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Alternative Ingredients for Immune and Respiratory Support


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Medically reviewed by Dr. Alex Keller, ND – Written by Ross Bailey, BKin, MKin

Now more than ever, practitioners and patients are focusing on natural ingredients to counteract pathogens that cause respiratory tract infections, and modulate the immune and anti-inflammatory responses to these pathogens.

Unfortunately, popularly used immune-supporting ingredients such as echinacea, vitamin C, zinc, elderberry, probiotics and vitamin D are in high demand, and at times, even difficult to find. However, there are many alternative natural ingredients that can be effectively used to fight off pathogens, support immune function, and treat symptoms of respiratory tract infections.

This article provides a high-level overview of respiratory tract infections, and several alternative natural ingredients that can be used to combat respiratory tract infections. These ingredients can support various pathological mechanisms that either combat pathological infection, or reduce the host’s physiological response to infection to ultimately reduce the severity of respiratory tract symptoms.

Please note that there are many more ingredients that can be used for immune and respiratory support that are not currently included in this article. Future editions will provide additional information on ingredients not currently covered in this version.

woman coughing into her elbow

There are many symptoms associated with respiratory tract infections, such as sore throat, cough, chills, fever, and headaches.

Pathogenesis and pathophysiology of respiratory tract infections

There are several origins (pathogenesis) and physiological outcomes (pathophysiology) related to respiratory tract infections.

Viruses are one of the most common causes of respiratory tract infections. The human rhinovirus, respiratory syncytial virus, influenza virus, parainfluenza virus and viruses of the coronavideae family can infect individuals of all health and age statuses. They may lead to a variety of acute airway conditions, or other disorders such as asthma, bronchitis, chronic obstructive pulmonary disease (COPD), the common cold, the flu, or pneumonia to name a few. (58)

Respiratory tract infections are not only caused by viruses, however. Bacterial colonization is another means by which both upper and lower respiratory tract infections may occur. (70) Most commonly, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the bacteria involved in respiratory tract infections. (6)

The body’s response to the presence of pathogens like viruses or bacteria can lead to an overstimulation of the inflammatory and immune response. The host’s immune and inflammatory hyper-response can cause a prolonged or more severe reaction to infection, leading to increased prevalence of symptoms associated with infection such as chills, coryza, cough, fever, headaches, myalgia, rhinorrhea, shortness of breath, sneezing, sore throat, sputum production, wheezing, and occasional gastrointestinal complications such as nausea or vomiting. These symptoms typically depend on the specific pathogen and can ultimately lead to the damaging of respiratory tract damage. (53)

Two of the most well known causes of respiratory tract infections involve viruses that cause the common cold and influenza. Several symptoms of cold and flu respiratory tract infections are shown below.

The table above provides a comparison of the symptoms of allergies, the common cold, and the flu. The references for this table are listed in the section titled “References for Table 1”, below.

Alternative ingredients for immune and respiratory support

Numerous ingredients provide a variety of pharmacological actions that may physiologically increase the body’s ability to fight off pathogens that cause symptoms of the respiratory tract, or the development of more severe respiratory conditions. These ingredients can also provide relief from the symptoms associated with infections of the respiratory tract.

For reference, the American Botanical Council (ABC), one of the leading sources for information on botanical and alternative medicine, has amassed terminology related to natural ingredient actions and their properties.

The terms that apply to the mechanistic uses of natural ingredients relating to the counteraction of respiratory pathogens and the reduction of symptoms caused by respiratory tract infections are summarized here:

To skip to any one of these mechanistic uses sections, please click on them! 

The following figure summarizes some of the main uses of several natural ingredients and their main mechanistic applications in immune and respiratory support.

The main uses were selected based on a mix of available human, in vivo and in vitro evidence, and/or a history of reported traditional use in respiratory conditions. The table at the end of this article presents more detail on the evidence supporting the main uses of these ingredients.

The primary uses of several ingredients for immune and respiratory support are shown in the figure above.

Disclaimer: The ingredients listed below and in the diagram are categorized based on a main mechanism of action within the respiratory system. However, they may have more than one application within and outside of the respiratory system. The main actions were selected based on a combination of available evidence and based on knowledge obtained from the ingredient’s traditional history of medicinal use as reviewed by Fullscript’s Integrative Medical Advisory Team.

For an explanation of the classes of evidence as shown below (A, B, C, D, E, and F), please see the Rating Scales for Evidence-Based Decision Support.

Anti-catarrhal

The following ingredients may be used in applications related to mucosal inflammation in the head and neck.

Essential oils

  • Nasal drops or inhaled: reduce rhinitis symptoms including congestion, runny nose, sneezing, mucosal edema, pallor, and peripheral eosinophil counts – C/D (37)(90)
  • Traditionally used for their healing properties, with many applications in catarrhal diseases – F (19)

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Propolis (Apis mellifera)

  • Reduce rhinitis symptoms within ~4 days and resolution of infectious rhinovirus symptoms by ~4-5th day – D (50)(78)
  • Reduce incidence of acute/chronic symptoms of rhinopharyngitis, and presence of viral microflora in upper airways – D (9)
  • Traditional uses relate primarily to its anti-microbial and anti-inflammatory properties, (7) which may translate into its se in infections of the upper respiratory tract – F (99)

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Anti-inflammatory

The following ingredients may be used to reduce inflammation in response to pathogenic infection.

Feverfew (Tanacetum parthenium)

  • Reduce epithelial, basal membrane, & subepithelial smooth muscle thickness (histologic parameters in asthmatic lung), and IL-4 inflammatory marker in vivoD (5)
  • Reduce inflammatory cell infiltration, airway permeability, production of inflammatory cytokines, and stimulation of NF-κB phosphorylation that leads to acute lung injury in vivo & in vitroD/E (33)
  • Reduce 5-LOX, PDE3 & PDE4 inflammatory enzymes activities, release of macrophage NO, PGE(2), & TNF-ɑ, and human PBMC TNF-ɑ, IL-2, IL-4, & IFN-γ in vitroE (74)
  • Traditional use in inflammatory conditions – F (55)

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Honeysuckle (Lonicera japonica)

  • Increase IL-10 anti-inflammatory cytokine in vivo – D (36)
  • Reduce NF-κB phosphorylation to prevent lung expression of PGE2, TNF-α, IL-1β and IL-6 in response to inflammatory stimuli in vivo – D (36)(56)(80)
  • Traditionally used to treat conditions related to inflammation and infection – F (43)

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Licorice (Glycyrrhiza glabra, Glycyrrhiza uralensis)

  • Reduce neutrophil infiltration causing reduced TNF-α, & IL-1β release, and consequential neutrophil recruitment to provide antioxidative activity in the lung in vivo – D (92)
  • Reduce COX-2, NO, TNF-α, ICAM-1 in vivo – D (97)
  • Traditional uses of licorice include the treatment of inflammatory conditions including those of the respiratory tract like sore throats, cough, or asthma – F (18)

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licorice root in a wooden bowl

Traditional uses of licorice include the treatment of sore throats, cough, and asthma.

Anti-microbial

The following ingredients may be used in applications related to the opposition of microbes such as bacteria or viruses that cause respiratory distress.

Artemisia (Artemisia asiatica, Artemisia capillaris, Artemisia rupestris, Artemisia scoparia, Artemisia vestita)

  • Reduce microbial respiratory pathogens in vivo and in vitroD/E (32)(94)(95)
  • Increase humoral & cellular immune response to influenza vaccination in vivoD (101)
  • Reduce influenza A replication in vitroE (54)(93)(102)
  • Traditionally used to prevent or treat pathogenic infections due to its species-wide anti-bacterial and anti-viral properties, with special applications in malaria – F (40)

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Licorice (Glycyrrhiza glabra, Glycyrrhiza inflata, Glycyrrhiza uralensis)

  • Increase humoral & cellular immune response to influenza vaccination in vivoD (1)
  • Increase protection against influenza inoculation, or INF-γ production from T cells, & inhibition of neuraminidase (viral replication enzyme) in response to influenza virus in vivo and in vitroD/E (11)(27)(45)(72)(83)(87)
  • Reduce human respiratory syncytial virus mainly via inoculation prevention. If inoculated, may stimulate INF-β for viral inhibition in vitro – E (16)(22)(85)
  • Exhibits broad antiviral properties against herpes, HIV, hepatitis, SARS-CoV-1, and influenza viruses – F (59)
  • Traditionally used in many diseases including respiratory disorders due to its anti-microbial and anti-parasitic properties – F (18)

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N-acetylcysteine

  • Reduce prevalence of A/H1N1 virus influenza, the frequency of influenza-like symptomatic episodes, symptom severity, and duration of infection – B (12)

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Propolis (Apis mellifera)

  • Reduce presence of viral microflora in upper airways – D (9)
  • Increase survival via influenza clearance from induction of TNF-related apoptosis-inducing ligand (TRAIL) mRNA in vivoD (79)
  • Reduce influenza hemagglutinin mRNA in vivo and in vitroD/E (67)(79)(82)
  • Reduce influenza presence in bronchoalveolar lavage fluid similarly to oseltamivir in vivoD (69)
  • Broad anti-bacterial activity for S. aureus, methicillin-resistant S. aureus, S. pyogenes, S. pneumoniae, H. influenzae, Enterococcus spp., E. coli, P. mirabilis, & P. aeruginosa, and broad anti-viral activity against adenovirus, influenza, parainfluenza, & herpes type 1 viruses in vitroE (17)(25)
  • Traditional uses relate primarily to its anti-infectious and anti-inflammatory properties – F (7)

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Anti-spasmodic

The following ingredients may be used in applications related to the improvement of breathing (lung function), particularly induced by airway spasms or constriction.

Elecampane (Inula helenium, Inula japonica)

  • Reduce NF-κB, ERK, and Akt pathway to reduce pro-inflammatory cytokines TNF-α, IL-1β, & IL-6, and consequential lung injury (lung edema, thickening of the alveolar wall, and inflammatory cell infiltration) in vivo; activates Nrf2 pathway – D (15)(98)
  • Reduce IgE & Th2 cytokines counts and infiltration in bronchoalveolar lavage fluid, airway hyperresponsiveness, and mucus hypersecretion in asthma in vivoD (57)
  • Traditionally used in respiratory conditions such as bronchitis and cough caused by inflammation or bacteria – F (66)

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Eucalyptus (Eucalyptus globulus)

  • Increase lung function – B
  • Reduce shortness of breath, & exacerbation frequency/severity in asthma or COPD – B (88)(89)
  • Reduce need for adjunct glucocorticosteroids – C (35)
  • Reduce bronchiolitis severity, mucin hypersecretion and inflammatory cell infiltration bronchoalveolar fluid in vivoD (47)
  • Traditional uses involve improvement of airway function by relaxing respiratory muscles and to cause expulsion of mucus – F (14)

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Horehound (Marrubium vulgare)

  • Traditionally used in conditions of the airways like bronchitis, asthma and cough – F (52)(60)

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Hyssop (Hyssopus officinalis, Hyssopus cuspidatus)

  • Reduce leukotriene secretion to halt bronchoconstriction in vivoD (23)
  • Modulates transcription for Th1, Th2 and Th17 differentiation in asthmatic inflammation in vivoD (84)
  • Traditionally used to treat asthma – F (34)

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Ivy (Hedera helix)

  • Increase respiratory function in bronchial asthma particularly as adjunctive therapy – A (30)(100)
  • Reduce bronchitis symptoms severity – B (10)(20)(63)(64)
  • Traditionally used in conditions of the respiratory tract with properties that relax airway musculature and expel mucus – F (71)

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Lobelia (Lobelia inflata)

  • Traditionally used to promote pulmonary ventilation and used in respiratory disorders. May favor use as an expectorant in the presence of mucus hypersecretion. Note: High doses can produce cough – F (75)

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Thyme (Thymus vulgaris)

  • Reduce bronchitis symptoms severity in use with other herbal combinations such as ivy, thyme, and primrose – B (28)(29)(38)(48)(51)
  • Increase B2-adrenergic receptor stimulation to cause airway relaxation in vivoD (68)
  • Traditional uses have wide applications in respiratory disorders of the bronchi, asthma, coughing and mucus expulsion – F (62)

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Yarrow (Achillea millefolium)

  • Increase airway relaxation via B2-adrenergic receptor stimulation, calcium-channel or histamine receptor blockades, or inhibition of muscarinic receptors in vivo and in vitroD/E (4)(21)(39)(41)(68)
  • Traditionally used in respiratory disorders through bronchodilation and anti-inflammatory properties – F (2)

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hyssop in plant form on a wooden spoon

Research has shown that hyssop may produce anti-spasmodic effects.

Anti-tussive

The following ingredients may be used in applications related to reduce or prevent coughing.

Ivy (Hedera helix)

  • Reduce URTI symptoms, particularly cough – A (10)(20)(31)(63)(64)(65)
  • Traditionally used in conditions of the respiratory tract particularly with cough – F (71)

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Tussilago (Tussilago Farfara)

  • Reduce cough with additional expectorant and anti-inflammatory properties in vivoD (44)(91)(96)
  • Traditionally used to treat cough in respiratory conditions – F (42)

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Demulcent

The following ingredients may be used in applications related to relieving inflamed mucus membranes via coverage with polysaccharide-rich substances.

Marshmallow (Althaea officinalis)

  • Reduce dry, ACE inhibitor-induced cough – B (61)
  • Reduce cough reflex in vivoD (76)(77)
  • Increase bioadhesive layers to promote cell vitality and proliferation in healing of irritated mucous membranes in vitroE (13)
  • Traditional use of its polysaccharides to soothe irritated mucous membranes, and reduce cough – F (49)

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Slippery elm (Ulmus rubra)

  • Traditional use of its polysaccharides to sooth mucosal inflammation and alleviate sensations signalling the need to cough – F (86)

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Expectorant

The following ingredients may be used in applications related to the removal of hypersecretions of mucus.

Horehound (Marrubium vulgare)

  • Traditionally used as an expectorant – F (60)

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Mullein (Verbascum thapsus)

  • Traditionally used for its properties as an expectorant to provide relief in respiratory conditions – F (81)

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N-acetylcysteine

  • Increase prevention of airway obstruction and inflammation in chronic bronchitis or COPD – A (8)
  • Reduce symptoms including cough, sputum, labored breathing – A (8)(26)(73)

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Febrifuge

The following ingredients may be used in applications related to the reduction of fever.

Feverfew (Tanacetum parthenium)

  • Traditionally used to treat fever – F (55)

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Honeysuckle (Lonicera japonica)

  • Reduce internal temperature in vivoD (24)(46)
  • Traditionally used to treat fever via anti-inflammatory properties – F (43)

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The bottom line

In addition to the more common immune-supporting natural ingredients like echinacea, elderberry, vitamin C, vitamin D, and zinc, there are numerous alternative immune-modulating and respiratory support ingredients that practitioners and patients can consider.

These ingredients may be used as a means to counteract pathogens like bacteria and viruses, or in the treatment of respiratory symptoms and more serious respiratory conditions related to pathogenic infection.

Note: this reference document and the associated infographic will continue to evolve, so check back often for updates.

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

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