5 Inte r v iew Glycyrrhiza glabra Doctor, how prevalent are respiratory tract infections (RTIs)? Most RTIs follow seasonal patterns, with a high incidence during winter. Several laboratory and clinical studies suggest that inhaling cold air and a lowered body temperature can cause vasoconstriction in the respiratory tract mucosa and suppress the immune system functioning. This leads to an increased susceptibility to infections of the respiratory tract. Per the WHOʼs reports, 2 to 5 million cases of RTIs are reported every year. COVID-19 is the latest addition to the etiology of respiratory infections. The infection is asymptomatic or mildly symptomatic in a majority of patients, but it can progress to severe complications and become lifethreatening. What are the red-flag symptoms of RTIs that could be lifethreatening? A majority of the RTIs that affect the upper respiratory tract are self-limiting. However, infections of the lower respiratory tract require medical attention to prevent serious consequences. Rapid respiratory rate, difficulty in breathing, intermittent apnea, hypoxia, and a history of chronic lung disease are some of the warning signs of worsening RTIs. Superinfection of the respiratory tract by bacteria such as Streptococcus pyogenes, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Haemophilus influenzae can further cause adverse effects if timely diagnosis is not done. It is important to be watchful of these red flags during diagnosis. Could you brief us about severe acute respiratory infection (SARI)? SARI is an acute respiratory infection that lasts for 10 days with a fever of ≥ 100°F and cough and requires hospitalization. SARI is most commonly caused by influenza A and B viruses, parainfluenza viruses, respiratory syncytial viruses, adenoviruses, rhinoviruses, and coronaviruses. SARI is among the leading causes of hospitalization and deaths worldwide. Due to the overlapping of symptoms of SARI and COVID-19, it is important to consider all patients with SARI for COVID-19 monitoring. Doctor, why are some individuals prone to recurrent RTIs? Transmission of respiratory pathogens occurs more frequently during winter, through aerosol droplets or by direct contact. Rhinoviruses account for more than 50% of recurrent RTIs. People with asthma or allergic rhinitis are more prone to recurrent RTIs. Exposure to external factors such as air pollution and passive smoking also increases the risk of developing recurrent RTIs. What do you prescribe to your patients with RTIs? I often prescribe Septilin to my patients with RTIs. Septilin is a polyherbal formulation from Himalaya Wellness Company, known for its immunomodulatory, antimicrobial, anti-inflammatory, antioxidant, and expectorant properties. Septilin’s immunity-boosting property has been proven to be beneficial in treating various infections including RTIs and also for preventing their recurrence. Dr B Ramana Rao, MBBS, FAGE, MD, FICA, FAIID Consulting Physician and Cardiologist Village Clinic T Begur, Nelamangala Taluk Bengaluru 562123, Karnataka India English name: Licorice Sanskrit name: Yashtimadhu Morphology and Habitat Glycyrrhiza glabra is a perennial shrub that grows up to 2.5 m.1 The leaves are pinnate, and the flowers are purple to pale whitish blue. The fruits are 2- to 3-cm long legumes or pods.2 The herb grows abundantly in temperate, warm, and subtropical climates and remains dormant in winter. It is mainly found in Spain, Italy, Turkey, Iran, Iraq, Central Asia, and northwestern China.3 Medicinal Uses G glabra is used for its antiviral, antioxidant, antimicrobial, antispasmodic, antiallergic, anti-inflammatory, immunomodulatory, antitussive, and expectorant properties.1 Glycyrrhizan GA, an acidic polysaccharide derived from the stolon of G glabra, has been shown to significantly increase the activity of the reticuloendothelial system and also to enhance phagocytosis. 18β-Glycyrrhetinic acid, a primary metabolite of glycyrrhizin, is a potent inhibitor of the classical complement pathway.3 G glabra is known for its anti-inflammatory property. A study shows that the anti-inflammatory effect of glycyrrhizin is due to the inhibition of generation of reactive oxygen species by the neutrophils.4 The administration of glycyrrhizin prior to carrageenan exerted a potent anti-inflammatory effect in mice.3 In a study, the antibacterial activity of different concentrations (2.5, 5, and 10 mg/mL) of the ethanolic root extract of G glabra was tested against Streptococcus mutans, Streptococcus sanguis, Streptococcus salivarius, Streptococcus mitis, and Lactobacillus acidophilus using the disk diffusion technique. Results showed that all the concentrations of G glabra exhibited antibacterial activity. The ethanolic root extract was highly effective against S mutans, with a good zone of inhibition. The minimum bactericidal concentration and minimum inhibitory concentration values were low (2 mg/mL) for S mutans and S sanguis, indicating the high efficacy of the extract.5 References 1. Kaur R, et al. Int J Pharm Sci Res. 2013;4(7):2470–2477. 2. Pastorino G, et al. Phytother Res. 2018;32(12):2323–2339. 3. Lim TK. Edible Med Non-Med Plant. 2015;354–457. 4. Akamatsu H, et al. Planta Med. 1991;57(2):119–121. 5. Geetha RV, Roy A. Int J Drug Dev Res. 2012;4(4):161–165. Septilin® Builds the body’s own defense mechanism Manage recurrent respiratory infections with… Septilin Builds the body’s own defense mechanism ® Regd. Trademark ( SYRUP , TABLET ) • Corrects the underlying pathological features of infections and allergies • Offers beneficial antimicrobial and antiviral actions • Improves the body’s immune defenses Indications • Recurrent RT and ENT infections (tonsillitis, pharyngitis, bronchitis, sinusitis, and otitis media) • Resistance to antibiotic therapy • As an adjuvant to anti-infective therapy Glycyrrhiza glabra is an ingredient of Septilin Syrup and Tablets.
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