use because of the high doses. Follow these recommendations for only a few days.

  1. Zinc Lozenges: Take two zinc lozenges (13-24 mg of zinc in each lozenge) immediately and again every 2 to 3 hours for the first day or two. Then slowly reduce the dose until symptoms dissipate.
  2. Garlic: Take 9000-18,000 mg of a high-allicin garlic supplement each day until symptoms subside. Take with food to minimize stomach irritation.
  3. Vitamin D: If you do not already maintain a blood level of 25-hydroxyvitamin D over 50 ng/mL, then take 50,000 IU of vitamin D the first day and continue for 3 more days. Slowly reduce the dose to around 5000 IU of vitamin D daily. If you already take around 5000 IU of vitamin D daily, then you probably do not need to increase your intake.
  4. Cimetidine: Take 800-1200 mg daily in divided doses. Cimetidine is a heartburn drug that has potent immune enhancing properties. (It is sold in pharmacies over-the-counter.)
  5. Melatonin: 3 to 50 mg at bedtime.

Do not delay implementing the above regimen. Once a respiratory virus infects too many cells, it replicates out of control and potentially progresses, rendering strategies like zinc lozenges ineffective. Treatment must be initiated as soon as symptoms manifest!

Nutritional Strategies Studied in Bronchitis

Pelargonium sidoides. Pelargonium sidoides is a botanical highly valued in the South African region as a remedy for several respiratory tract ailments, including acute bronchitis. Several studies have examined the efficacy of the root extract of Pelargonium sidoides in the treatment of various respiratory conditions, many of which have shown promising results (Tahan 2013; Luna 2011; Bachert 2009; Lizogub 2007; Bereznoy 2003).

Specifically regarding acute bronchitis, a number of human trials have found Pelargonium sidoides to be an effective treatment option. In one randomized, double-blind, placebo-controlled trial conducted on 406 adults with acute bronchitis, an herbal compound prepared from Pelargonium sidoides called EPs 7630 was significantly superior to placebo in relieving acute bronchitis symptoms (Matthys, Lizogub, Malek 2010). In another study that expanded on the findings from this same group of subjects, the benefits of Pelargonium sidoides over placebo were found to extend to improvements in impact of patient's sickness, duration of activity limitation, patient-reported treatment outcome, and satisfaction with treatment (Matthys, Lizogub, Funk 2010).

One of the first major studies to examine the effects of Pelargonium sidoides in adults with acute bronchitis was published in 2003. Study participants received 30 drops of EPs 7630 three times daily or placebo for 7 days. In this study, the plant extract was superior to placebo in reducing the severity of bronchitis and in shortening the duration of illness, with no serious adverse reactions reported (Matthys 2003).

A study on 200 children and adolescents aged 1 to 18 with acute bronchitis showed that Pelargonium sidoides administered in liquid extract form over a 7-day period (30 drops/day for children 1-6 years; 60 drops/day for children 6-12 years; and 90 drops/day for children 12-18 years) was significantly superior to placebo in relieving acute bronchitis symptoms (Kamin 2010). In a separate randomized, double-blind, placebo-controlled study, 217 adults with acute bronchitis received 30 drops of EPs 7360 three times daily, 30 minutes before or after a meal, or placebo for 7 consecutive days. This liquid extract of Pelargonium sidoides was superior to placebo in improving scores on a standardized bronchitis symptom assessment (ie, relieving specific symptoms such as cough, chest pain upon coughing, sputum, and shortness of breath). Moreover, very good subject satisfaction was seen during the study (Matthys, Heger 2007a).

German researchers studied the effects of Pelargonium sidoides in 2099 people with acute bronchitis. In this study, EPs 7630 was administered 3 times daily, 30 minutes before a meal, for a 14-day period. The EPs 7630 solution contained 80 g EPs 7630 in a 100 mL solution, and participants received 10 drops if under 6 years of age, 20 drops if between 6 and 12 years, and 30 drops if over 12 years. The study found that average symptom scores decreased significantly across the study group. Moreover, only 26 subjects reported an adverse reaction to the treatment regimen, none of which were serious (Matthys, Kamin 2007). A different study published by a group of scientists in Russia examined the effects of Pelargonium sidoides versus placebo in a double-blind, randomized fashion in 124 adults with acute bronchitis. Study participants received 30 drops of EPs 7630 three times daily or placebo. Results of a standardized assessment after 7 days of treatment showed Pelargonium sidoides to be superior to placebo for relief of acute bronchitis symptoms, with nearly 70% of subjects responding to treatment within the first 4 days (Chuchalin 2005).

A 2008 meta-analysis concluded, “There is encouraging evidence from currently available data that P. sidoides is effective compared to placebo for patients with acute bronchitis” (Agbabiaka 2008).

Laboratory studies indicate that EPs 7630 may act through multiple mechanisms to help fight respiratory tract conditions (Kolodziej 2003; Thale 2011). First, it possesses anti-infective properties by increasing phagocytosis (ie, a mechanism used by white blood cells to remove pathogens and cellular debris) (Conrad 2008). Second, infected cells treated with EPs 7630 showed augmented activation of defense mechanisms (Kolodziej 2007). Finally, EPs 7630 has been found to stimulate ciliary beat frequency which may help clear excess mucus (Neugebauer 2005).

Thyme. Thyme extract is a promising therapeutic option for the cough that occurs in acute bronchitis. A double-blind, placebo-controlled study used extracts of a combination of thyme leaf and primrose root to assess their ability to reduce cough on an objective scale, the Bronchitis Severity Score. On days 7 to 9, an average decrease of over 67% in coughing fits was seen in the thyme-primrose group. A 50% reduction in cough was achieved by the extract-combination treatment approximately 2 days earlier compared to placebo (Kemmerich 2007).

In another double-blind study, 361 people with acute bronchitis received a thyme-ivy combination for 11 days; researchers reported that its administration was superior to placebo for reduction of coughing fits (Kemmerich 2006). Another study examined an herbal combination that includes thyme extract called Bronchipret®. The authors reported Bronchipret® (containing 160 mg of thyme extract) was as effective as synthetic medications for the clinical outcomes of bronchitis in children and adults. In the adult subgroup analysis, there was a tendency for better results and less adverse reactions with the herbal combination as compared to synthetic medications (Ernst 1997).

N-acetyl cysteine. N-acetyl cysteine (NAC), a slightly modified version of the natural amino acid cysteine, has both mucolytic (can break down or “thin” mucus) and antiviral properties (Brochard 1980; Mata 2011). NAC has been shown to inhibit replication and ameliorate the inflammatory reaction caused by the influenza virus and other respiratory viruses (Hui 2013; Mata 2011). In experimental studies, NAC significantly offset the oxidative and inflammatory stress through multiple mechanisms, and it decreased the severity of influenza symptoms in animals and humans (McCarty 2010; Geiler 2010). NAC is also thought to inhibit intracellular signaling pathways that promote viral propagation (McCarty 2010). In addition, NAC is a precursor of glutathione, a potent antioxidant (Johnson 2012). A small-scale, placebo-controlled trial of treatment for serious inflammatory symptoms inflicted by mustard gas inhalation showed that 1200 mg oral NAC daily for 4 months significantly improved respiratory function in the control group (Ghanei 2008). Another trial showed that 1800 mg NAC daily for 4 months improved cough, shortness of breath, and sputum production (Shohrati 2008).

In a double-blind, placebo-controlled trial, the mucolytic activity of NAC was evaluated in 215 people with bronchitis (84 of which had acute bronchitis). Subjects were given 200 mg NAC three times daily for 10 days along with antibiotic therapy. NAC was found to be significantly more effective than placebo for reduction of cough, sputum volume and viscosity (Brochard 1980).

Eucalyptus essential oil and cineol. Inhaled eucalyptus essential oils have been used in traditional medicine to treat respiratory diseases including bronchitis. These essential oils have antibacterial, antiviral, and antifungal activity against pathogens implicated in these conditions (Elaissi 2012; Astani 2010; Yang 2010).

Essential oils contain many constituents including compounds called monoterpenes, which are thought to be at least partly responsible for their antiviral properties (Astani 2010). The eucalyptus monoterpene 1,8 cineole has been found to significantly decrease the signaling ability of NF-kappaB (NF-κB), a "master" pro-inflammatory molecule. NF-κB activates the production of many inflammatory molecules in response to infection (Greiner 2013). Inhibitors of NF-κB, which is part of a signaling pathway that the influenza virus may "hijack" after infecting human and animal cells, were shown to protect animals against highly pathogenic influenza viruses, and this molecule may become the target of novel anti-influenza drugs (Haasbach 2013).

One combination of essential oil monoterpenes that includes 75 mg of 1,8 cineole (in combination with limonene and alpha-pinene) has been found to be effective for acute bronchitis. In a double-blind, placebo-controlled clinical trial, 676 people with acute bronchitis were given either 300 mg of the combination four times daily, antibiotics, or placebo. The researchers reported signs and symptoms dissipated more rapidly and more completely for those taking the essential oil combination than those in the placebo group. The authors concluded that the combination of essential oil constituents “is a well-evidenced alternative to antibiotics for acute bronchitis without specified infective agent, without the risk to promote the development of bacterial resistance” (Matthys 2000). A 2013 multi-center, randomized, controlled trial found that coughing fits decreased by 62% after one week of treatment with the combination. In addition, there was less daytime coughing fits, difficulty coughing up, and sleep disturbance due to nighttime coughing as compared to placebo (Gillissen 2013).

Investigational Natural Interventions

Vitamin E. There is evidence that supplementation with vitamin E may improve or exert a protective effect upon lung health. Supplementation with gamma-tocopherol, an important form of vitamin E, decreased overall oxidative stress and suppressed the excessive release of inflammatory chemicals from the white blood cells of healthy and asthmatic human subjects (Wiser 2008). Gamma-tocopherol also showed anti-inflammatory effects in the upper airways of an animal model of allergic rhinosinusitis (Wagner 2009). A mouse model of airway inflammation caused by nitrogen mustard gas revealed that vitamin E decreases acute lung inflammation and inhibits collagen formation in the lungs (Wigenstam 2009). In addition, a study reported there is a benefit when incorporating vitamin E into pandemic influenza vaccines as an adjuvant (ie, a substance added to vaccines to enhance their immune response). One such adjuvant containing vitamin E (as alpha[α]-tocopherol) is known as AS03. In a trial of 1340 healthy individuals inoculated against the pandemic H1N1 influenza virus, those who received the vaccine with AS03 achieved the strongest immune response against the virus (Ferguson 2012).

Curcumin. Curcumin, which is derived from the spice turmeric, is a natural anti-inflammatory agent. Curcumin has an established role in protecting lung tissue against the inflammation induced by chemical and infectious agents (Punithavathi 2000; Aggarwal 2009; Parveen 2013). Curcumin was shown to reduce inflammatory response in the lung epithelium of mice (Yen 2013). In a study of 2478 Asian adults over the age of 55, dietary intake of curry (containing curcumin) at least once monthly was significantly linked to better lung function, even in current and past smokers (Ng 2012).

Bromelain. Bromelain, an extract of the pineapple plant, has anti-inflammatory, immunomodulatory, and mucolytic properties (Bernkop-Schnürch 2000; Hale 2005; Secor 2005; Grabovac 2006). Bromelain is a collective term for enzymes found in pineapple fruit, stem, and leaves (Hale 2005; Pavan 2012; Vilanova Neta 2012). These enzymes are proteolytic, meaning they break down proteins into their constituent peptides and amino acids. Bromelain may offer therapeutic benefits to individuals suffering from bronchitis and sinusitis (Pavan 2012).