Tuesday, 30 August 2016

Re: The Herbal Mixture Kan Jang® Reduces Cough Severity in Patients with Acute Upper Respiratory Tract Infections

  • Malabar Nut (Justicia adhatoda, Acanthaceae)
  • Echinacea (Echinacea purpurea, Asteraceae)
  • Eleuthero (Eleutherococcus senticosus, Araliaceae)
  • Upper Respiratory Tract Infections

Date: 08-15-2016 HC# 011623-550

Barth A, Hovhannisyan A, Jamalyan K, Narimanyan M. Antitussive effect of a fixed combination of Justicia adhatoda, Echinacea purpurea and Eleutherococcus senticosus extracts in patients with acute upper respiratory tract infection: a comparative, randomized, double-blind, placebo-controlled study. Phytomedicine. December 2015;22(13):1195-1200. 

Upper respiratory tract infections (URIs) are characterized by nasal congestion, a sore throat, and coughing. URIs are generally caused by viral infections and are self-limiting. Most treatments for URIs are intended to treat the symptoms associated with the infection and include antitussives, pain reducers, and expectorants. In preclinical studies, extracts of Malabar nut (Justicia adhatoda, Acanthaceae) have been shown to have antitussive, expectorant, mucolytic, antibacterial, and anti-inflammatory qualities. Vasicine, a quinazoline alkaloid compound found in alcohol extracts of Malabar nut, acts as a bronchodilator, inhibits bronchospasms, and increases cilia movement. In addition, both echinacea (Echinacea purpurea, Asteraceae) and eleuthero (Eleutherococcus senticosus, Araliaceae) have been shown to have immunomodulatory effects. Kan Jang® (Swedish Herbal Institute; Vallberga, Sweden) contains extracts of Malabar nut, echinacea, and eleuthero, and is used in Scandinavia to treat URIs. The goal of this placebo-controlled, randomized, double-blind, phase II clinical trial was to measure the efficacy and tolerability of Kan Jang in patients with acute URIs.
The study was conducted at the Yerevan State Medical Centre of Armenia, Yerevan, Armenia, between November 2012 and August 2014. Patients were included if they had acute, uncomplicated URIs. Patients were excluded if they had allergies to cut flowers; had fever; had symptoms for > 36 hours; were taking antibiotics, anti-inflammatants, or antihistamines; or were pregnant or lactating. Patients were divided randomly among 3 groups which consumed either Kan Jang, the active control bromhexine hydrochloride, or a placebo. The following ingredients made up the base solution for all of the treatments: sorbitol, ginger (Zingiber officinale, Zingiberaceae), peppermint (Mentha × piperita, Lamiaceae), dark syrup, benzoate, and water. The Kan Jang extract contained 9 mg/ml of ethanol-extracted dried echinacea root, 14 mg/ml aqueous-extracted dried Malabar nut leaves, and 2 mg/ml of ethanol-extracted dried eleuthero root. It was standardized for vasicine (0.2 mg/ml), chichoric acid (0.8 mg/ml), and eleutherosides B and E (0.03 mg/ml). The bromhexine hydrochloride (1.6 mg/ml; Boehringer Ingelheim; Ingelheim am Rhein, Germany) was diluted to 0.8 mg/ml in the standard solution. The placebo contained only the standard solution of ingredients.
Patients were instructed to take 30 ml of the treatment solution 30 minutes after breakfast for 5 days. At baseline, the number of coughing bouts in 30 minutes was measured in each patient. Patients were instructed to count the number of coughing bouts for 30 minutes once the first bout had started each morning of the study. The coughing frequency was calculated from these data on a scale from 0 to 9, with 9 being the most extreme number of coughing bouts. Blood samples were taken at baseline and day 5. Data were analyzed with one-way analysis of variance, paired t-tests, post hoc Dunn's multiple comparison tests, and Kruskal-Wallis non-parametric tests.
A total of 177 patients were divided equally among the 3 groups. All groups experienced a significant improvement in coughing frequency over the course of the study (P < 0.0001 for all). On days 3 and 4 of the study, the decrease in coughing frequency was greater in the Kan Jang group than in the placebo group (P < 0.05 for day 3 and P < 0.01 for day 4) or in the bromhexine group (P < 0.05 for day 3 and P < 0.01 for day 4). On day 5, the reduction in coughing in the Kan Jang group and in the bromhexine group was similar. Kan Jang resulted in a more rapid decrease in the frequency of coughing than did bromhexine. Adverse effects were minor and included pruritus, skin rash, diarrhea, and abdominal pain. There were no differences in the frequency of adverse effects among the groups.
Kan Jang reduced the severity of coughing more rapidly than did bromhexine in patients with acute URIs. Bromhexine is a synthetic derivative of vasicine, which is thought to be one of the more potent compounds found in Malabar nut for treating URIs. Kan Jang may provide faster relief from coughing than bromhexine alone because of other constituents within Malabar nut, echinacea, or eleuthero. Each of these species has been found to improve symptoms associated with URIs, and the combination of species may have a synergistic effect on improving cough severity. This study was partially supported by Swedish Herbal Institute.
Cheryl McCutchan, PhD