Volume 27, Issue 4 (Autumn 2021)                   Intern Med Today 2021, 27(4): 566-575 | Back to browse issues page

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Soleimani G, Shafiqi Shahri E, Ansari H, Ganjali A, Mollazehi A A. Effectiveness of the Eucalyptus Inhalation on the Upper Respiratory Tract Infections of 5-15 Years Old Children. Intern Med Today 2021; 27 (4) :566-575
URL: http://imtj.gmu.ac.ir/article-1-3562-en.html
1- Department of Children, Children and Adolescents Health Research Center, School of Medicine, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
2- Department of Children, Children and Adolescents Health Research Center, School of Medicine, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. , eshahri@yahoo.com
3- Department of Statistics and Epidemiology, Health Promotion Research Center, Faculty of Health, Zahedan University of Medical Sciences, Zahedan, Iran.
4- Department of Clinical Psychology, Health Promotion Research Center, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran.
5- Department of Pediatrics, School of Medicine, Ali Ibn Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
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1. Introduction
Respiratory infections are classified according to their symptoms and diagnosis. Severe upper respiratory infections include the common cold, pharyngitis, and laryngotracheitis. These infections are usually benign, transient, and self-limiting, but in some cases, they can cause serious illness in children and infants. The causative agents of these infections are viruses, bacteria, mycoplasmas, and fungi. Respiratory infections are more common in the fall and winter when school starts. Upper respiratory tract infections include common cold, sinusitis, otitis, pharyngitis, and laryngotracheitis [1].
 The genus Eucalyptus with more than 700 species belongs to the family Myrtaceae and is of Australian origin. However, the testing of different species in Iran has been started by administrative organizations for about 35 years [2]. Eucalyptus trees, sometimes up to 100 meters in height, are hardwood and durable. Their essential oil is colorless or bright reddish-yellow with a very strong, cool, burning, and highly volatile odor, which is extracted by a variety of special distillation methods [3].
Eucalyptus has grade 2 treatment in the monograph of the World Health Organization Commission and grade 6 in the monograph of European herbalists. Because of its abundant monoterpenes, it has anti-inflammatory, expectorant activities and is used to treat the common cold, nasal congestion, bronchitis, irritation secretion. It also has diuretic, anti-sugar, and anti-tumor properties. The plant oil is used externally as an anti-irritant drug and relieves rheumatism symptoms and minor skin disorders [4].
 The emergence of drug resistance and the ability of bacteria to cause acute infections has revived interest in plants to study their antimicrobial effects. Eucalyptus is one of the most famous medicinal plants long been considered its antimicrobial and other properties. This plant is a rich source of polyphenols and terpenoids, and its main leaf composition is eucalyptol or seoul (70% to 80%) [5].
 Eucalyptus has been used to treat many ailments such as tonsillitis, dysentery, and skin diseases. The leaf extract of this plant has anti-cancer, anti-inflammatory, analgesic, antioxidant, anti-hyperglycemic, anti-malarial, anti-fungal, and anti-viral properties [6, 7, 8]. Eucalyptus has been used in traditional medicine to treat bronchitis, asthma, and other respiratory diseases [9]. Drugs such as herbal incense, which are used to treat nasal congestion in the common cold and have anti-inflammatory effects, contain active ingredients like cineole and menthol, which are found in the essential oils of Eucalyptus and mint, too [10]. Seoul is the main ingredient in eucalyptus essential oil [11], which varies according to the type of species and region, and time of collection. It has different applications in medicine, cosmetics, and industry [12]. Cineol has positive effects on the shock frequency of respiratory cilia of the mucous membrane and is a bronchodilator and anti-inflammation. Researchers hypothesize that menthol has the exact mechanism as the ilium on the smooth muscle in bronchial smooth muscle and prevents calcium transport. On the other hand, in addition to its effect on smooth muscles, menthol affects the sensory nerves and thus has a two-way function [13].
Considering the importance and contagious nature of upper respiratory infections in children, as well as easy and cheap access to herbal remedies and their fewer side effects, we decided to evaluate this herbal medicine by assessing the impact of Eucalyptus incense on various respiratory infections in children.
2. Materials and Methods
This study was performed as a case-control study in Zahedan pediatric clinics, Zahedan City, Iran. The inclusion criteria were having an overt upper respiratory infection, being 5 to 15 years old, lacking immunodeficiency problems, giving parental consent to accept treatment, and lacking previous incomplete treatment. At the beginning of admission, the patients (208 children) were randomly divided into case and control groups. Also, first, the Canadian acute respiratory illness flu scale (CARIFS) evaluation score was recorded by the researcher. The case group had a diagnosis of acute upper respiratory infection (by a respected pediatrician) in specialized pediatric clinics in Zahedan in 2018-2019 (104 people). The control group consisted of patients matched with the case group. 
To prepare Eucalyptus incense, we mixed 2 drops of Eucalyptus oil (Sobhan Pharmaceutical Company) in 750 mL of hot water. In the case group, Eucalyptus was administered every 3 hours for 15 minutes for 3 days. In the control group, water fumigation was prescribed every 3 hours for 15 minutes for 3 days. Finally, the patients of both groups were evaluated by the researcher on the third day, and the information was entered into the CARIFS questionnaire. The obtained data were analyzed with descriptive statistics, including central indicators, dispersion, and frequency distribution, and presented by drawing diagrams and setting tables. An independent t test was also used to compare quantitative data. The significance level of the test was considered 0.05. All analysis was done in SPSS (version 22).
3. Results
In this study, two groups of cases and control (each group of 105 patients) were evaluated. The Mean±SD age of the study samples was 10.74±2.96 years. In each study group, 44.8% were boys, and 55.2% were girls. The study groups were also matched regarding gender, age, and diagnosed disease. As seen in Table 1, before using incense in the study groups, there was no significant difference between the scores of the questionnaires obtained (P<0.05).

However, according to Table 2, Eucalyptus incense significantly improved all types of upper respiratory tract infections in patients.

4. Discussion
The current study showed that administrating Eucalyptus incense in patients with upper respiratory tract infections (all types) improves their symptoms.
 In the study of Cermelli C et al. on the effect of Eucalyptus on bacterial and viral respiratory infections, they found that Parainfluenza, Haemophilus influenza, and Stenotrophomonas maltophilia were the most sensitive organisms to Eucalyptus essential oil. This plant also had anti-viral properties on adenovirus viruses [14]. The current study results are consistent with the above study results.
Eran Ben Arye performed a randomized study using aromatic herbs to evaluate the clinical effects of aromatic essential oil in patients with upper respiratory tract infections. A Eucalyptus spray was administered for the case group and a placebo spray for the control group and was used 3 times a day for 3 days. The primary outcome was the patient’s change in the severity of unpleasant symptoms (sore throat, fatigue, and cough). Intention to treat analysis showed that 20 minutes after spraying, participants in the case group reported a greater improvement in symptoms compared with participants in the placebo group (P=0.019). After 3 days of treatment, there was no difference in the severity of symptoms between the two groups. As a result, the use of Eucalyptus spray in this study resulted in a significant and immediate improvement in the symptoms of upper respiratory illness. This effect was not significant after 3 days of treatment [15]. The current study result was not consistent with our study.
Juergen Fischer et al. performed a placebo-controlled double-blind trial on the efficacy of sinoel in patients with acute bronchitis. After 4 days of treatment, it was found that the patient group using sinoel showed significantly improved bronchitis in comparison with the placebo group (P=0.03). There was also a statistically significant difference in clinical symptoms, especially cough, with the use of this substance after 4 days (P<0.001) [16]. The current study result is in line with the above study.
Acs (2018) reported that cinnamon, thyme, and clove have effective antibacterial activity, but Eucalyptus surprisingly has weak antibacterial activity [17]. The current study is not in line with our research.
5. Conclusion
 These studies showed that Eucalyptus oil is used to treat cough, cold, and the relief of symptoms of upper respiratory diseases [18].
Finally, one of the most important mechanisms for developing symptoms of upper respiratory tract infection is the pervasive inflammation in the host body. As we know, the Eucalyptus plant has anti-inflammatory properties that have been proven in various laboratory studies [19, 20]. So, it can be effective in reducing symptoms in the affected person. At the same time, the synergistic effects with antibacterial properties can make the performance of the plant extract more prominent than before.
Based on these studies, we found that Eucalyptus incense in all diseases involving the upper respiratory tract can significantly improve patients’ symptoms. Therefore, it is recommended that this extract be prescribed at the discretion of a specialist physician according to the patient’s condition.

Ethical Considerations
Compliance with ethical guidelines

This research has received a license and ethical code (IR.ZAUMS.REC.1398.441) from Zahedan University of Medical Sciences.

The research is self-funded.

Authors' contributions
All authors have equally contributed to the writing of this article.

Conflicts of interest
The authors declared no conflict of interest.

This article extracted from a doctoral dissertation at Zahedan University of Medical Sciences. Hereby, the authors express their gratitude and appreciation for the assistance of the Vice Chancellor for Research of the University and the Department of Children of Zahedan University of Medical Sciences in carrying out this project.

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Type of Study: Original | Subject: Pediatrics
Received: 2020/07/30 | Accepted: 2021/07/3 | Published: 2021/10/1

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