This document discusses several herbal medicines used to treat respiratory conditions: - Expectorants like thyme and ivy help reduce mucus viscosity and enable coughing up of phlegm for infections. Their efficacy is difficult to prove but they are popular. - Marshmallow root soothes irritation in the throat and inhibits coughing through its mucilage. It also has anti-inflammatory and analgesic effects. - Iceland moss' mucilage protects the throat from irritation and it has antibacterial and immunomodulating properties. It is used to soothe coughs and loss of appetite. - Thyme has antibacterial, antispasmodic and ciliary transport-improving effects. It treats

1. Herbal medicine in pulmonology
3
Zamotaeva M.N.

2. Expectorants and mucolytics.
• The purpose of these drugs is to reduce the viscosity of mucus in
the respiratory tract to enable expectoration of phlegm in cases of
chest and throat infection. Frequently, essential oils are used with
expectorant aromatic compounds such as camphor. Many
expectorants are included in cough mixtures and, although efficacy
is difficult to demonstrate, these products are very popular with
patients in the absence of other treatments. All are used for coughs
and colds, bronchitis and sinusitis, usually in conjunction with other
decongestants, demulcents, analgesics and, occasionally,
antibiotics. Some of these drugs contain essential oils and
salicylates (e.g. poplar buds, thyme), and may also include the
decongestants mentioned above (eucalyptus, menthol); others
contain saponins (e.g. senega, ivy).

3. Dry cough.
Marshmallow.
Marshmallow (Althaea
officinalis L.,
Malvaceae) has been
used in traditional
European medicine
since ancient times for
the local treatment of
wounds, burns and
injuries and internally
to treat cough.

4. Medicinal part of the plant. The medicinally
most important plant part are leaf and root.
Marshmallow root consists of peeled or
unpeeled, whole or cut, dried roots of Althaea
officinalis.
Chemical composition. The root contains 5-10%
polysaccharides, pectins, saccharose, starch,
phenolic acids and flavonoids.

5. Pharmacological effects and their
mechanism.
1. Protect from irritation. The mucilage of marshmallow root forms a
layer on the mucosa and protects it from irritation (clinical studies).
2. Antitussive effect. The antitussive effect may be related to the
inhibition of the mucociliary activity of the esophageal epithelium
(preclinical and clinical studies).
3. Antibacterial effect. Various extracts of marshmallow roots exert an
in vitro antimicrobial effect against several pathogens, including
Pseudomonas aeruginosa, Proteus vulgaris and Staphylococcus
aureus.
4. Anti -inflammatory effect. Following local application, marshmallow
extract exhibited anti-inflammatory activity due to flavonoids.
5. Analgesic effect (preclinical studies).
6. Anti-ulcer effect (preclinical studies).
7. Hypoglycemic effect (preclinical studies).

6. Efficacy and indications
1. Symptomatic treatment of oral or pharyngeal irritation and
an associated dry cough.
2. Symptomatic relief of mild gastrointestinal discomfort.
Dosage and dosage forms.
0.5–3 g for the macerate preparation, several times daily up to
a maximal daily dose of 15 g (for children aged 6-12 years:
at most 3 times daily; for children aged 3-6 years: a single
dose of 0.5–1 g for macerate preparation, 3 times daily).
Side-effects, interactions and contraindications.
Although the safety during pregnancy and lactation has not
been established, there are no data concerning the risk of
the application of marshmallow roots.

7. Iceland moss.
Iceland moss (Cetraria islandica)
grows in arctic and subarctic
areas, in northern and eastern
Europe, Siberia and North
America.
Medicinal part of the plant. The
medicinally most important
plant part is thallus. According
to the European
Pharmacopoeia, iceland moss
(Lichen islandicus) consists of
the whole or cut, dried thallus
of Cetraria islandica (L.)
Acharius s.l. (Parmeliaceae).

8. Chemical composition.
The pharmaceutically most important
connstituents of iceland moss are the
polysaccharides (25-50%). Other characteristic
constituents are the lichen acids.

9. Pharmacological effects and their mechanism.
1. Antitussive effect. The mucilage covers the
mucosa and protects it from local irritation
(preclinical, clinical studies).
2. Antibacterial effect (preclinical studies).
3. Immunomodulating effect (preclinical
studies). Purified polysaccahrides stimulated
granulocytic phagocytosis in vitro.
4. Anti-inflammatory effect (preclinical studies).

10. Efficacy and indications
Demulcent for the symptomatic treatment of oral
or pharyngeal irritation and the associated dry
cough.
To treat a temporary loss of appetite.
Dosage and dosage forms.
It may be used as a herbal tea prepared from 1–2 g
of the comminuted herbal substance as an
infusion or decoction 3 times daily, or as liquid
extracts.

11. Side-effects, interactions and contraindications.
Contraindications:
Hypersensitivity.

12. Productive cough.
Ivy.
Ivy (Hedera helix L.) It is a common
European plant, found also in
northern and eastern Asia and
introduced into America.
Medicinal part of the plant. The
medicinally most important plant
part is leaf. According to the
European Pharmacopoeia, Hederae
folium is the whole or cut, dried
leaves of Hedera helix L.
Chemical composition.
The actives are saponins based on
oleanolic acid, bayogenin and
hederagenin, including the
hederosaponins (or hederacosides) B,
C and D, and a- and b-hederin, the
polyyne falcarinol, and also
flavonoids.

13. Pharmacological effects and their mechanism.
1. Expectorant effect. Apart from the reflex expectorant
effect through irritation of the gastric mucosa, other
activities also play a part. (clinical studies)
2. Bronchodilating activity. Hedera treatment increased
the density of beta-adrenoreceptors (preclinical and
clinical studies). Moreover, the stimulation of beta2-
adrenoreceptors leads to increased surfactant
production.
3. Spasmolytic effect (preclinical studies).
4. Anti-inflammatory effect (preclinical studies).
5. Antibacterial effect (preclinical studies).

14. Efficacy and indications as an expectorant in cases of productive cough.
Dosage and dosage forms.
• The daily doses of these extracts are as follows:
• Dry extract (DER 4-8:1, extraction solvent ethanol 24-30%): adults: 45-105
mg; 6-12 years: 33-70 mg; 2-5 years: 24-36 mg.
• Dry extract (DER 6-7:1, extraction solvent ethanol 40%); adults: 42-54 mg;
6-12 years: 15-40 mg; 2-5 years: 17-27 mg.
• Dry extract (DER 3-6:1, extraction solvent ethanol 60%); adults: 66 mg; 6-
12 years: 50 mg; 34 mg.
• Liquid extract (DER 1:1, extraction solvent ethanol 70%); adults 300 mg; 6-
12 years: 225 mg.
• Its maximal daily dose for adults, for children aged 5-12 years and for 4-
years-old children is 120 mg, 80 mg and 60 mg, respectively. The use in
children between 2 and 4 years of age is not recommended.

15. Side-effects, interactions and contraindications.
Side-effects:
• Contact dermatitis
• Allergic reactions (urticaria, skin rash and dyspnea)
• Gastrointestinal reactions (nausea, vomiting and
diarrhea)
Contraindications
• pregnancy and lactation
• children under 2 years of age
• hypersensitivity to ivy or to plants of the Araliaceae
family

16. Thyme.
Thyme (Thymus vulgaris L. and
Thymus zygis) is indigenous to
Europe, especially the
Mediterranean region, and is
cultivated extensively.
Medicinal part of the plant. The
medicinally most important
plant parts are leaf and flower.
The whole leaves and flowers
are separated from the
previously dried stems of
Thymus vulgaris or Thymus
zygis or a mixture of both
species.

17. Chemical composition.
Thyme leaves contain a noteworthy amount (2-
2.5%) of essential oil. The main components
of the oil are thymol, carvacrol, p-cymene,
gamma-terpinene and terpinen-4-ol. The
leaves also contain triterpenes, flavonoids
(apigenin, luteolin and their derivatives) and
caffeic acid derivatives.

18. Pharmacological effects and their mechanism.
1. Antibacterial effect, antifungal effect, antiviral effect. The essential
oil exerts strong antibacterial (on both Gram-positive and Gram-
negative pathogens), antiviral and antifungal effects on several
strains (e.g. methicillin-resistant Staphyloccus aureus, Haemophilus
influenzae, Klebsiella pneumoniae, Streptococcus pneumoniae,
Streptococcus pyogenes, Candida albicans, Trichophyton sp. and
Herpes simplex). The activity is mainly attributed to thymol and
carvacrol.
2. Antispasmodic effect. This may be related to the agononistic effect
of the beta-2-adrenoreceptors. Flavonoids additionally play a role in
this effect, presumably through inhibition of the availability of Ca2+
for muscle contraction (preclinical studies).
3. Improving the ciliary transport in the respiratory tract (preclinical
studies).

19. Efficacy and indications
Thyme is used to treat the productive cough associated with a
cold.
Dosage and dosage forms.
• The herbal tea should be prepared from 1-2 g of the
comminuted herbal substance and consumed 3-4 times
daily. Certain preparations can be applied from the age of
4, but the usual lower age limit is 12 years.
• For the essential oil, the dose for oral use is 4-5 drops, 3-5
times daily. As cutaneous use, the essential oil in liquid or
semi-solid dosage forms in concentrations up to 10%
should be applied to the chest and the back up to 3 times
daily. As a bath additive 0.007–0.025 g/l should be used.

20. Side-effects, interactions and contraindications.
• Side-effects:
• Gastric disorders
• Laryngospasm can occur in children under 2 years of
age and infants when applying thyme oil to the face.
Contraindications:
• Hypersensitivity to thyme or other plants of the
Lamiaceae.
• Pregnancy and lactation
• Oral use of the oil in children and adolescents under 18
years of age is not recommended.