Bronchial Relaxants
Respiratory tract irritation that causes coughing also causes the bronchi to narrow. Some sedative expectorants used for dry, spasmodic coughs help reduce the tightness while not producing gastric irritation. Pleurisy root (Asclepias) is used for acute bronchitis or influenza with a tight, painful cough and difficult respiration. When there is a general reduction in respiratory secretions and the chest is sore from coughing, it is most beneficial, especially in children. Taken hot, it acts as a diaphoretic to help control fevers where there is hot, dry skin. One ounce of the powdered root is extracted with one quart of hot water and a teacupful is taken every 2-3 hours. In pleurisy the cough is short, due to the pain, and hacking. This type of cough provides no benefit and should be ameliorated with an appropriate combination containing pleurisy root.

Sundew (Drosera) is called for in similar acute or chronic cases where the cough is dry, irritable, and persistent, particularly if it is hoarse, resonant, or explosive. Nervous coughs or spasmodic coughs such as during measles or after whooping cough are treated with small doses to advantage. The dose of the fluidextract is from 5-20 drops. Sundew and pleurisy root are also useful for the persistent cough following influenza.

Lungwort (Sticta) is used in dry, persistent, irritative coughs with rasping and wheezing. Where there is asthmatic tightness or spasms such as in croup, it is useful. The exhaustive cough of acute bronchitis or laryngitis with short, sharp hacking and darting pains or muscular soreness in the chest indicates its usefulness. Pain in the back of the neck and shoulders or shoulder blades from coughing is another indication for lungwort. Red clover flowers (Trifolium) are used for dry, irritable coughs due to irritation of the larynx or bronchi and for spasmodic coughs such as occur with measles.

Where coughing is associated with asthma or emphysema, more potent remedies for opening the air tubes in the lungs should be used along with expectorants to provide relief for either dry or productive coughs. Ephedra (Ephedra) is a potent antispasmodic like lobelia which, unlike lobelia, is not an expectorant. However, ephedra is useful for coughs associated with airway spasms. In these cases it is always combined with other remedies. Unfortunately, ephedra is likely to cause rapid heart rate and raise the blood pressure.

Treating Productive Coughs
In cases of bacterial pneumonia the appropriate antibiotic is indicated by culturing the sputum. Antibiotics are not necessary for acute bacterial bronchitis unless there are large quantities of pus in the mucus, persistent high fever, asthma or emphysema, or underlying systemic conditions compromising immunity. In all types of pneumonia, whether viral or bacterial, herbs that enhance immunity are useful to stimulate the body's response to overcome the infection. Such herbs should also be taken for viral colds, influenza, and all forms of bronchitis. The most important of these herbs are the echinacea species (Echinacea). Echinacea should be used in combination not only with other remedies that help resolve infections but also those that relieve conditions which lead to coughing. Coughing should not be suppressed in cases of pneumonia, but the pulmonary congestion should be relieved.

In treating productive coughs demulcents and antiseptics should be used to soothe the irritation in the throat from coughing and reduce sputum production, respectively. Where there is irritation in the voice box demulcents such as licorice or syrups can also help ease discomfort, even though local contact is limited to the throat. Peppermint oil (Mentha) and its component menthol act as a local anesthetic to relieve irritation and is therefore useful in throat lozenges, as well as being mildly antiseptic. Antiseptic gargles can be used if there is a bacterial infection in the throat associated with the cough. Volatile aromatic antiseptics are also taken internally as expectorants.

Stimulant Expectorants
Volatile antiseptics taken internally are generally as stimulant expectorants. They do not act as nervous system stimulants, but rather their tonic and antiseptic actions help to stimulate repair and diminish fluid secretions due to inflammation. They are eliminated by the lungs when taken orally. These volatile increase sputum expulsion by stimulating normal respiratory fluid secretions through their mild irritant effects directly on the bronchial glands. Besides peppermint oil, commonly used stimulant expectorants containing aromatic oils include eucalyptus (Eucalyptus), garlic (Allium), and thyme (Thymus).

Eucalyptus oil and its component eucalyptol are common antiseptic flavoring ingredients in throat lozenges for coughs. The expectorant vapors are thereby inhaled to affect associated bronchitis as well. Taken internally eucalyptus reduces inflammatory respiratory secretions by its antiseptic action and facilitates expulsion of the sputum.

Garlic releases aromatics which are among the most potent and broad-range antibiotics from higher plants. Since these aromatics are readily excreted by the lungs, the use of garlic in the second stage of bronchitis concentrates its active aromatics where they can be most effective. For colds that are frequently repeated or become chronic, garlic is often useful.

Thyme and its oil are antispasmodic, especially for the small airway tubules in paroxysmal coughs such as whooping cough. Like garlic, its antiseptic volatiles are expelled through the lungs when taken internally and produce expectorant activity. Its active aromatic component thymol is used as an antiseptic in gargles.

Thymol and eucalyptol are also eliminated in the urine and act as an antiseptic there, but in too large of dosage can produce congestion in the kidneys. Thyme and eucalyptus oils should not be taken internally in high doses (less than 4 drops of thyme oil and less than 10 drops of eucalyptus oil for adults) and should be administered in a vehicle such as honey. Volatile irritants like these should never be used in any case of acute kidney inflammation. Garlic is relatively nontoxic but can cause stomach irritation.

Oral balsamic stimulant expectorants include storax (Liquidamber), Tolu balsam (Myroxylon), and benzoin (Styrax). Balsams are resinous mixtures with large proportions of benzoates and cinnamates. These compounds are expectorant and bacteriostatic. These stimulant expectorants are used internally for chronic bronchitis. Tolu balsam in particular is combined as an antiseptic tonic with other stimulant expectorants in cough syrups and taken for bronchial irritation in persistent and chronic cases and for laryngitis and sore throat as well. Tolu balsam is used where mucous membranes are relaxed and atonic with excessive secretions. The usual dose is 20-40 drops of the tincture.

Aromatic Relaxants
Several stimulant expectorant herbs contain a combination of volatiles with resinous components. In addition to having these antiseptic expectorant components, these herbs are also antispasmodic to the bronchial airways. Elecampane root (Inula) is used in short-term and persistent coughs where there is abundant expectoration, for chronic bronchitis, or after protracted colds or influenza. The dose for fluidextract of elecampane is 10-60 drops.

Gum plant (Grindelia) has mild expectorant activity. Gum plant is used mostly in persistent and chronic bronchitis with spasmodic coughs at a dose ranging from 30-60 drops of the fluidextract. It is often combined with other expectorants for rattling coughs with profuse secretion, especially with yerba santa (Eriodictyon) because of gum plant's bitter taste. An extract of yerba santa leaves is a useful flavoring vehicle for bitters as well as acting as a respiratory sedative for debilitating coughs of chronic bronchitis when there is excessive catarrhal discharge. The dosage of fluidextract of yerba santa is about 30 drops.

Inhalation Therapy
In treating bacterial infections below the voice box inhaling volatile antiseptics in steam is the most common method of using many stimulant expectorants. To achieve the best mucus-dissolving and antiseptic effects, volatile compounds should be inhaled and not just taken orally. The steam also helps liquify the sputum so that it can be more easily expelled. Volatile antiseptics include both essential oils and balsams. The aromatic vapors of the major volatile constituents have shown antiseptic activity. Volatile antiseptic expectorants derived from conifers are often used as inhalants. These include dwarf pine needle or Scotch pine needle oils (Pinus) and cedar leaf oil (Thuja).

Put in boiling water or a steam humidifier for inhalation the balsams are used as antiseptics for short-term and persistent laryngitis. The balsams are combined together in the frequently used Compound Tincture of Benzoin include 5 parts benzoin, 4 parts storax, 2 parts Tolu balsam, and 1 part aloe (Aloe). This combination is more expectorant when taken orally in a syrup base and more antiseptic when used with steam inhalation.

Besides the Compound Tincture of Benzoin other volatile combinations are commonly inhaled in steam. Pouring boiling water on chamomile (Matricaria) alone for its antibacterial, anti-inflammatory, and antispasmodic effects or together with thyme makes another useful steam inhalant. Eucalyptus or eucalyptol and peppermint oil or menthol are another effective combination.

Topical Treatments
Applied topically to the chest, neck and upper back and covered with a flannel binder, the combination of eucalyptol, menthol, thymol, and camphor act as counterirritants in a dry chest pack to relieve pulmonary congestion.

Black mustard seed (Brassica) powder can also be used topically as a rubefacient and counterirritant. The counterirritant effect is a reflex action affecting the circulation. Usually 1 part mustard seed powder to 6 parts flour (or 1 to 12 for children, fair-skinned, or sensitive individuals) is combined and mixed with tepid water to make a paste. The paste is spread on muslin which is folded to enclose the moist paste. Olive oil is rubbed on the skin, then the moist plaster is applied until the skin reddens (from 5 to 20 minutes maximum).wh It is placed over the chest for acute bronchitis to help relieve congestion. After removal the skin is washed and oil is again applied. Blistering can occur if the mustard paste is too strong or the plaster is left on too long.

A topical remedy that used to be quite popular for acute bronchial infections and cough was compound powder of lobelia (emetic powder). It consisted of 6 parts lobelia, 4 parts ipecac, 3 parts bloodroot, 3 parts skunk cabbage (Dracontium), and 1 part cayenne pepper. Cayenne is an effective rubefacient that does not cause blistering, while skunk cabbage is an antispasmodic. This combination was sprinkled on a cloth coated with an absorbable ointment base and then warmed and applied to the chest. This plaster was used for short-term bronchitis, pleurisy, and soreness of the chest walls to relieve the pain and inflammation.

Pharmaceutical Combinations for Coughs
Combination cough remedies are commonly available in pharmacies and groceries stores and often used. In the United States as many as 600 formulations of cough remedies are on sale, and they rank as the fifth most prescribed class of drugs. In addition to a central antitussive in a demulcent syrup they typically contain an expectorant, a decongestant, an antihistamine, an anesthetic. Sometimes they also include an agent for relaxing airway tubes, an analgesic, an anti-inflammatory, or a medicine for fever. These medicines often appear to be put together without any logical rationale for the combination. They are frequently combined to alleviate the totality of symptoms associated with an upper respiratory infection. Most of these ingredients are not necessary if the cough alone is all that requires treatment. For example, the decongestants act on the nose and sinuses, analgesics are intended for headaches and muscle aches, and antipyretics reduce fevers. Some have opposing actions, such as antihistamines which dry the respiratory mucous membranes and the expectorants which increase respiratory fluid secretion. It is better to use only those agents that are necessary to avoid side effects.