URTI-common cold Flashcards
Upper Respiratory Tract Infection (URTI):
-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:
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
Botanical treatment strategies:
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
Herbal actions:
-Antivirals/antimicrobials
-Immune stimulants
-Deep immune tonics
-Adaptogens
-Anti-catarrhal/mucolytics
-Expectorants
-Diaphoretics
-Demulcants
-Lymphatics
-Anti-inflammatories
Antimicrobials & immune stimulants:
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
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 herm. 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.
Batisia tinctoria:
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
Batisia tinctoria 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
Batisia tinctoria Pharmacy & Safety:
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
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
Echinacea Angustifolia/Purpurea pharmacology:
-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
Echinacea Angustifolia/Purpurea Pharmacy & safety:
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
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)
Zingiber officinale Pharmacology:
-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
Zingiber officinale pharmacy & safety:
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
Other considerations:
-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
How to do a steam inhalation:
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
Other considerations:
-Rest, hydration, & nutrition
-Food is medicine: herbal support through food, adding garlic, onion, ginger, thyme, oregano, sage or mushrooms to soups or stews
Immune support soup:
Preventing recurrence:
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
