BotanicalsHealthy Kids

Hello, Ivy. So Long, Cough.

A look at ivy leaf for lung health

Rattle, click, puff, inhale.

These are the sounds of a person using an inhaler (or “puffer”) to support their respiratory health. The life-saving medicine found in rescue inhalers often comes from a class of drugs known as beta (β) agonists. By mimicking the effects of epinephrine and norepinephrine, β agonists cause the muscles lining the airways to relax and open wider, allowing air to pass more readily into the lungs.[1]

In conditions like asthma, acute bronchitis, and chronic obstructive pulmonary disease (COPD), these same airway muscles constrict, tightening the airways and limiting the passage of air. The narrowing of the airways, coupled with accompanying inflammation, leads to symptoms like cough, shortness of breath, wheezing, and chest tightness.[2]

To make the picture even stickier (both literally and figuratively), thick, gluey mucus can further compromise breathing. In fact, mucus hypersecretion is a common challenge in chronic airway diseases like asthma, COPD, and cystic fibrosis (CF).[3,4]

Fortunately, there is an herbal remedy for all of the above, a natural preparation widely used in the care of both acute and chronic respiratory ailments. Dry extracts of ivy leaf – or, as it’s known in Latin, Hedera helix Linné folium – have been shown to support respiratory health by a variety of mechanisms, including β adrenergic mimicking.[5]

Ivy leaf’s properties as an anti-inflammatory, expectorant (phlegm-thinning), and bronchospasmolytic (airway muscle relaxing) agent have been proven by objective data metrics in several randomized placebo-controlled clinical trials and surveillance studies.[6–11]

Let’s take a closer look at what the research has to teach us about this botanical remedy for cough:

Relax, smooth muscles: ivy leaf is here

In one study of ivy leaf’s effects on the smooth muscles of the airways,[6] different saponins from ivy leaf – α-hederin, hederacoside C, and hederagenin – were applied to strips of muscle harvested from the tracheas of cows. (The beta adrenergic agonist isoprenaline was also administered). While none of the saponins affected histamine-related muscle contraction, α-hederin was shown to support smooth muscle relaxation via β-adrenergic activity. In other words, α-hederin relaxed the muscles of the airways, which in turn can translate into better air flow into the lungs.

The smooth muscle-relaxing effects of ivy leaf have also been observed in studies of human tissue, finding that human bronchial smooth muscle cells also respond positively to ivy leaf saponins. By affecting β2-adrenergic responsiveness, ivy leaf extract relaxes the airways, opening them up so more air can pass through.[5,12]

Ivy leaf extract relaxes the airways, opening them up so more air can can pass through.

Ivy leaf has also been shown to enhance the health of the alveoli – the small air sacs in the lungs that perform gas exchange. Specifically, ivy leaf has been observed to elevate intracellular levels of cyclic adenosine monophosphate (cAMP), an important messenger that signals human alveolar type II cells to produce surfactants. Surfactants allow the little air sacs of the lungs to stay open, preventing them from sticking together or choking off gas exchange. Surfactants also liquefy the sticky, thick mucus associated with respiratory diseases, allowing it to quit rattling around in the chest and clear away more effectively.[5,12]

Ivy leaf for pediatric asthma

In a review of randomized controlled trials assessing ivy leaf extract’s efficacy in treating pediatric asthma,[8] the authors report that various ivy leaf preparations improve respiratory functions in children ages four to 16 with chronic bronchial asthma. In one of the studies reviewed, ivy leaf cough drops were significantly better than placebo in mitigating airway resistance and improving respiratory function. While there were no safety concerns in any of the trials reviewed, the authors note that more research is warranted to assess the long-term efficacy of the preparation.

A proof-of-concept study also concludes that children with mild, uncontrolled asthma already taking inhaled corticosteroids could benefit from adding ivy leaf dry extract to their treatment regimen.[13]

Ivy leaf for pediatric productive cough

In a non-randomized, open-label study of an ivy leaf dry extract preparation in the treatment of productive cough in children,[14] 464 children ages two to 12 were examined. Regardless of whether they used pharmaceutical antibiotics, over 93% of the children had a reduction in their cough after taking ivy leaf dry extract. Almost 85% had improvements in chest pain, 90% had improvements in wheezing, and 88.7% had reduced shortness of breath. Almost 95% of them had audible improvements on auscultation (listening to the lungs through a stethoscope). A decline in or normalization of body temperature was observed in 96% of the children as well, and the herbal remedy was well tolerated by all ages.

Over 93% of the children had a reduction in their cough after taking ivy leaf dry extract.

Another open-label study examining the efficacy and safety of ivy herbal extract in the treatment of pediatric cough confirms both the usefulness and tolerability of ivy leaf syrup and drops. Of 268 children aged one month to 13 years observed in this study, only 1.9% had adverse events – all five of which were mild and non-serious.[15] Typical cough symptoms markedly improved in these children.

Ivy leaf for acute bronchitis in children and adults

Acute bronchitis is characterized by a sudden onset of inflammation in the bronchial tubes of the lung. Typically caused by viral infection, acute bronchitis causes a persistent cough, which can be either wet (productive) or dry.

In a study of adults and children with acute bronchitis, the benefits of ivy leaf cough syrup were compared to those of acetylcysteine, another natural mucolytic agent.[16] Both ivy leaf cough syrup and acetylcysteine had comparable beneficial effects on coughing fits, sputum production, and rales (crackles heard in the lungs with a stethoscope) after seven days of treatment. Those who took ivy leaf extract, however, had additional improvements with respect to shortness of breath, number of coughing fits, and cough-associated sleeping problems. Both medicines were well tolerated.

Ivy leaf for acute cough in adults

In consideration of ivy leaf extract’s potential in the treatment of adults with acute cough, a randomized, placebo-controlled, double-blind trial followed 181 adult patients.[17] These adults, all of whom suffered from acute cough, were treated either with placebo or with a liquid preparation of ivy leaf extract three times daily for one week. Compared to the placebo group, the adults who took ivy leaf liquid fared much better, with significant reductions in cough severity and bronchitis symptoms within 48 hours of starting the supplement. Even one week after ending treatment with ivy leaf, the ivy leaf group had better outcomes than those who took placebo.

Ivy leaf post-surgically

In a study examining ivy leaf’s effects as a secretolytic,[18] 70 people undergoing septoplasty (a surgery done to repair or straighten the septum of the nose) were observed.

Ivy leaf dry extract slowed the production of mucus and reduced the risk of infection infection.

While all of the patients performed regular nasal irrigation (rinsing) for five days after their surgical packing was removed, half were instructed to also take standardized dry ivy leaf extract syrup. On the sixth day, the production of nasal secretions was measured by both subjective measures and nasal endoscopic examination. The group treated with standardized dry ivy leaf extract syrup was not only found to have significantly less nasal secretion, but also fewer incidences of post-surgical infection. While none of the people who took dry ivy leaf extract had any signs of local infection, 14.29% of those in the nasal rinse-only group had signs of local infection requiring treatment with antibiotics. In summary, ivy leaf dry extract slowed the production of mucus and reduced the risk of post-op infection.

How much of a good thing?

According to the European Medicines Agency,[19] dry extract of ivy leaf can be taken by people age two and up. In children between the ages of two and five years, 8 to 20 mg may be taken two to three times daily. For children six to 11 years of age, 9 to 35 mg two to three times daily can be safely used by most. In adolescents, adults, and the elderly, doses anywhere from 15 to 100 mg two to three times daily may be appropriate, depending on the individual and the condition.

While ivy leaf is considered safe and is well tolerated by most, it can cause an upset stomach in sensitive individuals.

Summary

Ivy leaf extract is a natural remedy for respiratory ailments in both adults and children. With a propensity for opening up the airways, relaxing the smooth muscles of the respiratory tract, thinning out sticky mucus, and soothing inflammation, ivy leaf extract may very well deserve a prominent place in the family medicine cabinet.

References

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