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Dr. Bender is Professor of Medicine, University of Florida College of Medicine and Veterans Affairs Medical Center.
Correspondence to: Bradley S. Bender, MD, University of Florida College of Medicine, VA Medical Center 182, Gainesville, FL 32608-1197
Viral respiratory tract infections are extremely common. For example, there are an estimated 20 to 50 million influenza virus infections annually in the United States resulting in 24 million patient visits, 300,000 hospitalizations, and 20,000 to 50,000 deaths.1 Various folk remedies have long played a complementary role in the management of these infections. Simply stated, these are to rest, stay warm, and drink plenty of fluids.
Most patients with influenza who die do so from complications of pneumonia. Rest is thought to decrease the risk of aspirating virus from the upper airways into the lungs. The soldiers most affected in the swine flu outbreak of 1976 in Ft. Dix, NJ, were just beginning basic combat training, a time of exceptional exertion.2
Fever clearly has a beneficial effect on the course of most infections.3 In ferrets that were experimentally infected with influenza virus, significant inverse correlations were found between body temperature and nasal viral titers.4 Furthermore, the suppression of fever either by shaving or by treatment with sodium salicylate prolonged viral shedding.5 The treatment of rhinovirus-infected volunteers with antipyretics also prolongs viral shedding.6 7 The mechanisms by which elevated temperatures inhibit viral replication are not clear but include enhanced immune function and direct inhibition of viral growth. Influenza virus grows best at 34 to 35°C and poorly, if at all, at temperatures > 37°C. Hence, staying warm may have a beneficial antiviral effect. More properly stated, the patient should probably stay in a warm environment; this will keep the airways at a higher temperature.
Proper hydration also appears to be important for loosening secretions. Influenza infection produces a severe tracheitis.8 Early in the disease process, there are copious amounts of pulmonary secretions, which are associated with gaps in the tight junctions. This is followed by thicker secretions later on. The loss of ciliated epithelium emphasizes the need for hydration to improve the pulmonary toilet.
As best as I can determine, Moses Maimonides first wrote of the medicinal effects of chicken soup.9 Based on the above adages, chicken soup would appear to be an ideal remedy. First, chicken soup is best consumed while sitting down. I have an image of my mother and both grandmothers telling me to "Slow down! Don’t eat so fast! You’ll ruin your digestion!" If the infected subject also had to prepare the soup using Mrs. Fleischer’s recipe, cited in the article by Rennard et al in this issue of CHEST (see page 1150), additional "down time" would be assured. (By the way, this recipe is much too complicated for me.) Second, inhaling the warm steam of such a well-prepared delicacy would undoubtedly raise the temperature of the airways and help loosen secretions.10 Finally, the consumption of large amounts of liquid would maintain hydration. Though not true for all medications, in this case if a little is good, then a lot would be better.
Rennard et al address another potential biological benefit of chicken soup on respiratory viral infections. Oy, what a manuscript! (I hope the reader takes Dr. Soffer’s comments on previous chicken soup articles to heart while reading this one.11 ) They showed that extracts of chicken soup significantly inhibited neutrophil chemotaxis (migration) in a standard in vitro assay. The inhibitory substance was present in the chicken and in the vegetables. On a theoretical basis, it makes some sense that the inhibition of chemotaxis would be beneficial in reducing symptoms. Following viral infections, there is an influx of neutrophils to the infected site, which may be responsible for producing some of the local symptoms. This potential mechanism for the beneficial effect of chicken soup needs to be counterbalanced by the concern that the inhibition of chemotaxis may contribute to the increased bacterial superinfection seen in viral infections.12 More importantly, as the authors point out, this is an in vitro study, and whether there are physiologically significant changes in neutrophil chemotaxis following the ingestion of chicken soup has not been demonstrated. One possible method to determine this would be to measure neutrophil chemotaxis in a group of subjects, feed them chicken soup, and then repeat the chemotaxis measurements. (Even better would be to measure experimentally infected subjects’ chemotaxis before and after chicken soup ingestion.) Volunteers for this study should form a line behind me.
References
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