Chronic Cough Alternatives

June 1, 2014 Written by JP    [Font too small?]

The so-called “common cold” usually comes and goes in an expected, generic manner. You’re congested for a few days, you sneeze and your throat aches for a week tops. In most cases, it’s not a big deal and requires little or no medical intervention. But, for some, a lingering cough can stick around long after the cold exits stage right. There are several reasons why this typically occurs including bacterial infections, chronic irritation of the airways and/or overuse of nasal decongestant sprays – more than three days.

If you’re one the unlucky ones who encounter a chronic cough after a cold infection you can and should consider natural remedies to help restore your normal state of wellness. And, thankfully, you don’t have to rely on old wives’ tales or questionable anecdotes. Instead, consider the following, evidence-based approaches.

Far and away, the best documented natural remedy for chronic coughs in adults and children is pure honey. Normally, I don’t encourage the use of concentrated sweeteners. However, in the case of honey, it is well worth trying for those with long term coughs that don’t require antibiotic intervention. Acute use of honey is unlikely to cause any harmful, lasting effects. Furthermore, adding certain wholesome ingredients to honey such as coffee and pure cocoa powder may result in even better outcomes. For instance, a recent study published in Primary Care Respiratory Journal reports that combining instant coffee and honey is significantly more effective in reducing persistent post-infectious cough (PPC) as compared to systemic steroid treatment. In addition, theobromine, a naturally occurring chemical found in cocoa, is now considered a “novel and promising” antitussive “drug” thanks to positive, preliminary research and a favorable safety profile. This suggests that a natural cocktail containing cocoa, coffee and honey may be a tasty and viable alternative for those trying to overcome PPC.

If cocoa and coffee aren’t right for you or if you require more support, I suggest a well formulated herbal tincture consisting of eucalyptus, ivy, licorice and thyme. In the US, a liquid supplement containing all of these therapeutic ingredients is sold under the name Bronchosan – distributed and manufactured by A. Vogel. Gargling and then swallowing this composition appears to ease throat irritation, relax bronchial tubes and thins mucus in the lungs allowing for efficient expectoration. Also, this herbal blend possesses antibacterial properties which may assist the immune system in overcoming infections. Finally, this sugar-free formula may be further enhanced by mixing it with honey and warm water. Personally, I think it’s a far better option than conventional, synthetic cough syrups which only provide temporary symptomatic relief and the real risk of side-effects.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 – Honey + Coffee Versus Systemic Steroid in the Treatment of Persistent (link)

Study 2 – Antitussive and Immunomodulating Activities of Instant Coffee (link)

Study 3 – Theobromine Inhibits Sensory Nerve Activation and Cough (link)

Study 4 – Chocolate as a Cough Suppressant: Rationale and Justification for an (link)

Study 5 – Effect of Honey on Nocturnal Cough and Sleep Quality: A Double-Blind (link)

Study 6 – A Comparison of the Effect of Honey, Dextromethorphan and (link)

Study 7 – Effect of Honey, Dextromethorphan and No Treatment on Nocturnal (link)

Study 8 – Effect of Honey Versus Sucrose on Appetite, Appetite-Regulating (link)

Study 9 – Treatment of Acute Bronchitis in Children and Adolescents (link)

Study 10 – A Randomized, Double-Blind Comparison of Licorice Versus Sugar (link)

Various Honey Types Reduce Nocturnal Cough Symptoms

Source: Pediatrics. 2012 Sep;130(3):465-71. (link)

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Posted in Alternative Therapies, Children's Health, Nutritional Supplements

11 Comments & Updates to “Chronic Cough Alternatives”

  1. JP Says:

    Update 05/31/15:

    J Evid Based Complementary Altern Med. 2015 May 6.

    The Effect of Viola odorata Flower Syrup on the Cough of Children With Asthma: A Double-Blind, Randomized Controlled Trial.

    This study aimed to investigate the effect of violet syrup on cough alleviation in children with intermittent asthma. In a parallel, double-blind, randomized controlled trial, 182 children aged 2 to 12 years with intermittent asthma were randomly assigned 1:1 to receive violet syrup or placebo along with the common standard treatments in both groups (short-acting β-agonist). Both groups were evaluated in terms of the duration until cough suppression was achieved. No significant difference was observed in basic characteristics. The duration lasting to yield more than 50% cough reduction and 100% cough suppression was significantly less in the violet syrup group compared to placebo (P = .001, P < .001, respectively). There was no significant difference in therapeutic effects between boys and girls. There was a significant inverse correlation between the age of children and rate of cough alleviation and suppression by violet syrup. This study showed that the adjuvant use of violet syrup with short-acting β-agonist can enhance the cough suppression in children with intermittent asthma. Be well! JP

  2. JP Says:

    Update 05/31/15:

    BMC Fam Pract. 2015 Feb 25;16(1):24.

    The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: a meta-analysis.

    BACKGROUND: A previous meta-analysis found that high dose zinc acetate lozenges reduced the duration of common colds by 42%, whereas low zinc doses had no effect. Lozenges are dissolved in the pharyngeal region, thus there might be some difference in the effect of zinc lozenges on the duration of respiratory symptoms in the pharyngeal region compared with the nasal region. The objective of this study was to determine whether zinc acetate lozenges have different effects on the duration of common cold symptoms originating from different anatomical regions.

    METHODS: We analyzed three randomized trials on zinc acetate lozenges for the common cold administering zinc in doses of 80-92 mg/day. All three trials reported the effect of zinc on seven respiratory symptoms, and three systemic symptoms. We pooled the effects of zinc lozenges for each symptom and calculated point estimates and 95% confidence intervals (95% CI).

    RESULTS: Zinc acetate lozenges shortened the duration of nasal discharge by 34% (95% CI: 17% to 51%), nasal congestion by 37% (15% to 58%), sneezing by 22% (-1% to 45%), scratchy throat by 33% (8% to 59%), sore throat by 18% (-10% to 46%), hoarseness by 43% (3% to 83%), and cough by 46% (28% to 64%). Zinc lozenges shortened the duration of muscle ache by 54% (18% to 89%), but there was no difference in the duration of headache and fever.

    CONCLUSIONS: The effect of zinc acetate lozenges on cold symptoms may be associated with the local availability of zinc from the lozenges, with the levels being highest in the pharyngeal region. However our findings indicate that the effects of zinc ions are not limited to the pharyngeal region. There is no indication that the effect of zinc lozenges on nasal symptoms is less than the effect on the symptoms of the pharyngeal region, which is more exposed to released zinc ions. Given that the adverse effects of zinc in the three trials were minor, zinc acetate lozenges releasing zinc ions at doses of about 80 mg/day may be a useful treatment for the common cold, started within 24 hours, for a time period of less than two weeks.

    Be well!


  3. JP Says:

    Update 05/31/15:

    Phytomedicine. 2015 Apr 15;22(4):504-9.

    Evaluation of pharmacodynamic activities of EPs(®) 7630, a special extract from roots of Pelargonium sidoides, in animals models of cough, secretolytic activity and acute bronchitis.

    BACKGROUND: EPs(®) 7630 is a proprietary aqueous-ethanolic extract from roots of Pelargonium sidoides DC and has been demonstrated to dispose among others of antibacterial, antiviral, immunomodulatory, antioxidant, and tissue-protective activity. It is an approved medicinal product in more than 50 countries for the treatment of airway infections such as acute bronchitis, common cold, and sinusitis.

    PURPOSE: While the pharmacological effects of EPs(®) 7630 have extensively been evaluated in diverse in vitro test systems, the number of publications reporting results from in vivo models is limited.

    STUDY DESIGN: In the present study antitussive, secretolytic, and anti-inflammatory effects of EPs(®) 7630 were assessed in animal experiments following oral administration at human equivalent doses.

    METHODS: Antitussive effects were evaluated using ammonia- and citric acid-induced models of cough in mice (20, 40, 120 mg/kg) and guinea pigs (10, 20, 45 mg/kg), respectively. For the determination of secretolytic activity tracheobronchial secretion of intraperitoneally injected phenol red was determined in mice, while antiinflammatory action was assessed in an acute bacterial bronchitis model in rats.

    RESULTS: A significant and dose-dependent reduction of cough frequency was observed in both cough models, which was accompanied by a prolongation of cough latency time. Similarly, the extract exerted a marked secretolytic activity in mice. Induction of acute bacterial bronchitis caused characteristic histopathological changes in lung tissue adjacent to trachea and bronchi. The degree of these lesions was significantly reduced in rats treated with EPs(®) 7630 at doses of 30 and 60 mg/kg. This protective effect at least partially seems to be mediated by an up-regulation of superoxide dismutase and a subsequent protective effect against oxidative stress as indicated by a reduced serum level of malondialdehyde.

    CONCLUSION: The present data further support the therapeutic use of EPs(®) 7630 in respiratory tract infections and provide a basis for detailed studies on its bioactive constituents as well as their in vivo mode of action.

    Be well!


  4. JP Says:

    Update 07/10/15:

    Glob J Health Sci. 2015 Mar 18;7(5):43132.

    Green Tea Gargling Effect on Cough & Hoarseness After Coronary Artery Bypass Graft.

    INTRODUCTION: Endotracheal intubation is a method necessary for controlling and maintaining airway during general anesthesia. Cough and hoarseness are common complications after endotracheal intubation. Inflammation has an important role in postoperative cough and hoarseness outbreak. Also it has been stated that green tea has anti-inflammatory properties. Therefore, the current study has been conducted to investigate green tea gargling solution effect on cough and hoarseness after coronary artery bypass graft (CABG) surgery.

    METHODS: In this single-blind, randomized, & controlled clinical trial, we enrolled 121 patients undergoing CABG admitted to the ICU .The intervention group participants were asked to gargle 30 cc of green tea solution. The control group patients gargled 30 cc of distilled water. An hour after extubation, the intervention group patients were asked to gargle 30 cc of green tea and the control group patients were required to gargle 30 cc of distilled water every 6 hour up to 24 hour (each patient for 4 times (.Moreover, the cough and hoarseness questionnaire was also filled in 6, 12, and 24 hours after endotracheal extubation.

    RESULTS: The results showed no significant differences among the patients in both groups regarding age, gender, body mass index, smoking history, and anesthesia duration. There was a significant difference between the two groups in terms of cough 12 hours after removing the endotracheal tube. At other times, there was no significant difference between the two groups considering cough and hoarseness.

    CONCLUSION: The present study results showed that green tea gargling does not decrease hoarseness. Though, cough occurrence was less in the intervention group than the other group.

    Be well!


  5. JP Says:

    Updated 1/24/16:

    When It Comes to Coughs, Chocolate Is More Effective Than Codeine

    “According to Professor Alyn Morice, head of cardiovascular and respiratory studies at the University of Hull, chocolate is actually a more effective method for relieving a tickle (or hacking cough) than other over-the-counter drugs.

    The prof–and resident cough expert–references a recent study where patients who took a new medicine containing cocoa (versus cough syrup) saw a significant improvement in their cough within two days. Another study, performed at the Imperial College of London, further explains: There’s an alkaloid in cocoa that is better at suppressing the urge to cough than codeine. Codeine.”

    Be well!


  6. JP Says:

    Updated 03/18/16:

    Forsch Komplementmed. 2015;22(6):359-68.

    Herbal Medicine for Cough: a Systematic Review and Meta-Analysis.

    BACKGROUND: The aim of this review was to systematically assess the literature on herbal medicine for cough as a symptom of upper respiratory tract infections and common cold.

    METHODS: The Cochrane Library, Scopus, MEDLINE/PubMed, and Embase were searched through March 2012 for RCTs testing the effects of herbal medicine for cough. Risk of bias was assessed using the Cochrane tool.

    RESULTS: 34 RCTs (N = 7,083) on Pelargonium sidoides (11 RCTs), Echinacea (8 RCTs), Andrographis paniculata (6 RCTs), ivy/primrose/thyme (4 RCTs), essential oils (4 RCTs) and bakumondoto (1 RCT) were included. Controls were mainly placebo. Most studies had a low risk of bias. The meta-analysis revealed strong evidence for A. paniculata (SMD = -1.00, 95% CI = -1.85, -0.15; P<0.001) and ivy/primrose/thyme (RR = 1.40, 95% CI = 1.23, 1.60; P<0.001) in treating cough; moderate evidence for P. sidiodes (RR = 4.60; 95% CI = 2.89,7.31; P<0.001), and limited evidence for Echinacea (SMD = -0.68; 95% CI = -1.32, -0.04; P = 0.04).

    CONCLUSION: This review found strong evidence for A. paniculata and ivy/primrose/thyme-based preparations and moderate evidence for P. sidoides being significantly superior to placebo in alleviating the frequency and severity of patients' cough symptoms. Additional research, including other herbal treatments, is needed in this area.

    Be well!


  7. JP Says:

    Updated 08/02/16:

    World J Pediatr. 2016 Jul 23.

    Efficacy and tolerability of a polysaccharide-resin-honey based cough syrup as compared to carbocysteine syrup for children with colds: a randomized, single-blinded, multicenter study.

    BACKGROUND: Available pediatric treatments for acute cough are limited by lack of demonstrated efficacy. The objective of this trial is to compare the effects of a polysaccharide-resin-honey based cough syrup, and carbocysteine syrups on nocturnal and daytime cough associated with childhood upper respiratory tract infections (URIs).

    METHODS: Using a single-blind randomization design, the study recruited children from 4 general pediatric community clinics. Participants included 150 children aged 2 to 5 years with an URI, nocturnal and daytime cough and illness duration of ≤7 days. To be eligible, children had to be free of medication on the day before presentation. A survey was administered to parents on 4 consecutive days beginning from the day of presentation in clinic. Children received the study preparation on the first evening and then 3 times per day for 3 further days. Main outcome measures were cough frequency, cough severity, bothersome nature of cough, and quality of sleep for both child and parent.

    RESULTS: Both preparations were well tolerated and cough improved over the study period. After one night and on all survey days, there was a significantly better result for polysaccharide-resin-honey (P<0.05) for all the main outcome measures. The trend of improvement over the 4 days was steeper for polysaccharide-resin-honey (P<0.05) with regards to all cough parameters.

    CONCLUSIONS: Both polysaccharide-resin-honey and carbocysteine cough syrups were well tolerated in children over 2 years of age. The polysaccharide-resinhoney syrup was associated with a more rapid and greater improvement in all clinical cough symptoms measured, beginning from the first night of therapy. Both nocturnal and daytime cough improved, as did sleep quality for both children and parents.

    Be well!


  8. JP Says:

    Updated 08/13/16:

    Turk J Med Sci. 2016 Feb 17;46(2):483-8.

    Glycemic index values of monofloral Turkish honeys and the effect oftheir consumption on glucose metabolism.

    Clinical trials have shown that low glycemic index (GI) nutrition reduces mean blood glucose concentrations and insulin secretions. The aim of the present study was to determine the GI values of various monofloral (citrus, milk-vetch, chestnut, thyme, lime, pine) honeys of Turkey, and the effect of their consumption on glucose metabolism.

    MATERIALS AND METHODS: Processing data from 20 healthy volunteers, GI values were determined from the glycemia values by using the incremental area method. Serum insulin and C-peptide levels were also measured before and 120 min after the test.

    RESULTS: The GI values of citrus, thyme, lime, chestnut, pine, and milk-vetch honeys were found to be 44.9, 52.6, 55.3, 55.5, 58.8, and 69, respectively. Serum insulin and C-peptide values after honey consumption were relatively lower than those after reference food (glucose) consumption. By the end of the 120 min, serum insulin levels were significantly higher, while a significant decrease was observed after the consumption of chestnut honey (P < 0.05). CONCLUSION: Citrus and thyme honeys were determined to have low GI, while serum insulin levels were significantly lower after the consumption of chestnut honey. Long-term research is needed to compare the effects of honey consumption on healthy and diabetic individuals. Be well! JP

  9. JP Says:

    Updated 01/23/17:

    PLoS One. 2017 Jan 19;12(1):e0170277.

    Comparison of the Effect of Two Kinds of Iranian Honey and Diphenhydramine on Nocturnal Cough and the Sleep Quality in Coughing Children and Their Parents.

    Coughing in a child induced by upper respiratory tract infections (URTIs) can be a problem, both for the child and its parents. Current studies show a lack of proven efficacy for over-the counter (OTC) medications, but promising data support the use of honey for children. The aim of this study was to compare the effects of two kinds of Iranian honey with diphenhydramine (DPH) on nocturnal pediatric coughs and the sleep quality of children and their parents. This was a clinical trial (registered in IRCT; No.: 28.20.7932, 15 October 2013). The study consisted of 87 patients. All the parents completed a standard previously validated questionnaire. The children were randomly assigned to one of three treatment groups: Group 1, Honey type 1 (Kimia Company, Iran) (n = 42), Group 2, Honey type 2 (Shahde-Golha, Iran) (n = 25), and Group 3, DPH (n = 20). Each group received double doses of the respective treatments on two successive nights. A second survey was then administered via a telephone interview in which the parents were asked the same questions. The mean scores for all aspects of coughs were significantly decreased in each group before and after the treatment. All three treatments improved the cough and sleep scores. Honey type 1 was superior to DPH in improving all aspects of coughs, except the frequency, and Honey type 2 was more effective than DPH in improving all aspects of coughs, except the sleep quality of the child. There was no significant difference between Honey type 1 and 2 in any aspects of cough relief in the present study. The results suggest that honey may provide better cough relief than DPH in children and improve the sleep quality of children and their parents.

    Be well!


  10. JP Says:

    Updated 03/30/17:

    BMC Complement Altern Med. 2017 Mar 28;17(1):175.

    Effects of honey supplementation on inflammatory markers among chronic smokers: a randomized controlled trial.

    BACKGROUND: Honey has been demonstrated to possess anti-inflammatory property. This is a randomized, controlled, open-label trial to determine the effects of 12-week honey oral supplementation on plasma inflammatory markers such as high sensitive C-reactive protein, interleukin-6 and tumor necrosis factor-α among chronic smokers.

    METHODS/DESIGN: A total of 32 non-smokers and 64 chronic smokers from Quit Smoking Clinic and Health Campus, Universiti Sains Malaysia participated in the study. Smokers were then randomized into 2 groups: smokers with honey group that received Malaysian Tualang honey (20 g/day daily for 12 weeks) and smokers without honey group. Blood was obtained from non-smokers and smokers at pre-intervention, and from smokers at post-intervention for measurement of the inflammatory markers.

    RESULTS: At pre-intervention, smokers had significantly higher high sensitive C-reactive protein than non-smokers. In smokers with honey group, tumor necrosis factor-α was significantly increased while high sensitive C-reactive protein was significantly reduced at post-intervention than at pre-intervention.

    CONCLUSION: This study suggests that honey supplementation has opposite effects on tumor necrosis factor-α and high sensitive C-reactive protein indicating the inconclusive effect of honey on inflammation among chronic smokers which needs further study on other inflammatory markers.

    Be well!


  11. JP Says:

    Updated 02/27/18:

    Wiad Lek. 2017;70(6 pt 1):1026-1033.

    Efficacy of dry extract of ivy leaves in the treatment of productive cough.

    OBJECTIVE: Introduction: Coughing is a physiological, spontaneous defense mechanism against irritants that stimulate respiratory mucosa. Productive cough should be not suppressed; instead, mucus-dissolving agents are recommended. One of the expectorants, which increases the excretion volume, is the herbal medicine derived from ivy leaves. The ivy extract contains triterpene saponins, which have secretory properties. The aim of this study was to determine the effectiveness and safety of the treatment with the medicinal product Hedussin®, containing dry ivy extract, in the therapy of productive cough in the course of the respiratory tract infection.

    PATIENTS AND METHODS: Material and methods:This was a non-randomized, non-interventional, multicenter, open-label, post-authorization effectiveness study (PAES). The study group consisted of 464 patients aged 2-12 years with productive cough. The study was supported by a questionnaire that included: the type of cough etiological factor, Bronchitis Severity Score (BSS), temperature, and prescription of antibiotic therapy. Effectiveness and safety of the therapy with Hedussin® was assessed at the follow-up visit.

    RESULTS: Results and conclusion: Improvement in cough was reported in 93.3% subjects; improvement in chest pain on coughing was reported in 84.7%, in wheezing – in 90.0%, in dyspnoea – in 88.7%, and in auscultation changes – in 94.8%. In addition, decline or normalization of body temperature was found in 96.0% of subjects. No adverse drug reactions were reported in the study population. The non-antibiotic treated group showed similar proportions. The results of this study support the efficacy of Hedussin® prescribed for the treatment of productive cough in the course of respiratory tract infections. Hedussin® was well tolerated by sick children aged 2-12 years.

    Be well!


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