Nigella Sativa and Respiratory Illness
[COVID19 Research Included]

WRITTEN BY ZOE SMITH, PHARMACIST AND LEAD HEALTH WRITER
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 Respiratory tract infections are one of the most frequent diseases seen in children, the elderly, and immunocompromised persons. Even for international travelers, respiratory infections account for the third most frequent health problem encountered.
 
In developed countries, acute respiratory infections (ARIs) have been reported to account for a greater percentage of antibiotic prescriptions written, 20% of all medical conditions, and over 30% of work absence. Respiratory infections can also cause a significant deal of morbidity and mortality in complex emergencies, and as such, prevention and proper treatment are advised.

Nigella sativa (black cumin) has been widely used for centuries in folk medicine because of its therapeutic effects. It shows promise with preventive and restorative properties as an antioxidant, anti-inflammatory, anti-histaminic, immunomodulatory, anti-allergic, bronchodilatory, and antitussive agent as a lasting remedy for respiratory infections.

 Respiratory Infections
Respiratory infections (also known as respiratory tract infections) affect the sinuses, throat, airways, and lungs.

The human respiratory system consists of the nose, sinuses, mouth, throat (pharynx), voice box (larynx), windpipe (trachea), and lungs. Usually, respiratory tract infections are divided into two:  upper respiratory infections and lower respiratory infections.
 
Upper respiratory infections affect the higher parts of the respiratory system, such as the nose, sinuses, and the throat. Lower respiratory infections affect the airways and lungs, which are lower in the respiratory tract.
 
Upper Respiratory Tract Infections
The upper respiratory tract is made up of the sinuses, nasal passages, pharynx, and larynx. Infections that affect these parts are known as upper respiratory tract infections (URTIs). These infections are among the most common reasons for doctor visits, missed days at work or school. 
 
Examples of upper respiratory infections include:

• Common cold (nasopharyngitis)- the inflammation of the nares, pharynx, hypopharynx, uvula, and tonsils.
• Rhinitis- inflammation of the nasal cavity.
• Tonsillitis- inflammation of the tonsils.
•  Laryngitis- Inflammation of the larynx.
• Sinus infection (sinusitis or rhinosinusitis) - inflammation of the sinuses around the nose.
• Pharyngitis- inflammation of the pharynx, uvula, and tonsils.
• Epiglottitis –inflammation of the epiglottis, that is, the upper portion of the larynx.
• Laryngotracheitis- inflammation of the larynx and trachea.
• Tracheitis- inflammation of the trachea.

 
Flu may either be an upper or a lower respiratory tract infection.
 
Symptoms
Symptoms of URTIs include the following:

• Runny nose
• Cough
• Sneezing
• Sore throat
• Nasal discharge
• Nasal congestion
• Headache
• Painful swallowing
• Fever
• Difficulty in breathing (dyspnoea)

 
Other less common symptoms are:

• Foul breath
• Sinus pain
• Reduced ability to smell (hyposmia)
• Conjunctivitis (itchy and watery eyes)
• Nausea
• Vomiting
• Body aches

 
Usually, these symptoms last for three to fourteen (3-14) days. Symptoms lasting more than 14 days may require an alternative diagnosis.

 Causes
Usually, URTIs are caused by a direct invasion of the inner lining known as the mucus membrane or mucosa of the upper respiratory tract by a virus or bacteria.
 
The body naturally has certain physical and immunological barriers that prevent invasion by these pathogens and the resultant infections. Examples of physical barriers include hair in the nose and cilia (in the trachea). Adenoids and tonsils act as immunological barriers that help fight infections via the actions of antibodies, specialized cells, and chemicals within them by engulfing invading microbes.
 
However, when these barriers are compromised, infections set in. Viruses and bacteria that cause URTIs include rhinoviruses, Group A streptococci, influenza virus, parainfluenza virus, respiratory syncytial virus (RSV), diphtheria virus, and Epstein-Barr virus (EBV).
 
In other cases, environmental factors such as irritants may cause the respiratory tract's mucosa lining to be irritated and inflamed, leading to an infection. These irritants include pollen, chemicals, dust, and smoke, amongst others.
 
Risk factors include:

• Physical or close contact with someone with a URTI
• Coming in close proximity with children in daycare centers and schools
• Poor hand washing, especially after coming in contact with an infected person or substance.
• Smoking (including passive smoking)
• Being in an immunocompromised state of health
• Working in health-care facilities, hospitals, and nursing homes.
  

 Lower Respiratory Infections
They are any infections that affect the lower parts of the respiratory system, including the airways (particularly below the larynx) and the lungs. They usually last longer and more severe than URTIs.
 
Common lower respiratory tract infections include:

• Bronchitis- inflammation of the bronchi
• Pneumonia- infection of the alveoli
• Bronchiolitis –inflammation of the bronchioles
• Tuberculosis – caused by Mycobacterium tuberculosis, a pneumonia that gets worse slowly.
• Asthma – a condition where the airways are inflamed continuously, resulting in spasms.
• Other lung diseases such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, emphysema, acute respiratory distress syndrome (ARDS), pneumoconiosis, and lung cancer.

 
Symptoms
Symptoms of lower respiratory tract infections vary depending on the severity of the infection.

• Runny nose
• Dry cough
• Sore throat
• Headache
• Productive cough (one that produces phlegm)
• Breathing difficulty (dyspnoea)
• Rapid breathing (tachypnea)
• Wheezing
• Chest pain
• Fever
• Weakness
• Fatigue

 
Causes
Causes include:

• Viruses, such as a respiratory syncytial virus (RSV, parainfluenza virus, influenza A virus, adenovirus, coronavirus, etc.
• Bacteria, such as Streptococcus, Staphylococcus aureus, Klebsiella pneumonaie, Acinetobacter spp.
• Fungal infections caused by Candida spp., Aspergillus spp. Alternaria spp. Cladosporium spp.
• Mycoplasma (small organisms that share the characteristics of both viruses and bacteria but aren’t either)
• Irritants such as tobacco smoke, chemicals, fumes, dust, allergens, etc.

 
Risk factors that predispose a person to lower respiratory tract infections include:

• A recent flu or cold
• A compromised immune system
• Old age (>65 years old)
• Young age (<5 years old)
• Recent surgery
  

 Clinical Evidence: Nigella sativa as a Treatment for Respiratory Infections
Nigella sativa is a plant from the family Ranunculaceae. It is native to Southern Europe, North Africa, and Southwest Asia and cultivated across the globe in countries like the Middle Eastern Mediterranean region, South Europe, Turkey, India, Saudi Arabia, Pakistan, and Syria.
 
N. sativa is one of the various medicinal plants used over the years as a spice, food preservative, and in traditional medicine. However, it has been researched and revealed in recent times to have a broad spectrum of pharmacological potential.
 
It is also known by the following names: black seed, black cumin, kalonji, and haba al barakah.
 
Scientifically tested over the years, Nigella sativa ( black cumin) has been proven to have several therapeutic properties. In reference to respiratory infections, these include antioxidant, anti-inflammatory, antihistaminic, immunomodulatory, anti-allergic, bronchodilatory, and antitussive properties.
 
According to a 2019 study, when the bronchodilatory, antioxidant, anti-inflammatory and immunomodulatory are considered, N. sativa and its constituents are an effective remedy in allergic and obstructive lung diseases. They can also be regarded as preventive and relieving therapy for other respiratory diseases. These lung disease cases studied in the research included allergic rhinitis, asthma, bacterial rhinosinusitis, sepsis, lung injury and inflammation, aspiration lung injury, and pulmonary artery hypertension, amongst others.
 
In chemical war victims, N. sativa was proven to improve pulmonary function tests (PFT) values, respiratory symptoms, and chest wheeze. In geriatric patients, nostril spray of N. sativa oil relieved respiratory symptoms of nasal dryness, obstruction, and crusting. N. sativa extract also relieved sore throat in patients with acute tonsillo-pharyngitis.
 
A study on sinusitis, an upper respiratory tract infection, further confirmed the preventive effect of Nigella sativa (black cumin) oil in inhibiting inflammation of the sinuses and respiratory airways. When administered to patients suffering from sinusitis's clinical symptoms, it improved coryza, nasal congestion, headache, neck pain, earache, and toothache.
 
In asthma, N. sativa demonstrated multiple effects of bronchodilation, anti-histaminic, anti-inflammatory, anti-leukotrienes, and immunomodulatory effects.  A literature review reported that clinical studies showed improvements in symptoms, pulmonary function tests, and laboratory parameters, as well as alleviating airway inflammation. A 2018 study also confirmed NS effects on asthma. It stated that it was effective as an anti-inflammatory agent on mast cells by inhibiting the release of histamine with no toxic effect on the mast cell.

  
According to a comprehensive review that investigated the effects of thymoquinone (TQ), a significant bioactive constituent of N. sativa, on pulmonary disorders, TQ was confirmed to provide therapeutic effects of antioxidant, anti-inflammatory, anti-asthmatic, and anti-tumour activity against lung disorders. The lung disorders investigated were inflammatory lung diseases, lung fibrosis, asthma, and lung cancer.
 
Nigella sativa has also shown promise for lung tissue damage. According to a 2010 animal study, treatment with N.sativa (black cumin) seed extract inhibited inflammatory pulmonary responses. It was suggested as a remedy for cases of lung injury leading to lung tissue damage. Another similar study on rats with hyperoxia-induced lung injury showed that those treated with NS experienced a reduction in the severity of lung damage.
 
As a remedy for tuberculosis, thymoquinone (TQ) was found to possess activity against the causative microorganism of tuberculosis, Mycobacterium tuberculosis. In another research, N. sativa was proven to possess anti-tubercular property, even against drug-resistant tuberculosis.

 While some researchers have suggested Nigella sativa as a healing remedy for Covid-19, a Nigerian Governor in April 2020 revealed that he fought and survived Covid-19 infection with black seed oil, amongst other things. It was later reported in a study that N. sativa could be used as adjuvant therapy for Covid-19.

This could be linked to studies that proposed that thymoquinone (TQ), an active constituent in N. sativa, may inhibit SARS-CoV-2 and interfere with its binding to angiotensin II converting enzymes (ACE2) receptors. This action is said to prevent virus entry and replication in the host cell.

It also reduces the risk of infection by interfering with the attachment of SARS-CoV-2 to the HSPA5 substrate-binding domain b (SBDb) on the stressed cells.

Protocol - took lots of vitamin c and ate lots of carrots + 1 teaspoon of black seed oil and 1 teaspoon of honey morning and evening. 

Thus, with several positive results of the use of Nigella sativa (black cumin) seeds, oil, and extracts in several respiratory infections, it can be said that Nigella sativa stands as a potential preventive measure and treatment option for people with upper and lower respiratory tract infections.