URTI-common cold

Question 1

Upper Respiratory Tract Infection (URTI):

Answer 1

-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)

Question 2

Common cold:

Answer 2

SSx:
-Typically, mild and self-limiting
-Nasal mucosal erythema and edema
-Rhinorrhea and nasal congestion
-Sore throat
-Cough & 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

Question 3

Botanical treatment strategies:

Answer 3

1) Enhance immune system’s first line and second lines of defense

2) Choose herbs with tissue and microbial specificity

3) Relieve common symptoms such as sore throat, congestion, rhinorrhea, etc

4) Preventative recurrence

Question 4

Herbal actions:

Answer 4

-Antivirals/antimicrobials
-Immune stimulants
-Deep immune tonics
-Adaptogens
-Anti-catarrhal/mucolytics
-Expectorants
-Diaphoretics
-Demulcants
-Lymphatics
-Anti-inflammatories

Question 5

Antimicrobials & immune stimulants:

Answer 5

Herbs can have a direct effect by attacking the microorganism and/or destroying its cell wall and 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

Question 6

Where is the site of infection?

Answer 6

Choose antimicrobial herbs with a tissue specificity for the URT for common cold.

Question 7

Age of the patient and general health status?

Answer 7

Choose gentle antimicrobial herbs at lower dosing for children, elderly and those with chronic disease.

Question 8

Specific pathogen?

Answer 8

Use antimicrobial herbs that target the pathogen causing herm. ex) herbs that target rhinovirus for common cold.

Question 9

History of antibiotic use?

Answer 9

Some herbs require a healthy gut flora to activated bioavailable metabolites of herbs.

Question 10

Batisia tinctoria:

Answer 10

Common name: Wild indigo

Family: Fabaceae

Part used: Root

Main actions: lymphatic, antimicrobial, immune-stimulant, anti-catarrhal

Main constituents: Polysaccharides (arabinogalactans) & glycoproteins, quinolizidine alkaloids, isoflavones, flavonoids

Question 11

Batisia tinctoria Pharmacology:

Answer 11

-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

Question 12

Batisia tinctoria Pharmacy & Safety:

Answer 12

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

-Cl in long-term use or high doses, pregnancy & lactation

Question 13

Echinacea Angustifolia/Purpurea:

Answer 13

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

Question 14

Echinacea Angustifolia/Purpurea pharmacology:

Answer 14

-Polysaccharides, alkylamides and acffeic acid derivitives activate immune response via enhanced granulocyte chemotaxis, macrophage phagocytosis, and increased levels of TNF, IL-1, lg 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

Question 15

Echinacea Angustifolia/Purpurea Pharmacy & safety:

Answer 15

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 3-5ml 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

Question 16

Zingiber officinale:

Answer 16

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)

Question 17

Zingiber officinale Pharmacology:

Answer 17

-Sesquiterpenes in ginger have specific anti-viral effects against rhinovirus and RSV by inhibiting viral attachment and inoculation

-Fresh ginger may stimulate mucosal cells to secrete IFN-beta to counter viral infection

-Oleo-resins (gingerols & shogaols) help reduce pain, suppress coughing and modulate fever

Question 18

Zingiber officinale pharmacy & safety:

Answer 18

Pharmacy:
-Infusion: 1g/cup, 1 cup TID

-Tincture: (1:5, 90%) 1.5-3ml TID, 60ml weekly max

-Dry herb: 1-10g in divided doses

-Fresh herb: 5g QD

Safety:
-Caution with ulcers, GERD, gallstones, kidney disease, bleeding disorders, and those with sensitive stomachs

-Additive effect with anticoaglant medication

Question 19

Other considerations:

Answer 19

-Lozenges or infusions for symptom relief of sore throat using demulcant herbs like althea officinalis, glycyrrhiza glabra, verbascum thapsus and/or ulmus fulvus

-Steam inhalations with eucalyptus, thyme and/or peppermint essential oils to relieve cough and congestion

Question 20

How to do a steam inhalation:

Answer 20

1) half fill a fairly wide bowl with boiling water

2) Stir in 5 drops of EO

3) Immediately place a towel over head and bowl

4) 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

Question 21

Other considerations:

Answer 21

-Rest, hydration, & nutrition

-Food is medicine: herbal support through food, adding garlic, onion, ginger, thyme, oregano, sage or mushrooms to soups or stews

Question 22

Immune support soup:

Answer 22

Question 23

Preventing recurrence:

Answer 23

Long-term considerations of adaptogens and deep immune tonics to support HPA axis and strengthen immune system to prevent recurrence and recover from convalescence.

-Astragalus membranaceus
-Schisandra chinensis
-Panax ginseng
-Medicinal mushrooms: reishi, chaga, cordyceps