Clinical Question: In adults with acute bronchitis symptoms of short duration, is an extract of Pelargonium sidoides more effective than placebo in reducing symptoms?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (double-blinded)

Allocation: Concealed

Synopsis: Pelargonium sidoides is approved in several countries for the treatment of acute respiratory tract infection based on a possible antimicrobial or immune modulation action. Russian, German, and American researchers conducted this study using a root preparation available in Germany (Umckaloabo). They recruited 124 patients from outpatient clinics in Russia who had had acute bronchitis symptoms for less than 48 hours, defined clinically and by a bronchitis severity score (BSS) greater than 4 out of a possible 20 (average score = 9). The BSS rates cough, sputum, rales or rhonchi, chest pain during coughing, and dyspnea, each on a score from 0 to 4.

Approximately 25 percent of the patients were current smokers and another 31 percent had the designation of “no remark or classification not possible.” The patients were randomized, using concealed allocation, to receive taste- and color-matched placebo or the pelargonium extract at a dose of 1.5 mL (30 drops) three times daily for eight days. The intention-to-treat analysis was performed with the statistician blinded to treatment assignment.

At the end of treatment, BSS scores had decreased by an average of 7.2 points in the treatment group compared with 4.9 points in the placebo-treated patients (absolute difference = 2.3 points; 95% confidence interval, 1.2 to 3.6;P < .001). More than 90 percent of patients in the treated group had a BSS greater than 5; the rate in the placebo group was 52 percent (P < .001). Significantly more patients receiving treatment reported satisfaction than did those receiving placebo (80 versus 43 percent; number needed to treat = 2.7).

Bottom Line: Pelargonium sidoides extract produced a significantly greater reduction in symptoms of acute bronchitis than placebo, and more patients were satisfied with treatment. As with all herbal products, results may vary. (Level of Evidence: 1b)