Alternative/herbal medicines
Several natural products have been studied for the treatment of acute bronchitis. Based on a small number of studies conducted in Eastern Europe, Pelargonium sidoides (also known as EPs 7630) has been shown to reduce acute bronchitis symptom duration and intensity.[36]Timmer A, Günther J, Motschall E, et al. Pelargonium sidoides extract for acute respiratory tract infections. Cochrane Database Syst Rev. 2013;(10):CD006323.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006323.pub3/full
http://www.ncbi.nlm.nih.gov/pubmed/24146345?tool=bestpractice.com
[37]Agbabiaka T, Guo R, Ernst E. Pelargonium sidoides for acute bronchitis: A systematic review and meta-analysis. Phytomedicine. 2008;15:378-385.
http://www.ncbi.nlm.nih.gov/pubmed/18222667?tool=bestpractice.com
[38]Kamin W, Maydannik VG, Malek FA, et al. Efficacy and tolerability of EPs 7630 in patients (aged 6-18 years old) with acute bronchitis. Acta Paediatr. 2010;99:537-543.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2855831
http://www.ncbi.nlm.nih.gov/pubmed/20070280?tool=bestpractice.com
[39]Matthys H, Lizogub VG, Malek FA, et al. Efficacy and tolerability of EPs 7630 tablets in patients with acute bronchitis: a randomised, double-blind, placebo-controlled dose-finding study with a herbal drug preparation from Pelargonium sidoides. Curr Med Res Opin. 2010;26:1413-1422.
http://www.ncbi.nlm.nih.gov/pubmed/20387996?tool=bestpractice.com
A systematic review found that while ivy leaf preparations are safe to use in cough due to bronchitis, efficacy is minimal at best.[40]Sierocinski E, Holzinger F, Chenot JF. Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review. Eur J Clin Pharmacol. 2021 Aug;77(8):1113-22.
https://www.doi.org/10.1007/s00228-021-03090-4
http://www.ncbi.nlm.nih.gov/pubmed/33523253?tool=bestpractice.com
Cineole (eucalyptol), the main component of eucalyptus oil, has been observed to increase mucociliary beat rates and has bronchodilating effects. One randomised placebo-controlled trial found that it improved bronchitis symptoms scores, owing to a decrease in cough.[41]Fischer J, Dethlefsen U. Efficacy of cineole in patients suffering from acute bronchitis: a placebo-controlled double-blind trial. Cough. 2013;9:25.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842692
http://www.ncbi.nlm.nih.gov/pubmed/24261680?tool=bestpractice.com
Similar results were obtained in another randomised controlled trial of a preparation containing cineole, in which patients had a reduction in several cough-related symptoms, including night cough, coughing fits, and overall impairment.[42]Gillissen A, Wittig T, Ehmen M, et al. A multi-centre, randomised, double-blind, placebo-controlled clinical trial on the efficacy and tolerability of GeloMyrtol® forte in acute bronchitis. Drug Res (Stuttg). 2013;63:19-27.
http://www.ncbi.nlm.nih.gov/pubmed/23447044?tool=bestpractice.com
More trials are needed to assess the overall effectiveness and safety of these products. One small randomised controlled study using Spicae aetheroleum, an extract obtained from the flower portion of the Lavandula latifolia plant, showed a 25% reduction in symptom scores in patients with acute bronchitis along with improvements in quality of life scores. Patients in this study had no adverse side effects. Based on the small number of participants in this study, additional evidence is needed to determine how beneficial this supplement is for patients with acute bronchitis.[43]Kähler C, Derezinski T, Bocian-Sobkowska J, et al. Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial. Wien Med Wochenschr. 2019 Apr;169(5-6):137-148.
https://www.doi.org/10.1007/s10354-017-0612-0
http://www.ncbi.nlm.nih.gov/pubmed/29209859?tool=bestpractice.com
Guidelines for the management of acute bronchitis using Traditional Chinese Medicine (TCM) have been published.[44]Li J, Chen Y, Yu X, et al. Diagnosis and treatment guideline for Chinese medicine on acute trachea-bronchitis. J Evid Based Med. 2021 Dec;14(4):333-45.
https://www.doi.org/10.1111/jebm.12460
http://www.ncbi.nlm.nih.gov/pubmed/34936217?tool=bestpractice.com
However, the evidence base for the use of TCM in acute uncomplicated lower respiratory tract infections is weak.[45]Xia R, Wang D, Wang Y, et al. Evidence base of randomized controlled trials and guideline recommendations of patent Traditional Chinese Medicines for uncomplicated acute lower respiratory tract infections in adults. J Tradit Chin Med. 2018 Aug;38(4):490-503.
http://www.ncbi.nlm.nih.gov/pubmed/32186074?tool=bestpractice.com