Phytotherapeutic Approaches in Pediatric Respiratory Tract Diseases: A Review on Efficacy and Safety

Öz

Introduction: Respiratory tract infections (RTIs) are a leading cause of the morbidity in children, by resulting in frequent healthcare visits. Dueto the limited efficacy of thesystemic medications and the need to minimize antibiotic overuse in the viral RTIs to prevent antimicrobial resistance, the symptomatic treatment remains the primary approach. As a result, interest in the alternative treatments, particularly phytotherapeutic agents is growing. Objective: This review aims to systematically evaluate the use of the phytotherapeutic agents in the pediatric RTIs, by focusing on their medical applications, pharmacological mechanisms, safety profiles, and potential adverse effects. By analyzing the current literature, it seeks to provide an evidence-based perspective on the phytotherapy in the pediatric RTIs and offer guidance for its safe and effective integration into clinical practice. Results: Herbal remedies, recognized for their antibacterial, antiseptic, expectorant, and anti-inflammatory properties, were widely used in managing the pediatric RTIs. Their potential to accelerate recovery and reduce antibiotic dependency has significantly contributed to their increasing popularity. Phytotherapy is also gaining acceptance among pediatricians, with many expressing interest in further education on its applications. Several medicinal plants showed promising results in treating RTIs in children; however, challenges remain regarding standardization, appropriate dosing, and potential side effects. Conclusion: Phytotherapy offers a promising complementary approach in the management of the pediatric RTIs, with potential benefits in reducing antibiotic overuse and improving symptomatic relief. However, more clinical research is needed to establish standardized guidelines for the efficacy and safety. Promoting evidence-based phytotherapy practices will help ensure its responsible and effective use in the pediatric healthcare.

Anahtar Kelimeler

• Phytotherapy
• pediatric respiratory disease
• efficacy and safety
• literature review

Çocuklarda Solunum Yolu Hastalıklarında Fitoterapötik Yaklaşımlar: Etkililik ve Güvenlilik Üzerine Bir Derleme

Öz

Giriş: Solunum yolu enfeksiyonları (SYE), çocuklarda yaygın hastalıklardan biri olup, sağlık kuruluşlarına sık başvurulara neden olmaktadır. Sistemik ilaçların sınırlı etkinliği ve viral SYE’lerde antibiyotik kullanımının antimikrobiyal direnç riskini artırması nedeniyle semptomatik tedavi temel yaklaşım olarak kullanılmaktadır. Bu durum, özellikle fitoterapötik ajanlar gibi alternatif tedavilere olan ilgiyi artırmıştır. Amaç Bu derlemenin amacı, çocuklarda solunum yolu enfeksiyonlarının tedavisinde kullanılan fitoterapötik yaklaşımları sistematik olarak değerlendirmektir. Bu kapsamda bitkisel ürünlerin tıbbi kullanımları, farmakolojik mekanizmaları, güvenlilik profilleri ve olası yan etkileri ele alınmıştır. Güncel literatür ışığında fitoterapinin çocuk sağlığı pratiğine kanıta dayalı bir bakış açısıyla entegrasyonuna rehberlik etmek hedeflenmiştir. Bulgular: Antibakteriyel, antiseptik, ekspektoran ve antiinflamatuar özellikleriyle bilinen bitkisel ürünler, çocukluk çağı solunum yolu enfeksiyonlarının yönetiminde yaygın olarak kullanılmaktadır. Bu ürünlerin iyileşme sürecini hızlandırma ve antibiyotik kullanımını azaltma potansiyeli, fitoterapiye olan ilgiyi artırmıştır. Ayrıca, fitoterapi pediatristler arasında da giderek kabul görmekte olup, birçok hekimin bu alanda daha fazla eğitim alma isteği bulunmaktadır. Çeşitli tıbbi bitkilerin çocuklardaki SYE tedavisinde etkinlik ve güvenlilik açısından umut verici sonuçlar verdiği bildirilmektedir. Ancak doz standardizasyonu, uygun kullanım şekli ve olası yan etkiler gibi konularda hâlen bazı belirsizlikler mevcuttur. Sonuç: Fitoterapi, çocukluk çağı solunum yolu enfeksiyonlarının tedavisinde tamamlayıcı bir yaklaşım olarak umut vadetmektedir. Bu yöntem, antibiyotik kullanımını azaltma ve semptomatik rahatlama sağlama potansiyeline sahiptir. Bununla birlikte, etkinlik ve güvenlilik profillerini netleştirmek için daha fazla klinik çalışmaya ihtiyaç vardır. Fitoterapinin kanıta dayalı uygulamalarla desteklenmesi, bu tedavi seçeneğinin çocuk sağlığı hizmetlerine güvenli ve etkili bir şekilde entegrasyonuna katkı sağlayacaktır.

Anahtar Kelimeler

• Fitoterapi
• pediatrik solunum yolu hastalıkları
• etkililik ve güvenlik
• literatür taraması

Kaynakça

1. 1. Gambadauro A, et al. Immune response to respiratory viral infections. Int J Mol Sci. 2024;25(11):6178.
2. 2. Freymuth F, Vabret A, Gouarin S. Epidemiology of respiratory virus infections. Allergy Immunol. 2001;33:66–69.
3. 3. Schroeder K, Fahey T. Should we advise parents to administer over-the-counter cough medicines for acute cough? Systematic review of randomized controlled trials. Arch Dis Child. 2002;86(3):170–175.
4. 4. Turner RB. Epidemiology, pathogenesis, and treatment of the common cold. Ann Allergy Asthma Immunol. 1997;78:531–539.
5. 5. Loo M. Upper respiratory tract infection. In: Integrative Medicine for Children. 2009:450–455.
6. 6. File TM, Hadley JA. Rational use of antibiotics to treat respiratory tract infections. Am J Manag Care. 2002;8:713–727.
7. 7. Baars EW, et al. The contribution of complementary and alternative medicine to reduce antibiotic use: a narrative review. Evid Based Complement Alternat Med. 2019;2019:5365608.
8. 8. Wegener T. Herbal medicinal products in the pediatric population—status quo and perspectives. Wien Med Wochenschr. 2013;163(3–4):46–51.

9. 9. Rashrash M, Schommer JC, Brown LM. Prevalence and predictors of herbal medicine use among adults in the United States. J Patient Exp. 2017;4(3):108–113.
10. 10. Welz AN, Emberger-Klein A, Menrad K. The importance of herbal medicine use in the German health-care system. BMC Health Serv Res. 2019;19:952.
11. 11. Hümer M, et al. Use of herbal medicine in German children—prevalence, indications and motivation. Dtsch Med Wochenschr. 2010;135(19):959–964.
12. 12. Nieber K, et al. Pharmaco-epidemiological research on herbal medicinal products in the pediatric population: data from the PhytoVIS study. Eur J Pediatr. 2020;179(3):507–512.
13. 13. Italia S, Wolfenstetter SB, Teuner CM. Patterns of complementary and alternative medicine use in children: a systematic review. Eur J Pediatr. 2014;173(11):1413–1428.
14. 14. Nwaiwu O, Oyelade O. Traditional herbal medicines used in neonates and infants less than six months old in Lagos, Nigeria. Niger J Pediatr. 2016;43(1):40–45.
15. 15. Zhang Y, Fein EB, Fein SB. Feeding of dietary botanical supplements and teas to infants in the United States. Pediatrics. 2011;127(6):1060–1066.
16. 16. Zuzak TJ, et al. Use of complementary and alternative medicine by children in Europe. Complement Ther Med. 2013;21(Suppl):S34–S47.
17. 17. Akkuş A, Karakuş MM, Koca Çalışkan U. Çocuklarda bitki ve bitkisel ürün kullanımlarının araştırılması. Sağlık Bilimlerinde Değer. 2022;12(3):503–510.
18. 18. Cambaz Kurt N. Complementary medicine practices of mothers for their children with common cold/rhinitis. 44th Pediatric Days and 23rd Pediatric Nursing Days Congress; 17–20 April 2022.
19. 19. Kurt NC. Opinions of physicians on the application of phytotherapy in pediatric patients: a survey-based cross-sectional study. Med Bull Haseki. 2023;61(2):96–102.
20. 20. Huber BM, et al. Swiss pediatrician survey on complementary medicine. Swiss Med Wkly. 2019;149:w20091.
21. 21. Ahmed Al Saadoon M, et al. Factors associated with pediatrician attitudes toward complementary and traditional medicine in children. Int J Health Policy Manag. 2015;4(2):65–68.
22. 22. Liu L, et al. Complementary and alternative medicine—practice, attitudes, and knowledge among healthcare professionals in New Zealand. BMC Complement Med Ther. 2021;21(1):63.
23. 23. Schönknecht K, et al. Treatment of cough in respiratory tract infections—the effect of combining natural active compounds with thymol. Wiad Lek. 2016;69(6):791–798.
24. 24. Kowalczyk A, et al. Thymol and thyme essential oil: new insights into selected therapeutic applications. Molecules. 2020;25(18):4125.
25. 25. Salehi B, et al. Thymol, thyme, and other plant sources: health and potential uses. Phytother Res. 2018;32(9):1688–1706.
26. 26. Boskabady MH, Jandaghi P. Relaxant effects of carvacrol on guinea pig tracheal chains. Pharmazie. 2003;58(9):661–663.
27. 27. Hammoudi Halat D, et al. A focused insight into thyme. Nutrients. 2022;14(10):2104.
28. 28. Begrow F, et al. Impact of thymol in thyme extracts on antispasmodic action and ciliary clearance. Planta Med. 2010;76(4):311–318.
29. 29. Kemmerich B. Efficacy and tolerability of thyme herb and primrose root extract in acute bronchitis. Arzneimittelforschung. 2007;57(9):607–615.
30. 30. Fal AM, Schönknecht K. Efficacy and safety of Bronchosol® syrup in acute bronchitis. Wiad Lek. 2015;68(2):139–144.
31. 31. Üstü Y. Kekiğin tıbbi kullanımı. Ankara Med J. 2018;(2):242–245.
32. 32. European Medicines Agency. EMA/HMPC/342332/2013. Published June 2014.
33. 33. Balakrishnan A. Therapeutic uses of peppermint: a review. J Pharm Sci Res. 2015;7(7):474–476.
34. 34. Mahendran G, Rahman LU. Ethnomedicinal and pharmacological updates on peppermint. Phytother Res. 2020;34(9):2088–2139.
35. 35. Stinson RJ, Morice AH, Sadofsky LR. Modulation of TRP channels by plant-derived substances. Respir Res. 2023;24(1):45.
36. 36. Paul IM, et al. Vapor rub, petrolatum, and no treatment for children with nocturnal cough. Pediatrics. 2010;126(6):1092–1099.
37. 37. Santhi N, et al. Efficacy of topical aromatic rub on sleep in common cold patients. Open J Respir Dis. 2017;7:83–101.
38. 38. European Scientific Cooperative on Phytotherapy (ESCOP). The Scientific Foundation for Herbal Medicinal Products. 2nd ed. New York: Thieme; 2003.
39. 39. Memon T, et al. Trans-anethole of fennel oil as a TRPA1 agonist. Mol Pharmacol. 2019;95(4):433–441.
40. 40. Rahimi R, Ardekani MR. Medicinal properties of Foeniculum vulgare. Chin J Integr Med. 2013;19(1):73–79.
41. 41. Boskabady MH, Khatami A, Nazari A. Relaxant effects of Foeniculum vulgare on tracheal chains. Pharmazie. 2004;59(7):561–564.
42. 42. Jahan Y, et al. Future prospects of cough treatment: herbal medicines vs modern drugs. Int J Pharm Sci Res. 2015;6(9):3689–3697.
43. 43. El-Baz FK, et al. Antiviral and antimicrobial activities of Eucalyptus camaldulensis. Int J Pharm Sci Rev Res. 2015;31:262–268.
44. 44. Worth H, Dethlefsen U. Cineole therapy in asthma. J Asthma. 2012;49(8):849–853.
45. 45. Wacogne I. Vapour rub reduced nocturnal symptoms in children. Arch Dis Child Educ Pract Ed. 2011;96(6):240.
46. 46. Kenia P, Houghton T, Beardsmore C. Does inhaling menthol affect nasal patency or cough? Pediatr Pulmonol. 2008;43(6):532–537.
47. 47. Sai Chandar D, et al. Eucalyptus oil–induced seizures in children. Cureus. 2021;13(3):e14109.
48. 48. Ulbricht C, et al. Systematic review of elderberry and elderflower. J Diet Suppl. 2014;11(1):80–120.
49. 49. Della Volpe A, et al. Effects of Sambucus nigra–containing supplements in children. Eur Rev Med Pharmacol Sci. 2019;23(14):6360–6370.
50. 50. Macknin M, et al. Elderberry extract for influenza treatment. J Gen Intern Med. 2020;35(11):3271–3277.
51. 51. Gepdiremen A, et al. Anti-inflammatory activity of ivy saponins. Phytomedicine. 2005;12(6–7):440–444.
52. 52. Schmidt M, Thomsen M, Schmidt U. Suitability of ivy extract for pediatric cough. Phytother Res. 2012;26(12):1942–1947.
53. 53. Sierocinski E, Holzinger F, Chenot JF. Ivy leaf for acute upper respiratory tract infections. Eur J Clin Pharmacol. 2021;77(8):1113–1122.
54. 54. Careddu D, Pettenazzo A. Pelargonium sidoides extract EPs 7630 in children. Int J Gen Med. 2018;11:91–98.
55. 55. Llor C. Acute bronchitis: aetiology and treatment. Eur Respir Monogr. 2013;60:1–17.
56. 56. Walther C, Döring K, Schmidtke M. In vitro inhibition of rhinovirus and influenza virus by plant extracts. BMC Complement Med Ther. 2020;20(1):380.
57. 57. Bereznoy VV, et al. Pelargonium sidoides in pediatric tonsillopharyngitis. Altern Ther Health Med. 2003;9(5):68–79.
58. 58. Witkowska-Banaszczak E, Michalak A, Kędzia A. In vitro antimicrobial activity of Bronchosol. Acta Pol Pharm. 2015;72(2):367–375.
59. 59. Büyükkök N, Güngör B, Genç AA. Soğuk algınlığında kullanılan bitkisel droglar. Lokman Hekim Tıp Tarihi ve Folklorik Tıp Dergisi. 2022;12(2):262–271.
60. 60. Czerwińska ME, et al. Influence of procyanidins from Tilia cordata on human neutrophils. Fitoterapia. 2018;127:115–122.
61. 61. T.C. Sağlık Bakanlığı. Fitoterapi Uygulama Kitabı. Ankara: Sağlık Bakanlığı; 2022.