Hello, Ivy. So Long, Cough.
Ivy Leaf for Lung Health
By Erica Zelfand, ND
Rattle, click, puff, inhale.
So goes the pithy song of the rescue inhaler.
By mimicking the effects of epinephrine and norepinephrine, β-agonist drugs cause the smooth muscles lining the airways to relax and allow more air to pass into the lungs.1
In conditions like asthma, acute bronchitis, and chronic obstructive pulmonary disease (COPD), these same muscles constrict, limiting the passage of air. The narrowing of the airways, coupled with the accompanying inflammation, leads to cough, shortness of breath, wheezing, and chest tightness.2
To make the picture even stickier (both literally and figuratively), mucus can further compromise breathing. In fact, mucus hypersecretion is a common challenge in chronic airway diseases like asthma, COPD, and cystic fibrosis.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. Extracts of ivy leaf (Hedera helix) have been shown to support respiratory health through a variety of mechanisms, including that of β-adrenergic agonism.5
Ivy leaf’s properties as an anti-inflammatory, expectorant, and bronchospasmolytic agent have been demonstrated in several randomized, placebo-controlled clinical trials and scientific studies.6,7,8,9,10,11
Herein, we take a closer look at what the research has to teach us about some of the indications for this botanical remedy.
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—and the β-adrenergic agonist isoprenaline were concurrently applied to strips of muscle harvested from the tracheas of cows. Although none of the saponins affected histamine-related muscle contraction, α-hederin was shown to support smooth muscle relaxation via β-adrenergic activity. The smooth muscle-relaxing effects of ivy leaf have also been observed in studies of human tissue: human bronchial smooth muscle cells respond positively to ivy leaf saponins, with the effects being attributed to β2-adrenergic responsiveness.5,12
Ivy leaf has also been shown to enhance the health of the alveoli. Specifically, ivy leaf has been observed to elevate intracellular levels of cyclic adenosine monophosphate (cAMP), which 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.5,12
In a review of randomised, 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 randomised, double-blind, placebo-controlled crossover study concludes that children with mild, uncontrolled asthma already taking inhaled corticosteroids may benefit from the addition of a syrup made from ivy leaf dry extract.13
As compared to a placebo syrup, 70mg of the extract taken for one month was associated with significant improvements in multiple measurements of mean expiratory flow and vital capacity before bronchodilation.
Paediatric Productive Cough
In a non-randomised, open-label study of an ivy leaf extract preparation in the treatment of productive cough,14 464 children ages two to 12 were examined. Regardless of whether or not they used pharmaceutical antibiotics.
More than 93% of the children had a reduction in their cough after taking the ivy preparation, with similar percentages also having improvements in wheezing, dyspnea, and coughing-related chest pain.
Almost 85% had improvements in coughing-related chest pain, 90% had improvements in wheezing, 88.7% had reduced dyspnoea, and almost 95% had improvements on auscultation. A decline in or normalisation of body temperature was also observed in 96% of the children, and the herbal remedy was well tolerated across all ages.
Another open-label study examining the efficacy and safety of ivy herbal extract in the treatment of paediatric cough confirms both the usefulness and tolerability of ivy leaf syrup and drops.15 Of 268 children aged one month to 13 years observed in this study, only five (1.9%) had adverse events—all of which were mild and nonserious. Typical cough symptoms were observed to markedly improve in the children.
Acute Bronchitis in Children and Adults
Acute bronchitis is characterised 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 after seven days of treatment. Those who took ivy leaf extract, however, had additional improvements with respect to dyspnea, number of coughing fits, and cough-associated sleeping problems. Both remedies were well tolerated.
Acute Cough in Adults
A randomised, placebo-controlled, double-blind trial considered ivy leaf extract’s potential in the treatment of adults with acute cough.17 In this trial, 181 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.
In a study examining ivy leaf’s effects as a secretolytic,18 70 people undergoing septoplasty were observed. While all of the patients performed regular nasal irrigation 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 the ivy was not only found to have significantly less nasal secretions, but also fewer incidences of postsurgical infection. While none of the people who took the ivy preparation 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 infection post-op.
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 seniors, 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 may cause an upset stomach in sensitive individuals.
Ivy leaf extract is a natural remedy for respiratory ailments in both adults and children. With a propensity for relaxing the smooth muscles lining 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.
- Johnson M. Beta2-adrenoceptors: Mechanisms of action of beta2-agonists. Paediatr Respir Rev. 2001;2(1):57-62.
- Mims JW. Asthma: Definitions and pathophysiology. Int Forum Allergy Rhinol. 2015;5:S2-S6.
- Cohn L. Mucus in chronic airway diseases: Sorting out the sticky details. J Clin Invest. 2006;116(2):306-8.
- Athanazio R. Airway disease: similarities and differences between asthma, COPD and bronchiectasis. Clinics. 2012;67(11):1335.
- Greunke C, et al. A systematic study on the influence of the main ingredients of an ivy leaves dry extract on the β2-adrenergic responsiveness of human airway smooth muscle cells. Pulm Pharmacol Ther. 2015;31:92-8.
- Wolf A, et al. Pre-treatment with α-hederin increases β-adrenoceptor mediated relaxation of airway smooth muscle. Phytomedicine. 2011;18(2-3):214-8.
- Gulyas A, et al. Konsequente Therapie chronisch-obstruktiver Atemwegserkrankungen bei Kindern. Atemwegs-und Lungenkrankheiten. 1997.
- Hofmann D, et al. Efficacy of dry extract of ivy leaves in children with bronchial asthma – A review of randomized controlled trials. Phytomedicine. 2003;10(2-3):213-20.
- Kraft K. Vertraglichkeit von Efeublattertrockenextrakt im Kindesalter. Zeitschrift fur Phyther. 2004.
- Mansfeld H, et al. Sekretolyse und Bronchospasmolyse. TW Pädiatrie. 1997.
- Mansfeld H, et al. Therapie des Asthma bronchiale mit Efeublatter-Trockenextrakt. MMV Medizin. 1998.
- Schulte-Michels J, et al. α-Hederin inhibits G protein-coupled receptor kinase 2-mediated phosphorylation of β2-adrenergic receptors. Phytomedicine. 2016;23(1):52-7.
- Zeil S, et al. Tolerance and effect of an add-on treatment with a cough medicine containing ivy leaves dry extract on lung function in children with bronchial asthma. Phytomedicine. 2014;21(10):1216-20.
- Schönknecht K, et al. Efficacy of dry extract of ivy leaves in the treatment of productive cough. Wiad Lek. 2017;70(6 pt 1):1026-33.
- Schmidt M, et al. Suitability of ivy extract for the treatment of paediatric cough. Phyther Res. 2012;26(12):1942-7.
- Kruttschnitt E, et al. Assessment of the efficacy and safety of ivy leaf (Hedera helix) cough syrup compared with acetylcysteine in adults and children with acute bronchitis. Evid Based Complement Alternat Med. 2020;2020.
- Schaefer A, et al. A randomized, controlled, double-blind, multi-center trial to evaluate the efficacy and safety of a liquid containing ivy leaves dry extract (EA 575®) vs. placebo in the treatment of adults with acute cough. Pharmazie. 2016;71(9):504-9.
- Savović S, et al. The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal. Braz J Otorhinolaryngol. 2019;85(6):685-9.
- Committee on Herbal Medicinal Products (HMPC). European Union herbal monograph on Hedera helix L., folium [Internet]. London: European Medicines Agency; 2017 [cited 2020 Sept 4]. Available from: https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-hedera-helix-l-folium-revision-2_en.pdf
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