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Ivy Leaf Extract is a treatment of cough

Ivy Leaf Extract is a treatment of cough 

Purpose
Acute cough due to viral upper respiratory tract infections (URTIs) and bronchitis is a common reason for patients to seek medical care. Non-antibiotic over-the-counter cough medications such as ivy leaf extract are frequently used but their efficacy is uncertain. Our purpose was to update our previous systematic review and evaluate the effectiveness and tolerability of ivy leaf in the treatment of acute URTIs in adult and pediatric populations.

Methods
We searched MEDLINE, EMBASE, the Cochrane Library, and clinical trial registries from December 2009 to January 2020. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), and observational studies (OSs) investigating ivy leaf mono- or combination preparations were included. Two independent reviewers assessed records for eligibility and risk of bias and performed data extraction.

Results
Six RCTs, 1 CCT, and 4 OSs were identified. Since the publication of our previous review, the number of RCTs has increased. All studies concluded that ivy leaf extract is an effective and safe option for the treatment of cough due to URTIs and bronchitis. Three RCTs reported a more rapid reduction in cough severity and/or frequency under ivy leaf treatment. The clinical significance of these effects appears to be minimal. No serious adverse effects were reported. The overall quality of reporting was low and the risk of bias was high.

Introduction
Acute cough is one of the most common reasons for an individual to seek physician care and to require sick leave from work or school. Viral upper respiratory tract infections (URTIs) and acute bronchitis are the most common cause of acute cough and are hallmarked by general malaise, low or no fever, sore throat, rhinitis, congestion, headache, muscle aches, and cough. Systemic symptoms typically recede after 2–3 days but cough may persist for several weeks.

Antibiotics for viral URTIs and bronchitis are ineffective and even harmful due to potential side effects as well as the contribution to the development of bacterial resistance. Despite widespread knowledge of the associated risks, antibiotics are frequently prescribed to patients with URTIs and bronchitis. To combat this issue and to assist physicians in the challenge of alleviating acute cough caused by viral illnesses, a strong evidence base regarding the efficacy and safety of non-antibiotic cough remedies in adults and children is needed.

Ivy leaf (Hedera helix) extract preparations are widely used over-the-counter, non-antibiotic cough remedies authorized by the European Medicines Agency. Ivy leaf extract contains saponins which are believed to have expectorant properties. In vitro studies of ivy mono-preparations show evidence of potential antispasmodic and bronchodilating activity, anti-inflammatory effects, and antitussive properties. This review is an update of our systematic review published in 2011 which found that evidence for the efficacy of ivy leaf extract in acute cough was inconclusive due to lack of methodologically robust data. The objective of this review was to identify and evaluate new data regarding the effectiveness and tolerability of ivy leaf in the symptomatic treatment of acute bronchitis associated with acute URTIs in children and adults.

Conclusions
Ivy leaf preparations are safe for use in cough due to acute URTIs and bronchitis. However, effects are minimal at best and of uncertain clinical importance.



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