Spotlight on URTI Flashcards
Upper respiratory tract infection (URTI)
Where? Viral causes? Diagnosis? Complications?
Involves an infection of the nose, sinuses, pharynx, larynx and large airways
Viral causes: rhinovirus (m/c), adenovirus, parainfluenza virus, enterovirus, respiratory syncytial virus (RSV)
Diagnosis: typically a clinical diagnosis, but nasal & nasopharyngeal swabs/aspirates can be used
Complications: pneumonia; sinusitis; otitis media; coinfection with bacterial agents; and exacerbation of preexisting medical conditions (asthma & COPD)
Common cold: Symptoms?
Typically mild and self-limited
Nasal mucosal erythema and edema
Rhinorrhea and nasal congestion
Sore throat
Cough and sneezing
Headache and low-grade fever
Onset of symptoms usually begins one to three days after exposure and can last 7–10 days or persist up to 3 weeks.
Botanical treatment strategies
Enhance immune system’s first line and second lines of defense
Choose herbs with tissue and microbial specificity
Relieve common symptoms such as sore throat, congestion, rhinorrhea, etc
Prevent recurrence
First line: protect and support physical barriers (mucus membranes)
Second line: stimulate phagocytes and natural killer cells
Herbal actions
Antivirals / antimicrobials
Immune stimulants (only if immunity is an issue)
Deep immune tonics
Adaptogens
Anti-catarrhals / mucolytics
Expectorants
Diaphoretics
Demulcents
Lymphatics
Anti-inflammatories
Antimicrobials & Immune stimulants
Herbs can have a direct effect by attacking the microorganism and/or destroying its cell wall & inhibiting replication, or inhibiting enzymes involved in the pathogenesis of infection.
Or an indirect action by preventing viral entry into the cell or stimulating phagocytes, lymphocytes or other immune cells to attack the pathogen
Many herbal antimicrobials display tissue specificity
How to choose the right antimicrobial herbs
Where is the site of infection?
Choose antimicrobial herbs with a tissue specificity for the URT for common cold
Age of the patient and general health status?
Choose gentle antimicrobial herbs at lower dosing for children, elderly and those with chronic disease
Specific pathogen?
Use antimicrobial herbs that target the pathogen causing harm. Ex: herbs that target rhinovirus for common cold
History of antibiotic use?
Some herbs require a healthy gut flora to activated bioavailable metabolites of herbs
Materia medica - common cold
Achillea millefolium
Allium sativum
Althea officinalis
Andrographis paniculata
Baptisia tinctoria
Echinacea angustifolia / purpurea
Eleutherococcus senticosus
Eupatorium perfoliatum
Glycyrrhiza glabra
Hydrastis canadensis
Ligusticum porteri
Lomatium dissectum
Mentha piperita
Oleo europaea
Origanum vulgare
Panax ginseng
Phytolacca spp
Sambucus nigra
Salix alba
Thymus vulgaris
Verbascum Thapsus
Zingiber officinalis, etc
Baptisia tinctoria
Common name: Wild Indigo
Family: Fabaceae
Part used: Root
Main Actions: Lymphatic, anti-microbial, immune-stimulant, anti-catarrhal
Main Constituents: Polysaccharides (arabinogalactans) & glycoproteins, quinolizidine alkaloids, isoflavones, flavonoids
Pharmacology:
Glycoproteins and polysaccharides stimulate the immune system by increasing the number of WBCs and improving endogenous defense mechanisms
Stimulates lymphocyte DNA synthesis and antibody production
Indicated in acute infection with excessive mucus production associated with laryngitis, pharyngitis, tonsilitis, rhinitis and sinusitis
Has been shown to substantially reduce time to improvement in common cold in combination with Echinacea and Thuja
Pharmacy:
Decoction: 1 tbsp/cup, simmered 15 mins, 1 cup TID
Tincture (1:5, 60%): 1-3ml TID, max 60ml/week
Dried herb: 1g TID
Safety:
Can cause nausea, vomiting, anorexia, hypersalivation, tachypnea, tachycardia, respiratory paralysis with toxic doses internally
CI in long-term use or high doses, pregnancy & lactation
Echinacea angustifolia / purpurea
Common name: Echinacea / Coneflower
Family: Asteraceae
Part used: Root (aerial of E. purpurea also used)
Main Actions: Anti-microbial, immunomodulator, immune-stimulant, anti-inflammatory, diaphoretic, lymphatic, vulnerary, anti-catarrhal
Main Constituents: Caffeic acid esters (echinacosides), polysaccharides (arabinogalactans), alkylamides, VO, alkaloids
Purpurea – thin thread-like roots (use more the flowers and leaves)
Angustifolia – thicker and more fleshy roots (traditional echinacea used by Native Americans)
Pharmacology:
Polysaccharides, alkylamides and caffeic acid derivatives activate immune response via enhanced granulocyte chemotaxis, macrophage phagocytosis, and increased levels of TNF, IL-1, Ig binding, and neutrophils
Caffeic acid esters stabilize mucosal connective tissue against pathogen invasion and repair tissue damage via inhibition of hyaluronidase
When used preventatively, echinacea shows a 10-20% relative risk reduction for common cold
Pharmacy:
Best used preventatively or in high doses at early stages of acute infection
Decoction: 1g/cup, simmer 15 mins, 1 cup TID
Tincture: (1:2, 60%), 3-6ml QD. During acute infection, dose can be increased to 3-5 ml q 2 hours. 40 ml weekly max.
Powdered extract (standardized to 3.5% echinacoside): 300mg TID
Safety:
High doses may cause nausea, throat irritation and skin irritation
Caution in Asteraceae allergy
Selectively modulates CYP 3A4 substrates – potential for interactions
Zingiber officinale
Common name: Ginger
Family: Zingiberaceae
Part used: Rhizome
Main Actions: Anti-oxidant, anti-inflammatory, anti-microbial, diaphoretic, carminative, anti-spasmodic
Main Constituents: VO (zingiberene), sesquiterpenes, oleoresins (gingerols & shogaols)
Pharmacology:
Sesquiterpenes in ginger have specific anti-viral effects against rhinoviruses and RSV by inhibiting viral attachment and inoculation
Fresh ginger may stimulate mucosal cells to secrete IFN-β to counter viral infection
Oleo-resins (gingerols & shogaols) help reduce pain, suppress coughing and modulate fever
Pharmacy:
Infusion: 1g/cup, 1 cup TID
Tincture: (1:5, 90%) 1.5-3 ml TID, 60 ml weekly max
Dry herb: 1-10 g in divided doses
Fresh herb: 5 g QD
Safety:
Caution with ulcers, GERD, gallstones, kidney disease, bleeding disorders, and those with sensitive stomachs
Additive effect with anticoagulant medication
Herbal Pharmacy: Herbal selection: How will these herbs help a common cold?
Echinaceae angustifolia
Baptisia tinctoria
Zingiber officinale
*NB: there is mixed research on the efficacy of Echinacea during cold/flu (best used in high doses at the onset of symptoms, or used preventatively)
May consider substituting Echinacea for Andrographis, Siberian Ginseng or Elderflower/berry
What pharmacy will we choose?
Which will be our lead herb? Supporting herbs?
How will we dose this formula? For how long?
Tincture for best compliance and extraction
Echinacea – alkylamides & caffeic acid esters better extracted in ethanol, polysaccharides better extracted in H2O
Baptisia - polysaccharides & glycoproteins better extracted in H2O
Zingiber off – VO, oleo-resins better extracted in ethanol
Echinacea will be the lead herb (requires high dosing in acute infection) with zingiber and baptisia as supporting herbs
Herbal Pharmacy:Pharmacy & Posology: Why did we choose this ratio?
What is the therapeutic dose and weekly max of each herb?
100mL Tincture
50 ml - Echinaceae angustifolia
30 ml - Baptisia tinctoria
20 ml - Zingiber officinale
Dose: 1-2 tsp (5-10 ml) TID starting at onset of symptoms during acute infection, continue for 3-5 days
*Choosing 5 or 10 ml depends on symptom severity, patient tolerability and constitution/vitality of patient.
*Studies show greater efficacy for Echinacea & Baptisia at higher end of therapeutic range in acute infection
Amounts per dose TID:
2.5-5 ml TID Echinaceae angustifolia (3-6ml QD, 40ml weekly max) - during acute infection, dose can be increased to 3-5 ml q 2 hours
1.5-3 ml TID Baptisia tinctoria (1-3ml TID, max 60ml/week)
1-2 ml TID Zingiber officinale TID (1.5-3 ml TID, 60 ml weekly max)
Other considerations
Herbal lozenges or infusions for symptom relief of sore throat using demulcent herbs like Althea officinalis, Glycyrrhiza glabra, Verbascum thapsus and/or Ulmus fulvus. What other benefits would these herbs offer? (How to make an herbal lozenge)
Steam inhalations with Eucalyptus, Thyme and/or Peppermint essential oils to relieve cough and congestion
Rest, hydration & nutrition
Food as Medicine - Herbal support through food - adding garlic, onion, ginger, thyme, oregano, sage or mushrooms to soups or stews (see recipe on next slide)
How to do a Steam inhalation
Half fill a fairly wide bowl with boiling water
Stir in 5 drops EO
Immediately place a towel over head and bowl
Breathe in through nose and out through mouth for 10 minutes
Make sure towel is large enough to fall below sides of the bowl so steam is trapped
EO evaporate readily so use quickly
