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
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.
family practice. Clinically, a cough
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-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
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.
helpful in shortening the both the dura- •
tion of cough and the intensity with Coleus
which a cough persists. Extracts of coleus (Coleus forskohlii )
When prescribing a zinc lozenge, lessen bronchial spasm as a result of •
selecting the correct form of zinc and for- increasing intracellular c-adenosine •
mulation is critical. Much of the research monophosphate, which, in turn, leads to •
on forms of zinc has focused on zinc glu- bronchial smooth-muscle relaxation. •
conate. Additionally, researchers appear Coleus also decreases histamine release, •
to have concluded, at this point, that a thus, lessening airway congestion.10'11
zinc lozenge formulated in a base of Therefore, this herb is useful for treating
glycine optimized zinc's therapeutic patients who have asthma-related coughs •
effect. Researchers have also advised that as well as allergy-triggered airway irrita- •
it is important to avoid lozenges made tion. •
with mannitol, sorbitol, and citric acids, •
because these ingredients appear to lessen Drosera •
the action of zinc.7 Also referred to as Sundew, drosera •
Vagus nerve stimulation
(Drosera rotundifolia) has demonstrated •
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
7. Zarembo, J.E., et al. Zinc (II) in saliva: Deter-
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
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
found in the home include dust mites, down 17. Cambar, P., et al.
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.
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.