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74 CPD ACTIVITY FROM PAGE 73 Marshmallow root Althaea officinalis Marshmallow has demulcent (soothing) properties. The leaves and roots of this plant have been used for centuries for treating different diseases and conditions.8,9 The roots of Althaea officinalis contain rhamnogalacturonan, which has antispasmodic activity and is involved in suppressing coughs.10 However, the limited clinical evidence available does not support the use of marshmallow root for the treatment of coughs in children. Thyme Thymus vulgaris and Thymus zygis Used medicinally for thousands of years, thyme has been recommended by herbalists for its antimicrobial, antitussive, spasmolytic and antioxidant properties.11 The mechanism of action of thyme as an antitussive has been attributed to the phenol groups thymol and carvacrol. Also, in animal models, flavonoids in thyme seem to relax tracheal and ileal smooth muscle by inhibiting acetylcholine and histamine receptors or by blocking calcium channels.11 In 1997 Ernst et al conducted a study comparing a commercial thyme and primula combination product with other pharmaceutical options for acute bronchitis.11 The authors concluded that the clinical effects of the commercial thyme combination product was not less than other synthetic treatments, such as N-acetylcysteine. It also had a good side effect profile compared with the controls. This appeared to be a good preliminary finding. However, it was determined confirmation would require follow-up randomised, double blind trials. A more recent study conducted by Hosseini et al12 in Iran compared the Zataria multiflora plant to diphenhydramine in the treatment of common cold induced cough in children. Zataria multiflora, a thyme-like flowering plant, is chemically similar to Thymus vulgaris. The randomised double blind clinical trial consisted of a total of 52 paediatric patients aged between two and 12 years. There were five days of treatment in each arm of the study, and after day seven the parents were asked to complete a questionnaire. The results indicated that the clinical efficacy of Zataria multiflora extract syrup was associated with a statistically significant reduction in the severity of a cold- induced cough in children. The study didn’t note any incidents of side effects with the use of Zataria multiflora in the treatment group. Honey Traditionally recognised as a food, honey has a long history of use as a traditional treatment for coughs and colds, aided by the fact that it is cheap and readily available. Honey is known to have antimicrobial, antioxidant and anti-inflammatory properties13, and health professionals have continued to recommend honey for easing upper respiratory tract symptoms, especially coughs. In 2017, Ayazi et al14 undertook a comparative study of the effect of two types of Iranian honey and diphenhydramine on nocturnal cough and sleep quality in coughing children and their parents. The study consisted of 87 children, who were randomly assigned to one of three groups. Each group received double doses of the respective treatment on two successive nights. Honey type one was better than diphenhydramine in improving all aspects of cough except frequency, whereas honey type two was more effective than diphenhydramine in all aspects of cough bar the sleep quality of the child. There were no significant differences between the two types of honey and overall the results indicated that honey may be an efficacious alternative to diphenhydramine for children. In 2020, researchers at Oxford University concluded honey is reliable in improving the symptoms of URTIs, including coughs, nasal congestion and sore throats. It also has an excellent safety profile. However, it must not be recommended to infants under one year RETAIL PHARMACY • MAY 2021