Although discussed separately, the multifaceted activities of 1,8-cineole perform together in harmony to provide an effective intervention that can inherently adapt to the needs of the individual patient. As already described, 1,8-cineole is known to possess the following properties:
5. Ciliary transport promotion
Therefore, it may be seen that a diverse range of respiratory conditions of varying complexities will benefit from the use of pure 1,8-cineole or from essential oils containing this oxide as a major component.
11.15.3 Treatment with Blends Containing both Menthol and 1,8-Cineole
A study measured transthoracic impedance pneumographs of 60 young children (2-40 months) with acute bronchitis before and after a 3-min application of Vaporub® to the back and chest. The data showed an early increase in amplitude up to 33%, which slowly descended during the 70-min post-treatment period to slightly above the control. Breathing frequency progressively decreased during the same period by 19.4%. Clinical observations combined with these results suggested a condition of "easier breathing" (Berger et al., 1978a). Currently, the active ingredients of Vaporub are camphor 4.8%, 1,8-cineole 1.2%, and menthol 2.6, but these components and percentages may have changed over the years.
The same team employed a similar experiment but used the pneumographic data to examine the quiet periods, that is, parts of the pneumogram where changes in the baseline were at least half of the average amplitude in more than five consecutive breathing excursions. It was found that the application of Vaporub increased quiet periods by up to 213.8%, whereas the controls (petroleum jelly application or rubbing only) never exceeded 62.4%. Thus the breathing restlessness of children with bronchitis was diminished and this was confirmed by clinical observations (Berger et al., 1978b).
By the measurement of lung and forced expiratory volumes, nasal, lower, and total airway resistances, closing volume data, the phase III slope of the alveolar plateau, and the maximum expiratory flow volume, peripheral airway dysfunction was confirmed in 24 adults with common colds. In a randomized, controlled trial, an aromatic mixture of menthol, eucalyptus oil, and camphor (56%, 9%, and 35% w/w, respectively) were vaporized in a room where the subjects were seated. Respiratory function measurements were made at baseline, 20 and 60 min after exposure. After the last measurement, phenylephrine was sprayed into the nostrils and the measurements taken again 5-10 min later to determine potential airway responsiveness. The control consisted of tap water. The results showed significant changes in forced vital capacity, forced expiratory volume, closing capacity, and the phase III slope after aromatic therapy as compared to the control. It was concluded that the aromatic inhalation favorably modified the peripheral airway dysfunction (Cohen and Dressler, 1982).
In a randomized, placebo-controlled trial of citric acid-induced cough in 20 healthy subjects, the inhalation of a combination of menthol and eucalyptus oil (75% and 25%, respectively) significantly decreased the cough frequency (Morice et al., 1994).
The effect of an aromatic inunction (Vaporub) was studied by the inhalation of a radioaerosol in a randomized, single-blinded, placebo-controlled crossover trial with 12 chronic bronchitics. It was found that after the application of 7.5 g of the product to the chest, removal of the tracheobronchial deposit was significantly enhanced at 30 and 60 min postinhalation, although further effects could not be demonstrated during the following 5 h, despite further application of the rub. During the first hour, mucociliary clearance was correlated with the concentration level of the aromatics (Hasani et al., 2003).
Another commercial preparation Pinimenthol®, a mixture of eucalyptus and pine needle oils plus menthol, reduced bronchospasm and demonstrated significant secretolytic effects when insufflated through the respiratory tract and when applied to the epilated skin of animals (Schäfer and Schäfer, 1981). In addition to the known effects of menthol and 1,8-cineole, pine needle oil is considered to be weakly antiseptic and secretolytic (Approved Herbs, 1998).
In a randomized, double-blind 14-day trial, 100 patients with chronic obstructive bronchitis received a combination of theophylline with ß-adrenergica 2-3 times daily. The test group also received Pinimenthol. The parameters were investigated were objective (measurement of lung function and sputum) and subjective (cough, respiratory insufficiency, and pulmonary murmur). All differences in the subjective evaluations were statistically significant and of clinical importance; secretolysis was clearly shown. The addition of Pinimenthol showed a clear superiority to the basic combination therapy alone (Linsenmann and Swoboda, 1986).
A postmarketing survey was conducted of 3060 patients prescribed Pinimenthol suffering from cold, acute or chronic bronchitis, bronchial catarrh, or hoarseness. The product was given by inunction (29.6%), inhalation (17.3%), or inunction and inhalation (53.1%). Only 22 patients reported adverse effects and the efficacy of the product was judged as excellent or good by 88.3% of physicians and 88.1% of patients (Kamin and Kieser, 2007).
In a proof of concept study, a nasal spray was made from the essential oil of Artemisia abrota-num L. (4 mg/mL) and flavonoid extracts (2.5 pg/mL) from the same plant. The essential oil consisted primarily of 1,8-cineole and davanone at approximately 40% and 50%, respectively. Apart from a spasmolytic activity (Perfumi et al., 1995), little is known about the biological activity of davanone. The flavonoids present were thought to inhibit histamine release and interfere with arachidonic acid metabolism. The nasal spray was self-administered by 12 patients with allergic rhinitis, allergic conjunctivitis, and/or bronchial obstructive disease. They were instructed to use 1-2 puffs in each nostril at the first sign of symptoms, to a maximum of six treatments per day. All patients experienced rapid and significant relief of nasal symptoms and for those with allergic conjunctivitis, a significant relief of subjective eye symptoms was also experienced. Three of six patients with bronchial obstructive disease experienced rapid and clinically significant bronchial relief (Remberg et al., 2004).
A blend of 15 essential oils was developed into a commercial product called "Helps stop snoring" and 140 adult snorers were recruited into a randomized trial using the product as a spray or gargle. Visual analogue scales were completed by the snorers' partners relating to sleep disturbance each night. The treatment lasted for 14 days and results were compared to a pretrial period of the same length. The partners of 82% of the patients using the spray and 71% of patients using the gargle reported a reduction in snoring. This was compared to 44% of placebo users. The mode of action was postulated as being antispasmodic to the soft palate and pharynx (Pritchard, 2004).
A delayed triggering of the swallowing reflex, mainly in elderly people, predisposes to aspiration pneumonia. To improve dysphagia, two different approaches using essential oils have been tried with success.
As black pepper is a strong appetite stimulant, it was postulated that nasal inhalation of the essential oil may stimulate cerebral blood flow in the insular cortex, the dysfunction of which has been reported to play a role in dysphagia. A randomized, controlled study of 105 elderly patients found that the inhalation of black pepper oil for 1 min significantly shortened the delayed swallowing time and increased the number of swallowing movements. Emission computed tomography demonstrated activation of the anterior cingulate cortex by the treatment. The inhalation of lavender essential oil or water had no effects (Ebihara et al., 2006a).
A second study used the established stimulating effects of menthol on cold receptors, since cold stimulation was known to restore sensitivity to trigger the swallowing reflex in dysphagic patients. Menthol was introduced into the pharynx of patients with mild to moderate dysphagia via a nasal catheter. The latent time of swallowing reflex was reduced significantly by menthol in a concentration-dependent manner; 10-2 menthol reduced the time to 9.4 s as compared to 13.8 s for distilled water. The use of a menthol lozenge before meals was thought appropriate (Ebihara et al., 2006b).
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