- 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
