-IBIS-1.7.6-
tx
respiratory system
bronchitis
Nutrition

dietary guidelines

eating principles:
» acute:
• increase fluids: diluted vegetable juices, broths, herbal teas
• fruit and vegetable juice fasts
• low sugar
» chronic:
• elimination/rotation diet, rotation diet, rotation diet expanded
• Researchers have found that breast-feeding prevents the development of lower respiratory tract infections among infants.
(Pisacane A, et al. Acta Paediatr 1994;83:714-718; Kerr AA. New Zealand Med J 1981;93:333-335.)

therapeutic foods:
• apricots, carob, slippery elm, carrots, elderberries, dill, pineapple, onions (Jensen)
• foods rich in Vitamin A
• carrots, apricot kernels, persimmons, white fungus, pears, honey, ginger, water chestnuts, yams, sweet potatoes, jujube, daikon radish, walnuts, papaya, peach kernels, lotus roots, seaweed, pine nuts, pumpkin (Ni, 113.)

» for Wind-Cold Invading the Lung:
• increase Warming foods, easily digested foods: soups, porridges, meat broths

» for Phlegm Shi (Excess):
• marjoram, mustard greens, mushroom, strawberry, string bean, papaya, potato, pumpkin, radish, agar, garlic, fresh ginger, Job's tears, kohlrabi, tuna

» for Hot Lung without Phlegm Shi (Excess): clears Heat from the Lung:
• white fungus, agar, celery, asparagus, apple, pear, carrot, duck, Job's tears, mango, shark meat, mushroom, nori, octopus, papaya, peach, persimmon, pumpkin, radish, rice congee with carrot or adzuki bean

» for Lung Yin Xu (Deficiency): moisten and nourish Lung Yin:
• dairy foods, pears, applesauce, seaweed in small quantity, shark meat, watermelon, mutton, tangerine, pinenut, chicken broth, clam, barley malt, walnut, yam, peanut, chicken egg

» for Lung Qi Xu (Deficiency): support the Middle Warmer, nourish the Righteous Qi:
• Astragulus or Codonopsis cooked in soups, carrot, duck, celery, garlic, fresh ginger, grape, Job's tears, kohlrabi, tuna, barley malt, mango, mushroom, marjoram, mustard greens, olive, papaya, peach, peanut, pork, pumpkin, rice, yam

fresh juices:
• juice of 2 lemons and 3 tbsp. honey to one pint flax seed tea. Use one tsp. every hour (Jensen, 50.)
• carrot, beet, and cucumber (Walker, 128.)
• carrot and spinach (Walker, 128.)
• horseradish and lemon (Walker, 128.)
• carrot and dandelion (Walker, 128.)
• carrot (Walker, 128.)
• raw eggplant (Ni, 113.)

specific remedies:
• turnip pack externally on chest
• carrots and apricot kernels cooked with rice porridge, three times daily, for 30 days (Ni, 113.)
2-3 pears, reinvigorate the core and fill with honey and eat before bed every day for l month (Ni, 113.)
• juice from pineapple and lemon, drink before meals for relief (Ni, 113.)
to expel phlegm: mix honey and apple cider vinegar
• cough syrup made from soaking chopped onions (or garlic) in honey overnight covered until a syrup has formed (Shefi)
• 6 oz. chestnuts, 5 oz. pork. Braise together and eat 3-4 oz., twice daily. (Butt, Bloomfield, 124.)
• 1 pear, 7 scallions, 3 oz. raw brown sugar. Boil in 1 pt. water until reduced by half. Eat and drink twice daily using half each time (Butt, Bloomfield, 152.)
• take 10-15 g loquat fruit stones and crush them. Add 3 g fresh ginger, cover with water and simmer 1 hour. Serve twice daily. (Yin-fang, Cheng-jun, 48.)
cough with thick phlegm: take 2 dried persimmons and 30 g candied honey. Add water, steam in a covered pot, mash and eat, twice daily. (Yin-fang, Cheng-jun, 63.)
• take a fresh lemon or orange, slice, and add 15 g sugar. Steam in water until soft, mash and serve, including the skin, twice daily. (Yin-fang, Cheng-jun, 64, 84.)
• take 50 g of shelled peanuts, add water and boil, then mash. Drink the broth and eat the peanuts, twice daily. (Yin-fang and Cheng-jun, 97.)
• burning cough with Phlegm Shi (Excess): simmer bamboo shoots in water and serve (Chao-liang, Qing-rong, Bao-zhen, 23.)
• hot cough with Phlegm Shi (Excess): simmer bok choy in water and serve (Chao-liang, Qing-rong, Bao-zhen, 33.)
• burning in lungs with frequent cough: simmer watercress in water and serve (Chao-liang, Qing-rong, Bao-zhen, 37.)
• cough with excessive frothy Phlegm: blend together 1/4 cup fresh ginger juice and 30 ml honey and drink (Chao-liang, Qing-rong, Bao-zhen, 82.)
• cough with excessive frothy Phlegm: simmer together 30 g coriander, 10 g dried ginger and 3 g bitter apricot kernels and drink (Chao-liang, Qing-rong, Bao-zhen, 82.)

avoid:
Avoid allergens/food intolerances: First, try eliminating milk and dairy products. Second, try eliminating grains, especially wheat. Chronic bronchitis will often respond within the first few days of the restriction. A short fast, followed by a hypoallergenic diet, can also be beneficial. (Marz. 323, 1997.)

• stimulating foods, spicy foods, alcohol, caffeine and cold drinks (Ni, 113.)
cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, catarrh-forming foods: oranges, tofu, tomatoes; meat, ice cream, shellfish

» for Wind-Cold Invading the Lung:
• Cooling foods, eggs
» for excess Lung Phlegm:
• dairy, soy products, coconut, sugar, sweet rice, persimmon, pork, almond, honey, peanut
» for Hot Lung Phlegm:
• garlic, fresh ginger, pork, mustard green, sweet rice, sugar, walnut


supplements

Vitamin A: 25,000 IU twice daily, or Beta-carotene 50,000-100,000 IU per day, to enhance immune function and facilitate healing of respiratory tissue.
(Fawzi WW, et al. JAMA 1993;269:898-903; Kjolhede Cl, et al. J Pediatr 1995;126:807-812; Pinnock CB, et al. Aust Paediatr J 1986;22:95-99; Pinnock CB, et al. Aust Paediatr J 1988;24:286-289.)
Vitamin B6: 50 mg two to three times daily.
Vitamin C: 2 gms 3-4 times daily, stimulates a non-enzymatic histamine degradation.
(Bucca C, et al. Ann Allergy. 1990 Oct;65(4):311-314; Hunt C, et al. Int J Vitam Nutr Res 1994;64:212-219.)
Vitamin E: 400 IU twice daily, has been shown in one study to be effective in improving antibody response to influenza virus. (Bastyr)
Zinc picolinate: 30 mg twice daily, to enhance immune function and facilitate healing of respiratory tissue.
Quercetin is effective against parainfluenza virus. (Marz. 323, 1997.)
N-acetyl cysteine, 200 mg twice daily, betwen meals, facilitates breaking up of mucus and protects lungs from oxidative damage.
(Boman G, et al. Eur J Respir Dis 1983;64:405-415; Grassi C, Morandini GC. Eur J Clin Pharmacol 1976;9:393-396; Jackson IM, et al. J Int Med Res 1984;12:198-206; Riise GC, et al. Eur Respir J 1994;7:94-101.)
Thymus extract: especially for children with recurrent respiratory infections. (Fiocchi A, et al. Thymus 1986;8:331-339.)


» drug interactions:
Vitamin K and cephalosporins [cefuroxime (Ceftin), cephalexin (Cefanex, Keflet, Keflex, Keftab), cefixime (Suprax), cephadroxil (Duricef, Ultracef), cephaclor (Ceclor)]:
• Cephalosporins interfere with Vitamin K metabolism, sometimes leading to hemmorhage (Anonymous, 1984; 42 (4): 162-163.)
• Cephalosporins reduce Vitamin K synthesis by destroying the colonic bacteria responsible for that process


footnotes

Anderson TW, Beaton GH, Corey P, Spero L Winter illness and vitamin C: the effect of relatively low doses. Can Med Assoc J 1975 Apr 5;112(7):823-826.
Abstract: After their random allocation to one of three treatment aroups, 622 volunteers received either vitamin C or placebo in a maintenance dose of 500 mg once weekly and a therapeutic dose of 1500 mg daily on the 1st day and 1000 mg on the next 4 days of any illness. Two forms of vitamin C were employed: a sustained-release capsule containing ascorbic acid and a regular tabet containing a mixture of sodium and calcium ascorbate. In the 448 subjects who completed an average of 15 weeks in the study of total of 635 episodes of illness were recroded. Respiratory symptoms were recorded on at least 1 day in 92 per cent of these episodes. There were no consistent or significant differences in the sickness experience of the subjects receiving the sustained-release vitamin capsules compared to those receiving the vitamin tablets, but subjects in both vitamin groups experienced less severe illness than subjects in the placebo group, with approximately 25 per cent fewer days spent indoors because of the illness (P smaller than 0.05). These results are compatible with the belief that supplementary vitamin C can reduce the burden of winter illness, but the intake need not be as high as has sometimes been claimed.

Arrieta AC, Zaleska M, Stutman HR, Marks MI. Vitamin A levels in children with measles in Long Beach, California. J Pediatr 1992;121:75-78.

BarShalom R, Soileau J. (eds.) Natural Health Hotline. Beaverton, OR: Integrative Medical Arts, 1991-1999.

Boman G, Backer U, Larsson S, Melander B, Wahlander L. Oral acetylcysteine reduces exacerbation rate in chronic bronchitis: report of a trial organized by the Swedish Society for Pulmonary Diseases. Eur J Respir Dis 1983 Aug;64(6):405-415.
Abstract: This multicentre trial was undertaken to confirm previous results indicating that long-term treatment with oral acetylcysteine reduces the exacerbation rate in patients with chronic bronchitis. Two hundred and eighty-five patients, smokers or ex-smokers, with chronic bronchitis started a pre-trial placebo-period of 1 month. After this run-in period 259 patients were included in the trial and randomized into two parallel groups. The patients were treated in a double-blind way either with acetylcysteine 200 mg b.i.d. or placebo b.i.d. for 6 months. The trial was completed by 98 patients in the acetylcysteine group and by 105 patients in the placebo group. Initially, there were no significant differences between the groups. Twice weekly, the patients filled in a diary card concerning symptoms. The number of exacerbations was assessed from these cards and at visits 2, 4 and 6 months after institution of therapy. The exacerbation rate was significantly lower in the acetylcysteine group in which 40% of the patients remained free from exacerbations compared to 19% in the placebo group. Sick-leave due to acute exacerbation was significantly less common in the acetylcysteine group. The drug was well tolerated.

Bucca C, Rolla G, Oliva A, Farina JC. Effect of vitamin C on histamine bronchial responsiveness of patients with allergic rhinitis. Ann Allergy. 1990 Oct;65(4):311-314.
Abstract: 16 patients, with seasonal allergic rhinitis without history of asthma, off their normal medications were given 2 grams of vitamin C or placebo in a double-blind cross-over study. 44% of the patients were found to have reduced FEV1. The vitamin C supplemented group was found to have a significant increase in FEV1. It appears that vitamin C stimulates a non-enzymatic histamine degradation.

Fawzi WW, Chalmers TC, Herrera MG, Mosteller F. Vitamin A supplementation and child mortality. A meta-analysis. JAMA 1993 Feb 17;269(7):898-903.
Abstract: OBJECTIVE--A two-part meta-analysis of studies examining the relationship of vitamin A supplementation and child mortality. DATA SOURCES--We identified studies by searching the MEDLARS database from 1966 through 1992 and by scanning Current Contents and bibliographies of pertinent articles. STUDY SELECTION--All 12 vitamin A controlled trials with data on mortality identified in the search were used in the analysis. DATA EXTRACTION--Data were independently extracted by two investigators who also assessed the quality of each study using a previously described method. DATA SYNTHESIS--We formally tested for heterogeneity across studies. We pooled studies using the Mantel-Haenszel and the DerSimonian and Laird methods and adjusted for the effect of cluster assignment of treatment groups in community-based studies. Vitamin A supplementation to hospitalized measles patients was highly protective against mortality (DerSimonian and Laird odds ratio, 0.39; 95% confidence interval, 0.22 to 0.66; P = .0004) (part 1 of the meta-analysis). Supplementation was also protective against overall mortality in community-based studies (DerSimonian and Laird odds ratio, 0.70; clustering-adjusted 95% confidence interval, 0.56 to 0.87; P = .001) (part 2 of the meta-analysis). CONCLUSIONS--Vitamin A supplements are associated with a significant reduction in mortality when given periodically to children at the community level. Factors that affect the bioavailability of large doses of Vitamin A need to be studied further. Vitamin A supplements should be given to all measles patients in developing countries whether or not they have symptoms of vitamin A deficiency.

Fiocchi A, Borella E, Riva E, Arensi D, Travaglini P, Cazzola P, Giovannini M. A double-blind clinical trial for the evaluation of the therapeutical effectiveness of a calf thymus derivative (Thymomodulin) in children with recurrent respiratory infections. Thymus. 1986;8(6):331-339.
Abstract: The effectiveness of an orally administrable thymic derivative (Thymomodulin) for the treatment of the recurrent respiratory infections (RRI) in children has been studied in a double-blind clinical trial with historical comparison. In the Thymomodulin treated group a significant decrease of the monthly frequency of RRI has been observed in comparison with the previous year (P less than 0.05) and with the placebo treated group (P less than 0.002). The evaluation of the laboratory data at the beginning of the study didn't show in the two groups typical alterations of the common hematological and immunological parameters, but at the end of the trial a statistically significant increase of the levels of salivary IgA has been noticed only in the Thymomodulin treated group (P less than 0.02).

Grassi C, Morandini GC. A controlled trial of intermittent oral acetylcysteine in the long-term treatment of chronic bronchitis. Eur J Clin Pharmacol 1976 Mar 22;09(5-6):393-396.
Abstract: In 69 out-patients with chronic bronchitis in 6 centres the effects of acetylcysteine 600 mg daily, 3 days a week for 6 months, and a placebo have been compared in a double-blind controlled trial. Thirty-five patients were treated with the mucolytic and 34 with the dummy preparation. In the former the clinical course of the chronic bronchitis improved to a greater extent and a significantly lower number of exacerbations was observed. The advantages of long-term oral treatment with the mucolytic in chronic bronchitis suggest that it may be useful as an alternative to long-term antibiotic prophylaxis, or to complement brief courses of antibiotics, in addition to the usual physiotherapy.

Hughes BG, Lawson LD. Antimicrobial effects of Allium sativum L. (garlic), Allium ampeloprasum L. (elephant garlic) and Allium cepa L. (onion), garlic compounds and commercial garlic supplement products. Phytother Res 1991;4:154-158.

Hunt C, Chakravorty NK, Annan G, Habibzadeh N, Schorah CJ. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res 1994;64(3):212-219.
Abstract: A randomised double-blind trial involving vitamin C/placebo supplementation was conducted on 57 elderly patients admitted to hospital with acute respiratory infections (bronchitis and bronchopneumonia). Patients were assessed clinically and biochemically on admission and again at 2 and 4 weeks after admission having received either 200 mg vitamin C per day, or placebo. This relatively modest oral dose led to a significant increase in plasma and white cell vitamin C concentration even in the presence of acute respiratory infection. Using a clinical scoring system based on major symptoms of the respiratory condition, patients supplemented with the vitamin fared significantly better than those on placebo. This was particularly the case for those commencing the trial most severely ill, many of whom had very low plasma and white cell vitamin C concentrations on admission. Various mechanisms by which vitamin C could assist this type of patient are discussed.

Jackson IM, Barnes J, Cooksey P. Efficacy and tolerability of oral acetylcysteine (Fabrol) in chronic bronchitis: a double-blind placebo controlled study. J Int Med Res 1984;12:198-206.
Abstract: This multicentre, double-blind, placebo controlled, between-patient study in general practice in the United Kingdom examined the effect of oral N-acetylcysteine (Fabrol) on the symptomatology of patients with chronic bronchitis over a 3-month period. Although improvement in subjective symptoms (sputum viscosity and character, difficulty in expectoration and cough severity) occurred in both treatment groups over the trial period, improvements in difficulty in expectoration and cough severity were greater in patients receiving N-acetylcysteine compared to matching placebo. Trial medication was well tolerated, with a greater number of side-effects attributed to therapy occurring in patients receiving placebo.

Kerr AA. Lower respiratory tract illness in Polynesian infants. New Zealand Med J 1981 May 27;93(684):333-335.
Abstract: A follow-up at five months of 269 Polynesian infants born at Hutt Hospital over a nine month period showed an incidence of lower respiratory symptoms of 42 percent. Nineteen percent of the infants had recurrent or prolonged symptoms. These infants more frequently had a family history of asthma or bronchitis in first degree relatives, had a greater incidence of damp housing and were often of lower socio-economic status. There was a lower rate of breast feeding in the symptomatic groups suggesting that breast milk has a role in preventing the syndrome of recurrent respiratory illness in Polynesian infants.

Kjolhede Cl, Chew FJ, Gadomski AM, Marroquin DP. Clinical trial of vitamin A as adjuvant treatment for lower respiratory tract infections. J Pediatr 1995;126:807-812.

La Vecchia C, Decarli A, Pagano R. Vegetable consumption and risk of chronic disease. Epidemiology 1998 Mar;9(2):208-210.
Abstract: We used data from the 1993 Italian Household Multipurpose Survey, based on a sample of 46,693 subjects ages 15 years or over, to analyze the relation between frequency of vegetable consumption and prevalence of 12 chronic diseases. We observed little association with diabetes mellitus, hypertension, and allergy. There were inverse relations between vegetable consumption and myocardial infarction [odds ratio (OR) = 0.79 for the highest tertile], angina pectoris (OR = 0.89), chronic bronchitis (OR = 0.69), bronchial asthma (OR = 0.70), peptic ulcer (OR = 0.74), gallstones (OR = 0.92), liver cirrhosis (OR = 0.71), kidney stones (OR = 0.68), and arthritis (OR = 0.84). Adjustment for alcohol and tobacco use made little difference.

Menzel DB. Antioxidant vitamins and prevention of lung disease. Ann N Y Acad Sci 1992 Sep 30;669:141-155. (Review)

Pinnock CB, Douglas RM, Badcock NR. Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J 1986;22:95-99.

Pinnock CB, Douglas RM, Martin AJ, Badcock NR. Vitamin A status of children with a history of respiratory syncytial virus infection in infancy. Aust Paediatr J 1988;24:286-289.

Pisacane A, Graziano L, Zona G, Granata G, Dolezalova H, Cafiero M, Coppola A, Scarpellino B, Ummarino M, Mazzarella G. Breast feeding and acute lower respiratory infection. Acta Paediatr 1994 Jul;83(7):714-718.
Abstract: The association between breast feeding and acute lower respiratory infection (ALRI) was studied in a case-control study in southern Italy. Two groups of children were studied: the first group comprised 73 infants, aged 0-6 months, whose diagnosis was pneumonia or bronchiolitis; the second group included 88 infants less than 12 months of age with a diagnosis of pertussis-like illness. Control infants were two groups of infants admitted to the same ward. Compared with controls, infants in the first group were less likely to have been breast fed (odds ratio 0.42, 95% CI 0.19-0.90). The protection conferred by breast feeding was stronger among infants who were receiving human milk at the time of admission (odds ratio 0.22, 95% CI 0.09-0.55) and was absent among those infants who had stopped breast feeding for two or more weeks before admission. Among infants who were severely ill, breast feeding was less likely than among those with milder illnesses. There was evidence in the stratified analysis of effect modification by the presence of other children in the family. Among the infants with pertussis-like illness, the incidence and duration of breast feeding were not different compared with controls. The results suggest that breast feeding has a strong protective effect against ALRI in industrialized countries also. No protection seems to be conferred by human milk against pertussis-like illness.

Rautalahti M, Virtamo J, Haukka J, et al. The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care Med 1997;156:1447-1452.

Riise GC, Larsson S, Larsson P, et al. The intrabronchial microbial flora in chronic bronchitis patients: a target for N-acetylcysteine therapy? Eur Respir J 1994;7:94-101.

Rowe AH, Rowe A. Food Allergy: its role in emphysema and chronic bronchitis. Dis Chest 1965;48:609-612.

Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973;26:1180-1184.

See DM, Broumand N, Sahl L, Tilles JG. In vitro effects of echinacea and ginseng on natural killer and antibody-dependent cell cytotoxicity in healthy subjects and chronic fatigue syndrome or acquired immunodeficiency syndrome patients. Immunopharmacol 1997;35:229-235.

Tattersall AB, Bridgman KM, Huitson A. Acetylcysteine (Fabrol) in chronic bronchitis - a study in general practice. J Int Med Res 1983;11:279-284.

Venuto A, Spano C, Laudizi L, Bettelli F. Essential fatty acids: the effects of dietary supplementation among children with recurrent respiratory infections. J Intl Med Res 1996;24:325-330.