Longitudinal distribution of chlorine absorption in human airways: a comparison to ozone absorption.

The bolus inhalation method was used to measure the fraction of inhaled chlorine (Cl(2)) and ozone (O(3)) absorbed during a single breath as a function of longitudinal position in the respiratory system of 10 healthy nonsmokers during oral and nasal breathing at respired flows of 150, 250, and 1,000 ml/s. At all experimental conditions, <5% of inspired Cl(2) penetrated beyond the upper airways and none reached the respiratory air spaces. On the other hand, larger penetrations of O(3) beyond the upper airways occurred as flow increased and during nasal than during oral breathing. In the extreme case of oral breathing at 1,000 ml/s, 35% of inhaled O(3) penetrated beyond the upper airways and approximately 10% reached the respiratory air spaces. Mass transfer theory indicated that the diffusion resistance of the tissue phase was negligible for Cl(2) but important for O(3). The gas phase resistances were the same for Cl(2) and O(3) and were directly correlated with the volume of the nose and mouth during nasal and oral breathing, respectively.     

Depletion of urate in human nasal lavage following in vitro ozone exposure

Ozone, a strong oxidant present in summer smog, is thought to primarily react with antioxidant molecules found in the epithelial lining fluid of the respiratory tract. In humans, as much as 40% of inhaled ozone can be removed in the nasal cavity where the major extracellular antioxidant has been identified as uric acid. The present study was undertaken to examine urate/oxidant interactions in human nasal lavage fluid following in vitro exposure to ozone at concentrations relevant to the U.K. Lavage fluid was collected from 8 volunteers using a modified Foley catheter which permits prolonged contact of isotonic saline with the anterior nasal cavity. Nasal lavage samples in multiwell plates were exposed to ozone at concentrations of 50, 100 and 250 ppb. Samples were removed at intervals from 15 to 240 min following exposure and assayed for uric acid depletion. Uric acid concentrations in the nasal lavage were found to fall from 8.52 (time zero) to 3.99 μM, 0.05 and 0.07 μM after 240 min at 50, 100 and 250 ppb ozone respectively. At a non-environmentally relevant ozone concentration of 1000 ppb, uric acid was completely depleted after 60 min. Regression analysis showed a linear correlation between rate of loss of urate and ozone concentration (R² = 0.97). A novel, non-invasive technique is described to investigate antioxidant compromise and its importance in individual subjects. We conclude that uric acid in nasal lavage samples is scavenged by ozone in a dose and time dependant manner.     

Impacts of urban levels of ozone on Pinus halepensis foliage

Between May and September, 1996, seedlings of Pinus halepensis were placed at a site adjacent to an automated air pollution monitoring station within the urban area of Florence. Additional 'control' plants were placed in chambers ventilated with charcoal/Purafil(R)-filtered air. All trees were well watered throughout the whole experimental period. During the exposure period, ambient levels of sulphur dioxide were very low, whilst the accumulated hourly exposure to ozone above 40 ppb (i.e. AOT40) exceeded 20000 ppb h(-1) - peak hourly ozone concentrations rising to levels above 100 ppb. Trees exposed to ambient levels of air pollution exhibited typical symptoms of ozone damage (chlorotic mottle) on previous year needles toward the end of the summer. Similar symptoms were not observed on equivalent trees exposed to filtered-air, nor were visible symptoms accompanied by insect or pest infestation. Anatomical and ultrastructural observations made on symptomatic needles revealed degeneration in mesophyll cells bordering sub-stomatal cavities and alterations in chloroplast ultrastructure (fat accumulation, starch and tannin pattern modifications). These observations are consistent with the known effects of air pollutants (namely ozone) recorded in the literature. Findings are discussed in relation to the impacts of ozone on P. halepensis in the Mediterranean region.     

The effect of exercise on nasal uptake of ozone in healthy human adults.

The nose may help protect the lower respiratory tract from the effects of ambient ozone by scrubbing ozone from inspired air. Reductions in both nasal resistance and nitric oxide production with exercise may influence the efficiency of ozone uptake in the nose. Nasal ozone uptake was measured in 10 healthy volunteers before and after 15 min of moderate bicycle exercise. Ozone (0.2 parts/million) was pulled through both nostrils and out of the mouth at a constant flow while the subjects closed their epiglottises. Nasal uptake of ozone was determined by comparing the ozone concentration entering the nostrils to that exiting the mouth. Average preexercise uptake of ozone was 56 +/- 7.8 and 37 +/- 4.9% at 10 and 20 l/min, respectively. These averages did not significantly differ from those immediately postexercise (55 and 37%). Nasal ozone uptake increased significantly (P < 0.001) with decreasing flow rate, but intersubject variability in uptake could not be predicted by nasal volume or cross-sectional areas (as measured by acoustic rhinometry) or endogenous nitric oxide production. However, the percent change in ozone uptake after exercise, within an individual, was correlated with both 1) percent change in nasal volume (r = 0.70 at 10 l/min) and 2) percent change in the rate of volumetric expansion between the nasal valve and turbinates (r = 0.82 at 10 l/min). These results may be useful for assessing human risk associated with ozone exposure during exercise.     

The Effect of Elevated Ozone Concentrations with Varying Shading on Dry Matter Loss in a Winter Wheat-Producing Region in China

Surface-level ozone pollution causes crop production loss by directly reducing healthy green leaf area available for carbon fixation. Ozone and its precursors also affect crop photosynthesis indirectly by decreasing solar irradiance. Pollutants are reported to have become even more severe in Eastern China over the last ten years. In this study, we investigated the effect of a combination of elevated ozone concentrations and reduced solar irradiance on a popular winter wheat Yangmai13 (Triticum aestivum L.) at field and regional levels in China. Winter wheat was grown in artificial shading and open-top-chamber environments. Treatment 1 (T1, i.e., 60% shading with an enhanced ozone of 100±9 ppb), Treatment 2 (T2, i.e., 20% shading with an enhanced ozone of 100±9 ppb), and Control Check Treatment (CK, i.e., no shading with an enhanced ozone of 100±9 ppb), with two plots under each, were established to investigate the response of winter wheat under elevated ozone concentrations and varying solar irradiance. At the field level, linear temporal relationships between dry matter loss and cumulative stomatal ozone uptake were first established through a parameterized stomatal-flux model. At the regional level, ozone concentrations and meteorological variables, including solar irradiance, were simulated using the WRF-CMAQ model (i.e., a meteorology and air quality modeling system). These variables were then used to estimate cumulative stomatal ozone uptake for the four major winter wheat-growing provinces. The regional-level cumulative ozone uptake was then used as the independent variable in field data-based regression models to predict dry matter loss over space and time. Field-level results showed that over 85% (T1: R² = 0.85 & T2: R² = 0.89) of variation in dry matter loss was explained by cumulative ozone uptake. Dry matter was reduced by 3.8% in T1 and 2.2% in T2 for each mmol O₃·m^-2 of cumulative ozone uptake. At the regional level, dry matter loss in winter wheat would reach 50% under elevated ozone concentrations and reduced solar irradiance as determined in T1, and 30% under conditions as determined in T2. Results from this study suggest that a combination of elevated ozone concentrations and reduced solar irradiance could result in substantial dry matter loss in the Chinese wheat-growing regions.     

Community study of role of viral infections in exacerbations of asthma in 9-11 year old children.

OBJECTIVE--To study the association between upper and lower respiratory viral infections and acute exacerbations of asthma in schoolchildren in the community. DESIGN--Community based 13 month longitudinal study using diary card respiratory symptom and peak expiratory flow monitoring to allow early sampling for viruses. SUBJECTS--108 Children aged 9-11 years who had reported wheeze or cough, or both, in a questionnaire. SETTING--Southampton and surrounding community. MAIN OUTCOME MEASURES--Upper and lower respiratory viral infections detected by polymerase chain reaction or conventional methods, reported exacerbations of asthma, computer identified episodes of respiratory tract symptoms or peak flow reductions. RESULTS--Viruses were detected in 80% of reported episodes of reduced peak expiratory flow, 80% of reported episodes of wheeze, and in 85% of reported episodes of upper respiratory symptoms, cough, wheeze, and a fall in peak expiratory flow. The median duration of reported falls in peak expiratory flow was 14 days, and the median maximum fall in peak expiratory flow was 81 l/min. The most commonly identified virus type was rhinovirus. CONCLUSIONS--This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children.     

Impact of air pollution control measures and weather conditions on asthma during the 2008 Summer Olympic Games in Beijing

The alternative transportation strategy implemented during the 2008 Summer Olympic Games in Beijing provided an opportunity to study the impact of the control measures and weather conditions on air quality and asthma morbidity. An ecological study compared the 41 days of the Olympic Games (8 August–17 September 2008) to a baseline period (1–30 June). Also, in order to emphasize the impact of weather conditions on air quality, a pollution linking meteorological index (Plam) was introduced to represent the air pollution meteorological condition. Our study showed that the average number of outpatient visits for asthma was 12.5 per day at baseline and 7.3 per day during the Olympics—a 41.6% overall decrease. Compared with the baseline, the Games were associated with a significant reduction in asthma visits (RR 0.58, 95%CI: 0.52–0.65). At 16.5 visits per day, asthma visits were also significantly higher, during the pre-Olympic period (RR 1.32, 95% CI: 1.15–1.52). The study also showed that the RR of asthma events on a given day, as well as the average daily peak ozone concentration during the preceding 48–72 h, increased at cumulative ozone concentrations of 70 to 100 ppb and 100 ppb or more compared with ozone concentrations of less than 70 ppb (P < 0.05). We concluded that along with “good” weather conditions, efforts to reduce traffic congestion in Beijing during the Olympic Games were associated with a prolonged reduction in air pollution and significantly lower rates of adult asthma events. These data provide support for efforts to reduce air pollution and improve health via reductions in motor vehicle traffic.     

Corona discharge influences ozone concentrations near rats

Ozone can be produced by corona discharge either in dry air or when one electrode is submerged in water. Since ozone is toxic, we examined whether ozone production by corona near laboratory animals could reach levels of concern. Male rats were exposed to a corona discharge and the concentration of ozone produced was measured. The resulting concentration of ozone ranged from ambient levels to 250 ppb when animals were located 1 cm from a 10 kV source. Similar ozone concentrations were observed when a grounded water source was present. Possible explanations for, as well as concerns regarding, ozone production under these conditions are discussed.     

Response of genioglossus muscle activity to nasal airway occlusion in normal sleeping adults

To determine the combined effect of increased subatmospheric upper airway pressure and withdrawal of phasic volume feedback from the lung on genioglossus muscle activity, the response of this muscle to intermittent nasal airway occlusion was studied in 12 normal adult males during sleep. Nasal occlusion at end expiration was achieved by inflating balloon-tipped catheters located within the portals of a nose mask. No seal was placed over the mouth. During nose breathing in non-rapid-eye-movement (NREM) sleep, nasal airway occlusion resulted in multiple respiratory efforts before arousal. Mouth breathing was not initiated until arousal. Phasic inspiratory genioglossus activity was present in eight subjects during NREM sleep. In these subjects, comparison of peak genioglossus inspiratory activity on the first three occluded efforts to the value just before occlusion showed an increase of 4.7, 16.1, and 28.0%, respectively. The relative increases in peak genioglossus activity were very similar to respective increases in peak diaphragm activity. Arousal was associated with a large burst in genioglossus activity. During airway occlusion in rapid-eye-movement (REM) sleep, mouth breathing could occur without a change in sleep state. In general, genioglossus responses to airway occlusion in REM sleep were similar in pattern to those in NREM sleep. A relatively small reflex activation of upper airway muscles associated with a sudden increase in subatmospheric pressure in the potentially collapsible segment of the upper airway may help compromise upper airway patency during sleep.     

Persistent rhinitis and epithelial remodeling induced by cyclic ozone exposure in the nasal airways of infant monkeys

Children chronically exposed to high levels of ozone (O(3)), the principal oxidant pollutant in photochemical smog, are more vulnerable to respiratory illness and infections. The specific factors underlying this differential susceptibility are unknown but may be related to air pollutant-induced nasal alterations during postnatal development that impair the normal physiological functions (e.g., filtration and mucociliary clearance) serving to protect the more distal airways from inhaled xenobiotics. In adult animal models, chronic ozone exposure is associated with adaptations leading to a decrease in airway injury. The purpose of our study was to determine whether cyclic ozone exposure induces persistent morphological and biochemical effects on the developing nasal airways of infant monkeys early in life. Infant (180-day-old) rhesus macaques were exposed to 5 consecutive days of O(3) [0.5 parts per million (ppm), 8 h/day; "1-cycle"] or filtered air (FA) or 11 biweekly cycles of O(3) (FA days 1-9; 0.5 ppm, 8 h/day on days 10-14; "11-cycle"). The left nasal passage was processed for light microscopy and morphometric analysis. Mucosal samples from the right nasal passage were processed for GSH, GSSG, ascorbate (AH(2)), and uric acid (UA) concentration. Eleven-cycle O(3) induced persistent rhinitis, squamous metaplasia, and epithelial hyperplasia in the anterior nasal airways of infant monkeys, resulting in a 39% increase in the numeric density of epithelial cells. Eleven-cycle O(3) also induced a 65% increase in GSH concentrations at this site. The persistence of epithelial hyperplasia was positively correlated with changes in GSH. These results indicate that early life ozone exposure causes persistent nasal epithelial alterations in infant monkeys and provide a potential mechanism for the increased susceptibility to respiratory illness exhibited by children in polluted environments.     

Nasal flow-resistive responses to challenge with cold dry air.

Recent studies have suggested that the inhalation of cold air through the nose is associated with the subsequent release of mediators of immediate hypersensitivity. To determine if mucosal surface heat and water loss influence the nasal functional response to cold air, we measured nasal resistance by posterior rhinomanometry before and 1, 5, and 10 min after a 4-min period of isocapnic hyperventilation (30 l/min) through the nose in nine healthy subjects (5 males, 4 females; aged 25-39 yr) while they inhaled air at 0 degrees C. During the challenge period, the subjects breathed either in and out of the nose or in through the nose and out through the mouth. No changes in nasal resistance developed when subjects breathed exclusively through the nose; however, when subjects breathed in through the nose and out through the mouth, nasal resistance was increased 200% at 1 min (P less than 0.01) after the challenge and returned to baseline values by 10 min after cessation of the challenge. These data indicate that nasal functional responses to cold dry air are dependent on the pattern of the ventilatory challenge. If the heat given up from the nasal mucosa to the incoming air is not recovered during expiration (as is the case with inspiration through the nose and expiration through the mouth), nasal obstruction will occur. Hyperpnea of cold air, per se, does not influence nasal resistance.     

Elevated ozone reduces methane emissions from peatland mesocosms

Although the effects of elevated ozone on aboveground carbon (C) assimilation are well understood, its effects on soil C fluxes are less certain. Mesocosms taken from a lowland raised bog in northern England were exposed in open‐top chambers for 2 years to ambient air or ambient air plus ozone elevated for 8 h day^?1 by an average of 49 ppb in summer and 10 ppb in winter. The effects of elevated ozone on methane emission and ecosystem dark respiration were measured throughout this period, along with soil and plant variables. Methane emissions were significantly reduced, by about 25%, by elevated ozone during midsummer periods of both years, but no significant effect of ozone was found during the winter periods. Dark ecosystem respiration was not significantly affected by elevated ozone. There was no evidence that effects of elevated ozone on methane emissions were mediated through changes in aboveground plant biomass or soil water dissolved organic C concentrations. Our results imply that the increased northern hemisphere background ozone concentrations over the 21st century that are predicted by most models may reduce the rate of increase in methane emissions as the region warms.     

Comparison of health problems related to work and environmental measurements in two office buildings with different ventilation systems.

A cross sectional survey investigating "building sickness" was carried out in two buildings with similar populations of office workers but differing ventilation systems, one being fully air conditioned with humidification and the other naturally ventilated. The prevalence of symptoms related to work was assessed by a questionnaire administered by a doctor. A stratified, randomly selected sample of workers was seen (84% response). Building sickness includes several distinct syndromes related to work, most of which were significantly more common in the air conditioned building than the naturally ventilated building--namely, rhinitis (28% v 5%), nasal blockage and dry throat (35% v 9%), lethargy (36% v 13%), and headache (31% v 15%). The prevalence of work related asthma and humidifier fever was low and did not differ significantly between the two buildings. An environmental assessment of the offices was performed to attempt to identify possible factors responsible for the differences in the prevalence of disease. Globe temperature, dry bulb temperature, relative humidity, moisture content, air velocity, positive and negative ions, and carbon monoxide, ozone, and formaldehyde concentrations were all measured. None of these factors differed between the buildings, suggesting that building sickness is caused by other factors.     

Maximum airflow through the nose in humans

Inspiratory and expiratory flow via the nose and via the mouth during maximum-effort vital capacity (VC) maneuvers have been compared in 10 healthy subjects. Under baseline conditions maximum flow via the nose was lower than that via the mouth in the upper 50-60% of the VC on expiration and throughout the VC on inspiration. The mean ratio of maximum inspiratory to maximum expiratory flow at mid-VC was 1.38 during mouth breathing and 0.62 during nasal breathing. Inspiratory flow limitation with no increase in flow through the nose as driving pressure was increased above a critical value (usually between 12 and 30 cmH2O) was found in all six subjects studied. Stenting the alae nasi in seven subjects increased peak flow via the nose from a mean of 3.49 to 4.32 l/s on inspiration and from 4.83 to 5.61 l/s on expiration. Topical application of an alpha-adrenergic agonist in seven subjects increased mean peak nasal flow on inspiration from 3.25 to 3.89 l/s and on expiration from 5.03 to 7.09 l/s. Further increases in peak flow occurred with subsequent alan stenting. With the combination of stenting and topical mucosal vasoconstriction, nasal peak flow on expiration reached 81% and, on inspiration, 79% of corresponding peak flows via the mouth. The results demonstrate that narrowing of the alar vestibule and the state of the mucosal vasculature both influence maximum flow through the nose; under optimal conditions, nasal flow capacity is close to that via the mouth.     

Local hyperthermia benefits natural and experimental common colds.

OBJECTIVE--To determine whether inhaling fully humidified air at 43 degrees C gave more benefit to cold sufferers than inhaling air at 30 degrees C. DESIGN--Randomised double blind trial. Setting--General practice and the common cold research unit. SUBJECTS--87 Unselected patients with typical acute nasal and upper respiratory symptoms (general practice study), and 84 volunteers aged 18-50 without a history of chronic or allergic diseases. INTERVENTIONS--Subjects breathed from apparatus delivering 40 litres of room air heated to 43 degrees C or 30 degrees C and fully humidified (relative humidity 100%) per minute. End point--Reduction in severity of disease. MEASUREMENTS and main results--Patients recorded their symptoms (general practice study) and observers recorded symptoms and signs, weight of nasal secretions, isolation of virus, and antibody responses in volunteers. Patients treated for 20 minutes at 43 degrees C had in the succeeding days roughly half the score for symptoms of those treated at 30 degrees C. Volunteers treated for 30 minutes on three occasions when they were starting a cold showed an 18% [corrected] reduction in symptoms. Treatment of volunteers for 20 minutes at the onset of the cold and for 10 minutes on succeeding days showed no difference between 43 degrees C and 30 degrees C. CONCLUSIONS--Nasal hyperthermia can improve the course of a common cold and also give immediate relief of symptoms.     

Effects of ozone on cell organelles of alfalfa (Medicago sativa L.) seedlings

Seedlings of alfalfa (Medicago sativa L.) were exposed to different concentrations of atmospheric ozone (20–30 (control), 40–60, 65–80, and 85–120 ppb) in four distinct areas in the Riyadh region, so as to decide how ozone affected some of the seedling cellular organelles. Results acquired utilizing transmission electron microscopy demonstrated certifiable impacts to exist on the cell organelles in the tissues of both the leaf mesophyll and stem cortex; contrasted with control plants, the chloroplasts seemed enlarged, irregular, different sizes, decomposed, and possibly dissolved, while the plastoglobules seemed deformed, more widely spaced, and enlarged, also the vacuoles contained no clear non-living components. Moreover, some parts of the cytoplasmic membranes were ruptured, with only a few vesicles created at all concentrations, particularly in plants exposed to concentrations of 65–80 and 85–120 ppb, while no effects were noted in these organelles in control plants or plants exposed to 40–60 ppb. High concentrations (85–120 ppb) led to enlarged, irregularly shaped nuclei and chromatin intensification; however, no clear effects of ozone were noted on the shapes of chloroplast starch grains or the mitochondria in leaf mesophyll and cortex cells in the stem. The high ozone concentrations can cause negative effects on the growth of alfalfa seedlings, leading to imbalances in their vital functions and acceleration of aging, thus potentially decreasing the total plant yield. The discoveries hence propose that alfalfa plants should not be planted near polluted areas, and that they can be utilized as bioindicators of air pollution by ozone.     

Upper airway CO2 receptors in tegu lizards: localization and ventilatory sensitivity

1. Tidal volume, end-tidal CO2, and ventilatory frequency in Tupinambis nigropunctatus were measured in response to CO2 (1-4%) delivered to either the mouth or nares. Additionally, the sensitivity of the ventilatory response to nasal CO2 was evaluated at CO2 concentrations less than 1%. The ventilatory parameters were also measured in response to CO2 (1-4%) delivered to the nares after the olfactory peduncle was transected. 2. It was found that (0.4-4%) nasal CO2 depressed ventilatory frequency by 9% to 83% respectively, while tidal volume was not significantly altered. CO2 (1-4%) delivered to the mouth produced no apparent changes in any of the ventilatory parameters. Following transection of the olfactory peduncle, nasal CO2 was ineffective in producing any change in ventilatory frequency or depth. 3. These findings indicate that CO2-sensitive receptors are located in either the nasal or vomeronasal membranes of tegu lizards and that the olfactory peduncle must be intact for these receptors to affect ventilatory changes in response to elevated CO2 concentrations. The receptors are capable of mediating a ventilatory response to CO2 concentrations lower than those found in either expired air or in confined spaces such as occupied burrows. 4. The discrepancies in the ventilatory responses of lizards and snakes to inspired CO2 reported in past experiments may be partially explained by the presence of nasal or vomeronasal CO2-sensitive receptors.     

An epidemiological approach investigating respiratory disease response in sensitive individuals to indoor and outdoor pollen exposure in Tucson,Arizona

Summary We conducted this study during the early spring to demonstrate direct response between increases in atmospheric pollen concentrations and symptom prevalence in a general population. We examined pollen concentrations indoors, outdoors and regionally in 31 households with similar background vegetation, pollen concentration, TSP and pollulant gas levels. Indoor pollen concentrations were low but persistent (X=16 grains/m³ air); local outdoor concentrations were 3 times greater. Regional daily mean pollen values of grasses, ragweed, mulberry and total pollen were compared with symptom scores using X² contingency tests. We obtained daily symptom scores and measures of peak expiratory flow from 121 individuals characterized as ?normal?, ?atopic? or ?peak flow responsive?. In atopic individuals, prevalence of nasal symptoms increased with pollen concentration increases for ragweed, mulberry and total pollen exposure. No significant response was found with spring grasses whose atmospheric pollen concentration was limited in the selected cluster. Decrease of lung function in the peak flow responsive population was found associated with mulberry pollen only. The small pollen grain size may result in greater tracheo-bronchial deposition.     

Indoor Air Pollution Aggravates Symptoms of Atopic Dermatitis in Children

Most of researches on the impact of indoor air pollutants on atopic dermatitis (AD) have been based upon animal models, in vitro experiments and case-control studies. However, human data to elucidate the role of indoor air pollution on worsening symptoms of pre-existing AD from a longitudinal study are scarce. The objective of this prospective study was to evaluate the effect of indoor air pollution on AD symptoms in children. We surveyed 30 children with AD in a day-care centre, which moved to a new building during the study. These children stayed there for 8 hours a day Monday through Friday, and their daily symptom scores were recorded. Indoor and outdoor air pollutant levels were continuously measured 24 hours a day for 12 months (Period 1 to 4). Data were analyzed using a generalized linear mixed model. Compared to the period before moving (Period 1), concentrations of indoor air pollutants mostly increased after moving (Period 2) and decreased by natural ventilation and bake-out (Periods 3 and 4). The rate of positive AD symptom increased from 32.8% (Period 1) up to 43.8% (Period 2) and 50.5% (Period 3), then decreased to 35.4% in Period 4 (P < 0.0001). When the delayed effects of indoor air pollutants on AD symptoms 2 days later were evaluated, AD symptoms significantly increased by 12.7% (95% CI: -0.01 to 27.1) as toluene levels increased by 1 ppb (P = 0.05). In conclusion, indoor air pollutants increase the risk of AD aggravation in children and toluene in the indoor environment might act as an aggravating factor.     

A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis.

A double blind, placebo-controlled, parallel-group clinical study was carried out to evaluate the effect of an Andrographis paniculata (N.) extract SHA-10 fixed combination, Kan Jang, in the treatment of acute upper respiratory tract infections, including sinusitis. Ninety-five individuals in the treatment group and 90 individuals in the placebo group completed the study according to the protocol. The medication was taken for 5 days. Temperature, headache, muscle aches, throat symptoms, cough, nasal symptoms, general malaise and eye symptoms were taken as outcome measures with given scores. The total score analysis showed a highly significant improvement in the verum group versus the placebo. This result applied to the group as a whole and to the sinusitis subgroups. The individual symptoms of headache and nasal and throat symptoms together with general malaise showed the most significant improvement while cough and eye symptoms did not differ significantly between the groups. Temperature was moderately reduced in the verum group. It can be concluded that Kan Jang has a positive effect in the treatment of acute upper respiratory tract infections and also relieves the inflammatory symptoms of sinusitis. The study drug was well tolerated.