5 Respiratory Diseases – Acute catarrhal rhinitis (head cold) • Head colds are most commonly caused by viruses, especially rhino-viruses. • The preliminary stage is marked by nasal dryness, often with sneezing or severe itching. • This is followed by a catarrhal stage with profuse discharge of watery mucus. Yellowish-green mucus is indicative of a secondary bacterial infection. • After a few days, the viscosity of the nasal mucus increases, and the nasal membranes become inflamed, swollen, and congested. Drainage of mucus is impaired, and the local immune defenses are weakened. Sinusitis can develop if marked swelling of the paranasal sinuses occurs. • The symptoms of a harmless head cold normally subside within a week. – Acute sinusitis • Acute sinusitis is characterized by congestion of the entire nasal sinus system. Individuals with congenitally narrow sinuses or narrowing of the sinuses due to chronic allergy-related inflammation are especially prone to sinusitis. • Sinusitis often occurs secondary to rhinitis. • The lack of sufficient drainage of mucus leads to an oxygen deficiency and inadequate mucous membrane function. The membranes start to produce a very thick discharge (dyscrinism) that is an ideal breeding ground for bacteria. The mucociliary clearance mechanisms responsible for transporting the discharge out of the mucous membranes become inactivated. • Acute sinusitis is marked by a clear feeling of malaise, usually with fever and unpleasant sensations in the cheeks, eyes, or temples ranging from pressure sensations to severe pain. Earaches can also occur. The condition can become chronic if acute episodes do not fully subside before the next bout. Chronic sinusitis can lead to massive changes in the mucous membranes. – All patients with respiratory tract infections should drink plenty of fluids. – Nasal douches with isotonic saline solution are helpful, especially in the first two stages of acute rhinitis. – The sooner herbal remedies are administered, the better the chance of successful treatment. – Different herbal remedies have different effects. Some stimulate the immune system, whereas others counteract inflammation. Combinations of remedies can therefore be very useful. – Indications: Acute rhinitis. – Contraindications: Known allergy to plants from the Asteraceae (aster or daisy family). – Action: The essential oil in chamomile is not irritating to the mucous membranes. Two of its constituents, β-bisabolol and chamazulene, counteract inflammation. – Dosage and administration: Inhalation: Add 2 to 3 tablespoons dried chamomile flower, 1 teaspoon chamomile extract, or 5 drops of the essential oil to boiling water and inhale, several times daily (see p. 18). If this is not possible, administer chamomile nose drops or chamomile cream to each nostril, 3 to 4 times a day. – Side effects: None known. – Action: These preparations stimulate cold receptors in the nose, making it easier to breathe. They also have secretolytic, antimicrobial, and antiviral effects, but do not reduce swelling of the mucous membranes. The remedies are generally safe, except in the specified contraindications. – Indications: Acute rhinitis. – Contraindications: Exanthematous skin and childhood diseases, bronchial asthma. Infants and small children should not inhale peppermint oil or use nasal ointments containing menthol. Camphor should not be used during pregnancy or lactation. Individuals with hypertension or heart failure should use it with caution. • When administered to infants and small children, peppermint oil and preparations containing menthol and camphor can trigger respiratory problems ranging from shortness of breath and choking to laryngeal spasms or cardiovascular problems. These herbal remedies should never be applied to the face or to large areas of the chest or back of infants and small children. • Do not apply peppermint oil, mentholated nasal ointments or camphor to the eyes or to broken skin. Camphor should not be allowed to come in contact with the mucous membranes. – Dosage and administration: Peppermint oil: Add 2 to 4 drops of peppermint oil to boiling water and inhale, several times a day, or apply 1 drop of the oil directly below the nostrils (school-aged children and adults only). Camphor: Apply the ointment directly to the chest, several times a day, to inhale the vapors. Nasal ointment: Apply a pea-sized amount to the nostrils, 3 to 4 times daily. – Side effects: Allergic skin reactions and unpleasant local sensations can occur in isolated cases (in conjunction with mentholated nasal ointments). Rare incidences of contact eczema (camphor) have also been reported. Paleflowered echinacea root (Echinaceae pallidae radix, see p. 56). – Action: Increases the ability of granulocytes and macrophages to ward off disease. The immunostimulatory effect of echinacea develops over a few days of oral administration. No comparable synthetic preparations exist. See pp. 150, 153 for other therapeutic actions. – Indications: Chronic sinusitis. – Contraindications: Chronic-progressive systemic diseases (e. g., tuberculosis), leukoses, inflammatory rheumatic diseases, multiple sclerosis, HIV infection, known hypersensitivity to composite plants, autoimmune diseases. – Dosage and administration: Liquid tinctures are widely available that include either or both of E. purpurea and E. angustifolia. The roots, leaves, seeds, or flowers are included in many products, and are sometimes blended. • Flavored liquid products that include glycerin instead of alcohol are popular, especially for children. – Side effects: Rarely, allergic skin reactions, which disappear after use is discontinued. – None of the available data confirms the efficacy of oral echinacea preparations for sinus infections. – Action: See those of the individual herbs contained in compound remedies. Herbal remedies are highly recommended for adjunctive treatment of acute sinusitis. – Indications: Acute sinusitis; adjunctive treatment of chronic sinusitis. – Contraindications: See cautions noted on labels of commercial products. – Dosage and administration: Oral preparations should be used as directed on the product label. – Side effects: Occasionally allergic reactions in the skin, respiratory tract, and gastrointestinal tract. Although rare, stomach complaints, nausea, vomiting, and diarrhea can occur. – Interactions: See cautions noted on labels of commercial products. – Colds and flu are the most common reasons for the loss of working hours. – Around 90% of all catarrhal disorders are caused by viruses, especially rhino-viruses. Secondary bacterial infection can also develop. Viral and secondary bacterial infections are especially common in individuals with temporary or permanent asthenia of the unspecific (congenital) or specific (acquired) immune system. – Drafts, cold weather, excessive indoor heating, stress, and loss of sleep are factors that promote the development of colds. When the body (especially lower body) is subjected to hypothermia or ischemia, it responds by reducing the blood flow to the mucous membranes in the upper respiratory passages. This and the drying of the mucous membranes due to excessive room heating promote the growth of pathogens. – Once a cold has fully developed, treatment focuses on alleviating typical symptoms, such as a runny nose, sore throat, and hoarseness with or without fever. Nasal douches, throat wraps, inhalation, sweat-inducing agents (diaphoretics), and baths with aromatic herbs have proved to be effective. Cold remedies usually contain secretolytic and expectorant herbs with essential oils, mucilage, and saponins. – Hot baths for colds and flu are prepared with aromatic oils, such as spruce oil, pine needle oil, eucalyptus oil, thyme oil, camphor and/or menthol. See p. 283 for details. – The administration of a diaphoretic tea after a hot bath can enhance the febrifuge effects of the treatment. – Action • Echinacea: Certain compounds in echinacea (arabinogalactans, arabinogalactan proteins) enhance the body’s nonspecific immune defenses by activating the granulocytes and macrophages, thereby improving the body’s capacity to phagocytose viruses and bacteria. Activated macrophages secrete interleukin-1, interleukin-6, and tumor necrosis factor-α, substances that stimulate the specific immune system and protect the cells from viral attacks. These mechanisms are activated when the pathogen comes in contact with the oral mucous membranes. • Caffeic acid derivatives such as chicoric acid and alkylamides are responsible for the antiviral effect of purple echinacea juice. • Echinacea juice inhibits hyaluronidase, thereby reducing the permeability of the blood vessels and inhibiting the spread of local infection. • Clinical and postmarketing surveillance studies indicate that echinacea juice and alcoholic extracts of Echinacea pallida root increase the time until the occurrence of a new infection. In those who already have a cold, the course of the infection is less severe and the symptoms subside more quickly. Since many antibiotics can suppress the immune system, these herbal remedies should be helpful in patients with bacterial infections. • Wild indigo promotes the release of interleukin 1 and stimulates the production of interferons. • Arbor vitae stimulates the T cells, increases interleukin-2 secretion, and has a direct antiviral effect. – Indications: Viral and bacterial infections of the upper respiratory passages. – Contraindications: See cautions noted on labels of commercial products. See p. 149. – Dosage and administration: Oral echinacea preparations are available. See p. 57
5.1 Diseases of the Nose and Nasal Sinuses
Clinical Considerations
General comments
Herbal and general treatment measures
Clinical value of herbal medicine: Herbal remedies for acute rhinitis (head colds) are cheap and safe. They do not damage the mucous membranes of the nose, even when used for long periods of time, if administered at low doses. In the case of sinusitis, a qualified physician should determine whether antibiotic treatment is necessary. Herbal treatments are always useful adjunctive measures.
Recommended Herbal Remedies (Overview)
Antiphlogistics
Chamomile flower (Matricariae flos, see p. 47).
Cold Receptor Stimulators
Peppermint oil (from the leaves of Mentha piperita L. (see p. 103)); Mentha arvensis var. piperascens (mint oil; sometimes mislabeled as peppermint oil); menthol; camphor tree (see p. 45).
Immunostimulants
Purple echinacea herb (Echinaceae purpureae herba, see p. 56);
In severely ill patients, the patient’s immune status should be checked before starting immunostimulatory therapy. The expected benefits of treatment must clearly outweigh the potential risks.
Compound Remedies for Acute Sinusitis
We do not recommend single-component commercial preparations for this indication.
The patient should consult a physician if the symptoms persist for more than 7 to 14 days or re-occur periodically. Pregnant women should not use echinacea unless directed by a qualified health care practitioner.
5.2 Colds and Flu
Clinical Considerations
General comments
Herbal and general treatment measures
Clinical value of herbal medicine: All measures that improve the natural function of the mucous membranes of the upper respiratory tract, alleviate cold symptoms, and strengthen the immune system, can be recommended for symptomatic treatment of all virally induced catarrhal disorders. There are no comparable synthetic drug preparations. Self-treatment measures should be coordinated with the help of a physician.
Recommended Herbal Remedies (Overview)
Immunostimulants
Purple echinacea herb (Echinaceae purpureae herba, see p. 150); paleflowered echinacea root (Echinacea pallidae radix, see p. 150); wild indigo (Baptisiae tinctoriae radix); and arbor vitae tips (Thujae occidentalis stipites, see p. 119).
The efficacy of other plant parts of the two Echinacea species has not been convincingly demonstrated, although the roots of E. purpurea, and especially E. angustifolia are frequently thought to be more potent in North America.
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