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Into the pediatrician's practice
M.I. Petrovskaya, T.V. Kulichenko
Scientific Center of Children's Health, RAMS, Moscow

Herbal Treatment of Inflammatory Diseases of the Upper
Respiratory Tract
This article is devoted to one of the most common manifestations of diseases of
respiratory system and upper respiratory tract - coughing. While performing a
protective function , the cough in some cases significantly impairs a child's
condition. The choice of treatment requires a clear understanding of the
mechanism of a drug's action, its safety profile and effectiveness. In this paper the
authors present a comparative description of herbal remedies relating to secreting
motor antitussives. Along with the description of the pharmacological actions of
the components of these drugs, the issues of safety and efficacy are also described.
We consider the herbal remedies, which can be used in wet and dry cough in
patients older than 2 years.

Keywords: cough, respiratory infections, treatment, expectorants, herbal medicine.

Contact Information:
Kulichenko Tatiana Vladimirovna, head of department
Address: 119991, Lomonosov Avenue, Building 2, p.1
Tel. 8 (495) 967-14-20 8 (495) 967-14-20
E-mail: TKulichenko@yandex.ru
Received on: 02.10.2011, accepted for publication: 15.01.2012 г

"Anti cough" plant-based remedies are still occupying the market firmly in spite of
the abundance of other drugs. The demand for herbal remedies is caused by a
satisfactory safety profile with an efficiency comparable to synthetic analogues, as
well as the possibility of achieving a high commitment to patient care. It’s not a
secret that many parents have a negative attitude towards the prescription of
synthetic drugs and they willingly resort to herbal medicine, which allows to
achieve a higher compliance that is an important factor for success in the child’s
treatment.
The classification of antitussive drugs, indications for usage
Cough is a protective physiological reflex of the body, providing passage of
respiratory system, clearing the airways from foreign material and mucus. When
the cough becomes constant, excessive and disturbing, it is necessary to begin
treatment, despite the fact that it is a natural defense mechanism.
Drugs "for cough" can be divided into a centrally acting drugs (cough
suppressors): secretomotor (stimulating expectoration) and secretolytic [1].
Expectorants are indicated for phlegm congestion, which leads to airway
obstruction and for unproductive cough. The choice of anti cough remedies is
caused by specific action and the nature of pathology that disturbs drainage
function.
There is a distinction among secretomotor drugs into directly acting on bronchial
glands and drugs acting gastric mucosa reflexes (containing emetine, saponins and
essential oils). Among mucolytic drugs there are drugs operating on the disulfide
bonds of mucopolysaccharides and peptide bonds of protein molecules, as well as
normalizing the intracellular formation of bronchial secretions.
Although herbals are classified as secretomotor drugs they often have a mixed
effect. They irritate the stomach receptors and stimulate the neurons of the
vomiting reflex, respiratory center, leading to increased peristalsis of the
bronchioles and increased activity of ciliate bronchial epithelium. Herbal remedies
contained in essential oils and other ingredients, stands out through the airways,
causing increased secretion of mucus and thinning ( secret dissolving resorbing
effect) [2, 3].
In this review the characteristic of Gerbion is introduced which consists of plantain
and primrose syrups. Both drugs have expectorant, anti-inflammatory,
antimicrobial effect, and are prescribed in inflammatory diseases of the upper
respiratory tract (URT) for bronchitis, tracheid, laryngitis, and tracheobronchitis.

Composition, Description of drugs
Active ingredients of the drug in the form of syrup are aqueous extracts of
primrose root, herbs, thyme and menthol.
The drug helps to reduce the viscosity of sputum and improves its discharge due to
saponins and glycosides contained in the extract of primrose. Their action is
directed at suppressing the inflammatory process, thinning mucus and stimulating
the respiratory center [3]. Essential oils of thyme (20-55% thymol) levomentol
help to reduce bronchospasm; remove sputum from the bronchial tubes through the
excitation of the respiratory center; and provide antiseptic effect[3].
Thus, the primrose syrup has mucolytic and secretomotor properties; indicated as
an expectorant in the treatment of inflammatory diseases of the URT with difficult
expectoration (Table 1).
Aqueous extracts of lance late plantain, mallow flowers and ascorbic acid are
included in the remedy. The action of the components is aimed at reducing the
sensitivity of the mucous membranes, and thus, decreases the frequency of cough.
Extracts of Mallow and plantain have a defensive effect on the mucous membrane
of the URT: they protect against irritation [3], resulting in a reduced intensity and
frequency of cough. In addition, these extracts possess anti-inflammatory effects
[3]. Aukubin contained in plantain has bacteriostatic effect and ascorbic acid as an
addition has antioxidant effect.
Thus, remedies in the form of plantain syrup are indicated for diseases
accompanied by dry cough (Table 2).
Comparison with other antitussive drugs
We know that every drug has some side effects. Thus, derivatives of cysteine with
large volumes of bronchial secretions can cause stagnation of phlegm, and also
provoke bronchospasm. In addition, this group of drugs is incompatible with some
antibacterial drugs (tetracycline derivatives, semisynthetic penicillin,
aminoglycosides and cephalosporin) [2, 4]. Syrup "Gerbion" is compatible with all
antibacterial agents and doesn’t have similar side effects.
Often, expectorants include ethyl alcohol and ammonia as additions, which make
them not possible to be used in children, as well as in human with liver and kidney
problems [4]. Represented syrups are prepared on the basis of the water.
Many herbal expectorants include the extract of ivy leaves [4]. The plant is
poisonous, as it is reflected in the safety profile of medical products containing an
extract of ivy leaves. In case of overdose, nausea, vomiting, headache, increased
blood pressure and diarrhea appear.
Medicines which include the istod root extract cause stool disorders and
conjunctivitis as side effects due to increased secretion of mucous and salivary
glands [3, 4]. Active ingredients of syrups "Gerbion" cause the only secret motor
effect on bronchial glands secret.
Some plant-based expectorant drugs contain anise, licorice, and oregano and
produce laxative effect [2]. Gerbion syrup does not contain substances that have a
laxative effect.
Increased temperature, tachycardia, hoarseness (due to irritation of the mucous
membranes of the respiratory tract) may be caused by the usage of proteolysis
agents. [2,4]. They can also cause bronchospasm and allergic reactions.
Medications are contraindicated in diseases of the liver, pancreas, and heart failure.
Herbal psyllium as a syrup and syrup primrose do not have systemic effects and
can be assigned to patients with chronic diseases.

The effectiveness of herbal remedies
According to clinical studies in adults, the drugs in the form of syrup, and plantain
syrup primrose showed high efficacy in the treatment of cough. Multicenter
comparative open study was conducted at the Research Institute of Pulmonology
State Medical University named by Pavlov and the St. Petersburg Institute of MH
(St. Petersburg) in 2007. The safety and efficacy of both syrups - plantain and
primrose were studied in parallel groups: the medications were used for relieving
symptoms of laryngitis, bronchitis (acute / exacerbation of chronic), tracheitis, and
tracheobronchitis. The intensity of cough, sputum quantity and quality were
assessed over time during treatment with syrups.
Primrose syrup was used as an expectorant in the treatment of inflammatory
diseases of the URT with difficult expectoration (bronchitis, tracheitis, bronchitis,
etc.) and acute respiratory diseases involving non-productive cough. It was shown
that treatment with primrose syrup cough reduced frequency by 30% for 3-4th day
of the disease and by 59% - to 8-9th day of illness (Fig. 1). Sputum was
significantly improved: 16% for 3-4th day of illness, compared with the control
group and 21% - to 8-9th day of illness (Fig. 2).
The studied plantain syrup was used in the treatment of inflammatory diseases of
the URT, accompanied by a dry cough. It is noted that the frequency of attacks of
dry cough for 3-4th day of illness decreased by 15% compared with the control
group and 22% - to 8-9th day of illness (Fig. 3). In addition, psyllium reduced 1/3
the frequency of sputum (Fig. 4).
The results obtained in the course of follow-up of patients indicate that psyllium
syrup is more effective for severe attacks of coughing. Thus, this study
demonstrates the high efficacy of the studied drugs in the treatment of
inflammatory diseases of the URT.
Safety of herbal medicines
The safety of active substances and included additions were proved. In study with
adult patients no serious adverse events were indicated. However, using syrups
might develop allergic reactions in very rare cases such as nausea, vomiting.
Syrups are prepared on the basis of water, which makes them easy to assign for
children older than 2 years old; a simple dosing regimen makes it possible to use
the drug at home. It should be marked that the syrup should not be simultaneously
used with antitussive drugs and drugs that reduce the formation of mucus [2, 4].
The main contraindications to the use of syrups are associated with carbohydrate
metabolism disorders, and hypersensitivity to the active components of drugs:
hypersensitivity to the drug, as well as to medications, containing active
ingredients of Primrose family and the family of Dead-nettle , diabetes, congenital
intolerance to fructose, malabsorption syndrome glucose / GA lactose, congenital
deficiency of sucrose / isomaltase for children younger than 2 years after acute
obstructive laryngitis (croup syndrome) [4].
Dosage and administration
Gerbion psyllium syrup is assigned 3-4 times a day; for children older than 14
years - 10 ml; for children aged 7 to 14 years - 5 ml; for children aged 2 to 7 years
- 2.5 ml [4].
Gerbion primrose syrup is assigned after meal, 3-4 times a day; for children
older than 14 years - 10 ml; for children aged 5 to 14 years - 5 ml; for children
aged 2 to 5 years - 2.5 ml [4]. Duration of treatment is 2-3 weeks. Medications are
taken orally with drinking plenty of warm water.
Conclusion
Easy choice, depending on the clinical disease, ease of usage, proven clinical
safety and efficacy; easy achievement of treatment compliance can confidently
recommend these remedies as herbal expectorants in the treatment of diseases of
the bronchopulmonary system, leading to acute and chronic cough.
Literature:
1. Clinical pharmacology: a national guide / ed. J.B. Belousova, V.G. Kukesa, V.K. Lepahina, V.I. Petrova. M. GEOTAR-Medicine. , 2009. P. 964 2. Chuchalin A.G., S.N. Avdeev, V.V. Arkhipov and etc. Rational pharmacotherapy and other respiratory diseases: Hands-on for medical practitioners. M. Litterra. In 2004. P. 874. 3. S. Y. Sokolov, I.P. Zamotaev Handbook of Medicinal Plants (Phyto therapy). 3rd ed. Moscow: Metallurgy. In 1990. P. 427. 4. Vidal’s handbook. Pharmaceuticals in Russia: A Handbook. M. Astra
Table 1 Main effects of herbs components in wet cough
Gerbion syrup Primrose
primrose

Table 2 Main effects of herbs components in a dry cough
psyllium
Psyllium herb flowers

Fig. A. The dynamics of cough frequency in the treatment of herbal medicines
such as primrose syrup

Fig. 2 Effect of primrose syrup on sputum passage

Fig. 3 The dynamics of cough frequency in the treatment with psyllius syrup

Fig. 4 Effect of plantain syrup on the frequency of sputum

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