Cough Control the Natural Way

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					                                   Cough Control
                                  the Natural Way

       Chris D. Meletis, N.D.                     Consuming sufficient pristine water is       effectiveness of cough-related expectora-
                                                by far the simplest way to lessen irrita-      tion,    by downregulating the nervous
                                                                                                       or
                                                tion and decrease the likelihood of an         system responsiveness that frequently
              is the most common present-       upper-airway infection and its resultant       leads to bouts of spasmodic coughing.

Cough  ing
       family practice. Clinically, a cough
is almost
             symptom seen in a general
         always merely a symptom of an
                                                cough. Numerous studies have support-
                                                ed the conclusion that dehydrated
                                                mucous membranes are much more sus-
                                                                                               N-Acetyl Cysteine
                                                                                                 N-acetylcysteine (NAC) is a diverse
underlying condition. It is important to        ceptible to external assault than well-        and clinically useful amino acid that has
look beyond the cough to treat the cause        hydrated tissues. Proper hydration             been used in the form of an inhalant in
and, hence, achieve maximal relief.             confers protection and healthy tissues         hospitals as a mucolytic. NAC mucolytic
   Cough is a normal protective mecha-          function better at a cellular level. When      properties have been attributed to its
nism for   clearing the airway of secretions,   tissues are hydrated, they have an             cleaving of the disulfide bonds within
irritants, and foreign materials. Air expul-    enhanced ability to produce the protec-        mucous strands, which contribute to the
sion in excess of 500 miles per hour has        tive coating of secretory IgA.                 viscosity of sputum. Although NAC is
been recorded during a coughing                    Intake of liquids, other than water, that   traditionally administered via inhalation
episode. The emphasis when treating a           contain fructose, sucrose, glucose, honey,     or parenteral routes, oral dosing has

cough is to help the body expectorate           or citrus juice is not advisable.1-3 These     proven to be clinically effective with peak
more efficiently and lessen undue irrita-       forms of sugar may actually lower              levels of NAC occurring within 45 min-
tion, thus, lessening the need to cough.        immune function and increase suscepti-         utes after ingestion.
   Among the leading causes of coughs           bility to, or progression of, infection.          Clinically, the use of NAC helps to loosen
are colds, bronchitis, pneumonia, aller-        Avoiding other forms of sugar, in the          sputum up within the airway, assisting in
gies, and asthma. Coughs are also               form of foods, while combating a cough         successful expectoration, thereby lessening
induced by drugs, nonspecific upper-            that may be immune related is equally          airflow restriction and irritation resulting
respiratory-tract irritations, infections,      critical. One of the current theories that     from excess mucus. It is advisable to
and environmental triggers. Because             explains the role of sugar in immune reg-      increase the dosage slowly when adminis-
coughs can also be symptomatic of other         ulation is that ascorbic acid and glucose      tering NAC, because its ability to loosen
conditions, such as respiratory cancers,        compete for white blood cell (WBC) trans-      mucus can, at times, overwhelm a compro-

congestive heart failure, and chronic           port sites, thus, leading to a downregula-     mised respiratory tract's ability to facilitate
obstructive pulmonary disease, unremit-         tion of WBC function.                          expectoration. Because NAC is also a pow-
ting coughs must always be investigated           Other foods that nutritionally minded        erful antioxidant that may assist in confer-
further.                                        physicians commonly recommend avoid-           ring localized respiratory protection, as well
   Whether a cough is caused by viral or        ing for patients who suffer from conges-       as enhancing glutathione levels within the
bacterial infection or by another condi-        tion-related coughs include dairy              body, this nutrient is frequently used to aid
tion, many of the same natural medicine         products, bananas, oranges, peanuts, and       in protecting respiratory tissues when
interventions can be beneficial in alleviat-    other citrus fruits and juices.                patients have conditions that can result in
ing the discomfort.                                                                            tissue damage.
                                                     Nutrient Recommendations                  Zinc
      Dietary   Recommendations                    There are numerous nutrients that have        Zinc, particularly in the form of zinc
   Healthy respiratory-tract membranes          proven themselves to be clinically useful      lozenges, has been shown to help relieve
are of paramount importance when it             for immune stimulation, yet there are          the reflex cough associated with upper-
comes to addressing susceptibility to, or       substantially fewer nutrients that are spe-    respiratory-tract irritation and infection.
persistence of, coughs. The first and fore-     cific for treating coughs. Generally speak-    Beyond this direct effect, it has been well
most step is to ensure that the respiratory     ing, a product can help to suppress a          documented that zinc helps to enhance
tissues are optimally hydrated, resilient,      cough by lessening direct irritation,          immune-system function and actually has
and resistant to infection and irritation.      decreasing inflammation, enhancing             antiviral effects.4-6 In one study, subjects
 12
ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2000                                                                                         13




                                                                  Subjects in a group treated with
                                                       zinc lozenges had significantly fewer days of
                                              coughing—4.4 days compared to 7.6 days without zinc.

in a group treated with zinc lozenges had     cautioned to avoid using bromelain
significantly fewer days of coughing—4.4      because it can contribute to exacerbation            Common Causes of Cough
days compared to 7.6 days without zinc.       of symptoms of these disorders and to
The use of zinc lozenges can be extremely     worsening of the underlying conditions.
                                                                                               •
                                                                                                   Airway Irritants
                                                                                               •
                                                                                                   Aspiration
helpful in shortening the both the dura-                                                       •
                                                                                                   Asthma
tion of cough and the intensity with          Coleus
which a cough persists.                         Extracts of coleus (Coleus forskohlii )
                                                                                               •
                                                                                                   Benign nodules
                                                                                               •
                                                                                                   Bronchitis
   When prescribing a zinc lozenge,           lessen bronchial spasm as a result of            •
                                                                                                   Diaphragmatic irritation
selecting the correct form of zinc and for-   increasing intracellular c-adenosine             •
                                                                                                   Foreign bodies
mulation is critical. Much of the research    monophosphate, which, in turn, leads to          •
                                                                                                   Fungal infections
on forms of zinc has focused on zinc glu-     bronchial smooth-muscle relaxation.              •
                                                                                                   Gastroesophageal reflux
conate. Additionally, researchers appear      Coleus also decreases histamine release,         •
                                                                                                   Interstitial fibrosis
to have concluded, at this point, that a      thus, lessening airway congestion.10'11
                                                                                               •
                                                                                                   Malignant diseases
zinc lozenge formulated in a base of          Therefore, this herb is useful for treating
                                                                                               •
                                                                                                   Pharyngitis
                                                                                               •
                                                                                                   Pleural irritations
glycine optimized zinc's therapeutic          patients   who have asthma-related coughs        •
                                                                                                   Pneumonia
effect. Researchers have also advised that    as well as allergy-triggered airway irrita-      •
                                                                                                   Postnasal drip
it is important to avoid lozenges made        tion.                                            •
                                                                                                   Psychogenic disorders
with mannitol, sorbitol, and citric acids,                                                     •
                                                                                                   Sinusitis
because these ingredients appear to lessen    Drosera                                          •
                                                                                                   Smoking
the action of zinc.7                            Also referred to     as   Sundew, drosera      •
                                                                                                   Vagus nerve stimulation
                                              (Drosera rotundifolia) has demonstrated          •
                                                                                                   Viral infections

         Herbal Recommendations               bronchoantispasmodic and antitussive
                                              effects.12 This botanical is particularly
   Herbal remedies have long been used        helpful for treating patients who have          Licorice
to alleviatecoughs and to promote expec-      bronchial irritations and spasmodic and            Glycyrrhizin and glycyrrhetinic acid,
toration. Traditionally, herbs have been      croupy coughing episodes.                       derived from licorice (Glycyrrhizia glabra),
used to increase the quantity and elimina-                                                    bind to glucocorticoid receptors and exert
tion of mucus while decreasing its viscos-    Glyceryl guaiacolate                            anti-inflammatory effects.1 In addition,
ity.                                             This herbal-based medication is, by far,     licorice extracts also induce inferieron
                                              one  of the most popular over-the-counter       production and inhibit the growth of
Bromelain                                     (OTC) medicines to assist in treating           many DNA and RNA viruses.13-15
   Bromelain, a proteolytic enzyme            cough and reducing thickened mucus.
derived from pineapple, has been shown        This medicine increases respiratory-tract       Lobelia
to be helpful in the treatment of upper-      secretory production to help liquefy and          Lobelia       (Lobelia inflata) is an effective
respiratory-tract infections. Clinically,     reduce the viscosity of tenacious secre-        expectorant with a proposed mechanism of
bromelain can exert a cough suppressant       tions.                                          action that arises from adrenal-gland stimu-
effect. Its additional mucolytic effect                                                       lation, which results in bronchial smooth-
helps to break sputum viscosity       up.8    Grindelia                                       muscle relaxation.16'17 This herb has also
Bromelain has also proven to be effective       Grindelia   (Grindelia spp.), also known as   been used to help in achieving smoking ces-
in the treatment of sinusitis and the asso-   gumweed, can be helpful in reducing             sation and may actually decrease the classi-
ciated cough that can arise from postnasal    excess mucous  secretion in the upper respi-    cal smoker's cough via another mechanism.
drip.9  Conditions associated with inflam-    ratory tract. Grindelia is most effective
mation respond particularly well to           when cough symptoms are associated with         Wild Cherry
bromelain. On a precautionary note, how-      an excess accumulation of thick mucous            Wild cherry (Prunus serótina) has a long
ever, patients who are suffering from gas-    congestion, yet, gumweed can also lessen        history of use for cough, bronchitis, and
tritis, esophagitis, or ulcers should be      the frequency of dry repetitive coughs.         whooping cough. The use of this herb as
14                                                                          ALTERNATIVE & COMPLEMENTARY THERAPIES—FEBRUARY 2000




Environmental irritants are frequently
implicated in both the propagation and                            prolongation of coughs.
                                                                                                     for treating common cold: A randomized, dou-
                       Natural Treatments for                                                        ble blind, controlled study. Ann Int Med
                                                            Coughs                                   125:142-144,1996.
                                                                                                     7. Zarembo, J.E., et al. Zinc (II) in saliva: Deter-
 Remedy                                  Dosage
                                                                                                     mination of concentrations produced by zinc
Bromelain (2400 mcu potency)             375 mg, 3—4 times per day, not with food
                                                                                                     gluconate lozenges containing common excipi-
Coleus forskohlii (18%)                  50 mg, 2-3 times per day                                    ents. / Pharm Sei 81:128-130,1992
Drosera (Sundew, Drosera rotundifolia)   1000 mg, 2-3 times per day                                  8. Rimoldi, R., et al. The use of bromelain in
Glyceryl guaiacolate                     200 mg, 4-6 times per day                                   pneumological therapy. Drugs Exp Clin Res
Grindelia (Gumweed, Grindella spp.)      1000 mg, 3 times per day                                    4:55-66,1978.
Licorice (glycyrrhizin)                  200 mg, 3 times per day                                     9.  Ryan, R. A double blind clinical evaluation
                                                                                                     of bromelains in the treatment of acute sinusi-
Lobelia (Lobelia inflata ) (1%)          100 mg, 2 times per day
                                                                                                     tis. Headache 7:13-17,1967.
N-acetylcysteine                         500 mg, 2—4 times per day                                   10. Ammon, H.P.T., et al. Forskolin: From
Zinc                                     15-25 mg of elemental zinc every 2 hours for 7     days     Ayurvedic remedy to a modern agent. Planta
                                                                                                     Medica 51:473-477,1985.
                                                                                                     11. Marone, G., et al. Forskolin inhibits the
                                                                                                     release of histamine from human basophils and
an  antitussive is still prevalent in many      endless cycles of coughing, the numer-               mast cells. Agents Actions 18:96-99,1986.
OTC and natural medicines.18 However,           ous variables that can either improve or             12. Blumenthal, M, et al. The Complete German
because of concerns about potential toxic-      worsen a cough, and the frequent des-                Commission E Monographs: Therapeutic Guide to
ity, wild cherry is not readily available for   peration of patients who often seek help             Herbal Medicines. Austin: American Botanical
use by itself.                                  after sleepless nights all contribute to the         Council, 1998, p.218.
                                                need to approach the treatment in a com-             13. Kumagai, A., et al., Effects of glycyrrhizin
 Environmental Recommendations                  plementary and comprehensive manner.                 on  thymolytic and immunosuppressive action
                                                                                                     of cortisone. Endocrinol Jpn 14:39-42,1967.
                                                By far, the most important step when a               14. Abe, N., et al. Interferon induction by gly-
  Environmental irritants are frequently
                                                practitioner is faced with a patient who             cyrrhizin and glycyrrhetinic acid in mice.
implicated in both the propagation and pro-     has a persistent cough is to remove or
                                                                                                     Microb Immunol 26:535-539,1982.
longation of coughs. By far, the most com-      lessen the cause and then to follow up               15. Pompei, R., et al. Antiviral activity of gly-
mon    offending agents are cigarette, cigar    with a systematic approach that will
                                                                                                     cyrrhizic acid. Experientia 36:304-305,1980.
and pipe smoke. Other contributing factors      assist the patient's own body in the heal-           16. Halmagyi, D., et al. Adrenocortical path-
can be industrial exposures, such as dust
that comes from paper, metal, fabric, and
                                                ing process.                              D          way of lobeline protection in some forms of
other materials. Airway irritants that are
                                                                                                     experimental lung edema of the rat. Dis Chest
                                                                                                     33:285-296,1958.
found in the home include dust mites, down                                                           17. Cambar, P., et al.
                                                                                                                          Bronchopulmonary and
                                                                   References
and feather pillows and comforters, clean-       1. Sanchez, A., et al. Role of sugars in human      gastrointestinal effects of lobeline. Arch Int
ers, paints, wood-stove smoke, and solvents.                                                         Pharmacodyn 177:1-27,1969.
                                                 neutrophil phagocytosis. Am J Clin Nutr             18. PDRfor Herbal Medicines. Montvale, NJ:
And, finally, air pollutants that frequently     26:1180-1184,1973.
cause coughs include sulfur dioxide, nitro-      2. Ringsdorf W, et al. Sucrose,                     Medical Economics Data, 1998, p.1069.
                                                                                   neutrophil
gen dioxide, and ozone. In the latter case,      phagocytosis, and resistance to disease. Dent
people that work or live in large cities with    Surv 52:46-48,1976.
smog conditions are at a higher risk for         3. Bernstein, J., et al. Depression of lymphocyte   Chris D. Meletis, N.D., serves as the dean of
                                                 transformation following oral glucose inges-        clinical affairs/chief medical officer, National
developing conditions that cause coughs.         tion. Am J Clin Nutr 30:613,1977.                   College of Naturopathic Medicine, Portland,
                                                 4. Katz, E., et al. Zinc inhibition of Vaccinia     Oregon.
                 Summary                         virus maturation by zinc chloride. Antimicrob
  There is no single more frustrating            Agents Chemother 19:213-217,1981.
                                                 5. Eby, G.A., et al. Reduction in duration of       To order reprints of this article, write to or call:
condition for a clinician to face than the
                                                 common colds by zinc gluconate lozenges in a        Karen Ballen, ALTERNATIVE & COMPLE-
very simple yet common symptom of a              Double Blind Study. Antimicrob Agents               MENTARY THERAPIES, Mary Ann Liebert,
cough. The nervous system involvement             Chemother 25:20-24,1984.                           Inc., 2 Madison Avenue, Larchmont, NY 10538-
that can potentiate what often seems like         6. Mossad S.B., et al. Zinc                        1962, (914) 834-3100.
                                                                                gluconate lozenges

				
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