Archive | August 2013

Herbal Approaches to Pertussis

Pertussis, commonly known as Whooping Cough, is an acute, highly communicative bacterial infection of Bordetella pertussis or B. parapertussis affecting the respiratory tract. B. pertussis/parapertussis bacterium attach to the cilia of the epithelial cells of the respiratory tract, produce toxins that paralyze the cilia and cause inflammation, and this in turn interferes with the clearing of pulmonary secretions (1). General symptoms may include cough, runny nose, low fever, vomiting, and diarrhea (2). It is characterized by a deep spasmodic cough, often with a sharp, noisy intake of breath, during stage two of the infection. The illness can be broken down into three stages: the catarrhal stage, when the patient is contagious, and mild flu-like symptoms appear one to two weeks after exposure (lasting 1-3 weeks); the paroxysmal stage, when the infection has gone deep into the lungs and the whooping cough is at its peak (lasting 1-6 weeks); and the convalescent or recovery stage, which may include a chronic cough (lasting 1-4 weeks) (11, 12, 13).

Populations affected by pertussis span across all groups. The complications associated with pertussis in healthy people are low. In normally healthy adults, it may present as nothing more than a mild, irritating cough. The “whooping” cough is most prevalent in young children, sometimes causing vomiting, and in infants (0-4 months) it can be fatal in cases where breathing may become obstructed and stop. Complete recovery is expected unless there are major complications (5).
The pertussis vaccine (now given combined as DTaP- diphtheria, tetanus, and acellular pertussis) is only considered effective against (and may be ineffective or may actually cause) pertussis after the fourth shot at the age of one year. According to the medical establishment and government, resistance decreases rapidly after vaccination, becoming ineffectual in 3-4 years or less (13). Therefore, it is directly ineffective for those that are at highest risk from the infection due to age. Because the pertussis vaccine has been implicated in a large number of negative vaccine reactions, because it requires frequent updates, because full vaccination does not necessarily confer immunity, and for a variety of other medical, personal, and political reasons, fewer people are now electing to get the vaccine or get re-vaccinated as frequently as suggested (4).

Special Considerations for Infants
Since the contagion stage is often asymptomatic or mild, infants are often inadvertently exposed to pertussis by adults and other children who do not realize they have contracted the illness. If caregivers believe an infant has been exposed to pertussis but has not yet contracted it, it is prudent to immediately give herbal antibiotics/antimicrobials (as described below) through the breastmilk, added to formula, or directly (if the infant is at least one month old). If the illness has already been contracted, antibiotics will not change the clinical course of the illness, but may reduce the spreading of infection to others (this applies to all age groups) (3, 11).
Infected infants should be given small but frequent feedings, especially if they are breastfed and their mother is taking herbs for them. After one month of age, infants can take non-breastmilk liquids as well, in a daily amount of up to one ounce per month of age. For example, at two months of age, an infant can tolerate up to two ounces of herbal tea per day, broken up and given in small doses throughout the day (16).
The infant’s passages should be cleared frequently with a bulb. If any complications with breathing appear, the infant should be taken to the urgent care or emergency room immediately for breathing assistance. For babies under two months, the parents or caregivers may wish to take the child in for constant respiratory monitoring.
Unless otherwise noted, herbal recommendations made below are appropriate for a breastfeeding mother to take for her baby, and to be given directly to the baby in small amounts with consideration for their age, health history, and other factors. Honey should not be given directly to babies under one year of age, due to the risk of botulism.

Chinese Medicine
In Traditional Chinese Medicine (TCM), pertussis is called “the 100 days cough”. It is considered a challenge to the spirit of the child, and that when they get through it they will have reached a new level of enlightenment. Lo Han Kuo Infusion/Luo Han Guo Chong Ji TCM formula is recommended to soothe the cough (6). Ma-Huang Combination is given for severe coughs: ma huang (Ephedra sinica) 5g, cinnamon twig 4g, licorice 1.5g, and apricot seed 5g, as a decoction (8). Use caution in giving ma huang to infants, as it is very stimulating.

Herbal Suggestions
Herbal remedies can be used to help strengthen the immune system, soothe symptoms, and aid in faster, healthier recovery. Honey with crushed garlic (Allium sativum) (8, 10, 11), and garlic macerated in olive oil (10) are excellent to help fight the infection- give 1 teaspoon every two hours, or make a tea from the honey and garlic, adding a small amount of lemon if desired for taste (10, 11). This can also be combined with teas such as thyme (Thymus vulgaris) for spasmodic cough (10, 8) and other symptoms. It is most beneficial to give demulcents during the day and spasmolytics at night to help the patient sleep. Aviva Romm, MD, midwife, and herbalist, recommends the following recipes for pertussis:

Pertussis Syrup: 1/2 oz each of the following tinctures: echinacea (Echinacea angustifolia or E. purpurea), marshmallow root (Althaea officinalis), licorice (Glycorrhiza uralenis or G. glabra- DGL free if person has blood pressure or adrenal disorders), thyme, anise (Pimpinella anisum), and passionflower (Passiflora incarnata). Combine with 1 oz of elderberry (Sambucus nigra or S. canadensis) syrup. Give 1/2 to 2 teaspoons of this mixture every 2-4 hours. This formula is anti-microbial to prevent secondary infections, breaks up cough, soothes respiratory passages, promotes relaxation, and has anti-inflammatory action.

Whoop Ease Tea: 1/4 oz each of: dried thyme (Thymus vulgaris), dried red clover blossoms (Trifolium pratense), and marshmallow root (Althea officinalis). Make a tea with 1 quart of water and steep for 1 hour. Strain and add honey for children over 2 (can be taken honey-free for babies). Give 1/4 to 1/2 cup every 2-4 hours. Soothes the respiratory passages.

Tincture for sleep and relaxing the cough: 1/2 oz each of: black cohosh (Actaea racemosa), anise seed, passionflower, and lemon balm (Melissa officinalis) tinctures. Give 2-3 mL, every 15 minutes if needed, up to 3 doses.

Other herbal suggestions include:
Antimicrobials: tinctures of usnea (Usnea spp.), goldenseal (Hydrastis canadensis), garlic.
Immune Stimulants: elderberry (syrup: 1-2 teaspoons 3x/d) (11), spilanthes (Spilanthes acemella), echinacea.
Antispasmodics: wild black cherry bark (Prunus serotina- can be made into a syrup for coughs), california poppy (Eschscholzia californica) (10).
Decongestants: elder, mullein (Verbascum thapsus), elecampane (Inula helenium- not for infants), bee balm (Monarda spp).
Demulcents: Marshmallow root (Althaea officinalis), slippery elm inner bark (Ulmus rubra or U. fulva), Glycorrhiza uralenis or G. glabra- see note above).
Pure honey can be taken for cough (for those over the age of 2): 1/2-1 1/2 teaspoons, several times a day (11).

Lifestyle Recommendations
Infected people should be quarantined to prevent spreading the illness to others. This means no school, no work, and no outings until completely recovered! This is an important community health measure. Those infected should be given as much rest as they can take and more, and they should keep well hydrated to prevent mucous from congealing (10). Baths with thyme (Thymus vulgaris) herb (8) or essential oils of thyme, eucalyptus, rosemary, menthol, camphor, or pine will help to clear congestion. Chest rubs with these essential oils can also help. Menthol, camphor, and all essential oils are very potent, so care must be taken not to use too much. They should always be blended with a carrier oil, and applied in small amounts at first. Caregivers should be particularly cautious when using these oils on children under two years of age. All these essential oils are also helpful in steams and showers and can be added to a humidifier for this purpose. The humidifier is also useful by itself to help the person keep from drying out and further irritating the membranes. (10).

Dietary Recommendations
Lots of fluids and small, frequent meals are best (7). Foods should be nutritious, easy to chew and swallow, and hydrating, such as soups. Reduce or eliminate intake of dairy, wheat, and sugars (10, 12), as these foods can increase mucosal secretions and lead to more coughing and choking.

Supplementation
Vitamin C may reduce the longevity of the illness and aid in rebuilding immune system health (14).

Resources:

1. cdc.gov/pertussis/clinical/disease-specifics.html
2. http://umm.edu/health/medical/ency/articles/pertussis
3. Clinical Naturopathic Medicine, Leah Hechtman (pg 494)
4. Vaccinations: A Thoughtful Parent’s Guide, Aviva Jill Romm
5. Patient and Professional Information on Conditions, Herbs, and Supplements (Quick Access)
6. Chinese Herbal Medicine, Thomas Joiner
7. The Holistic Pediatrician, Kathi Kemper
8. Manual of Natural Therapy, Olshevsky PhD, Noy MD, Zwang PhD, Burger
9. Journal of Pediatrics, Volume 115, Issue 5, Pages 686-693, November 1989
10. Whooping Cough Webinar, Rosalee de la Foret and Michael Tierra (Notes: http://www.planetherbs.com/therapies/whooping-cough-notes-from-5-29-12-webinar.html)
11. Whooping Cough: In the Thick of It (Pertussis Webinar), Dr. Aviva Romm (available at http://avivaromm.com/whooping-cough-in-the-thick-of-it)
12. http://emedicine.medscape.com/article/967268-clinical
13. Pertussis Outbreaks, presentation by Zack Moore, MD, MPH
14. http://lpi.oregonstate.edu/infocenter/vitamins/vitaminC/
15. http://www.nvic.org/Vaccines-and-Diseases/Whooping-Cough.aspx
16. Presentation by Chelsea Gomes, herbalist
17. http://www.nytimes.com/2013/11/26/health/study-finds-vaccinated-baboons-can-still-carry-whooping-cough.html?emc=eta1&_r=1&

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