Document Type : review article


1 Department of Pediatric Pulmonology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

4 Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Pediatric Pulmonology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Background: Patients with Cystic Fibrosis (CF) often have respiratory tract infections and bacterial colonization requiring antibiotic treatment. The use of complementary treatments such as Compound Honey Syrup (CHS) in Persian medicine is increasing in the treatment of diseases. This study aimed to assess the effects of Compound Honey Syrup (CHS) on CF-induced changes in pulmonary symptoms, and Body Mass Index (BMI) in children.
Method: In a before/after clinical trial, 44 children aged ≥6 suffering from CF were included. They were referred to Mofid children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, between March 2020 and March 2021. The patients received their standard treatment, plus CHS (prescribed at 5-10 cc dose twice daily according to the weight of children (weight over 30 kg 10 ccs and under 30 kg 5 ccs) for 12 weeks. The Cystic Fibrosis Questionnaire-Revised (CFQ-R) was used to determine the Severity of pulmonary symptoms. Moreover, BMIs were compared before and after CHS intervention.
Results: CHS administration for 12 weeks improved daily cough (P=0.000), sputum production (P=0.003), wheezing (P=0.000), difficulty breathing (P=0.002), and night-time cough scores (P=0.004) considerably in CF patients after intervention. Moreover, CHS consumption increased BMI (P=0.000) in these patients.
Conclusion: It can be concluded that compound honey syrup can be a safe and effective complementary medicine to improve pulmonary symptoms and nutritional status of cystic fibrosis patients. In order to confirm these results, it is recommended to conduct more studies with larger sample sizes in order to evaluate the effect of CHS on pulmonary symptoms and BMI in cystic fibrosis patients.


  1. Bierlaagh MC, Muilwijk D, Beekman JM, Ent CKvd, A new era for people with cystic fibrosis. European Journal of Pediatrics, 2021. 180(9): p. 2731-2739.
  2. Stoltz, D.A., D.K. Meyerholz, and M.J. Welsh, Origins of cystic fibrosis lung disease. New England Journal of Medicine, 2015. 372(4): p. 351-362.
  3. Ehre, C., C. Ridley, and D.J. Thornton, Cystic fibrosis: an inherited disease affecting mucin-producing organs. The international journal of biochemistry & cell biology, 2014. 52: p. 136-145.
  4. Garcia, A.M. and J. Dorsey, Nonpulmonary manifestations of cystic fibrosis, in Kendig's Disorders of the Respiratory Tract in Children. 2019, Elsevier. p. 788-799. e3.
  5. Collins, S., Nutritional management of cystic fibrosis–an update for the 21st century. Paediatric respiratory reviews, 2018. 26: p. 4-6.
  6. Pillarisetti N, Williamson E, Linnane B, Skoric B, Robertson CF, Robinson P, Massie J, Hall GL, Sly P, Stick S, Ranganathan S; Australian Respiratory Early Surveillance Team for Cystic Fibrosis (AREST CF), Infection, inflammation, and lung function decline in infants with cystic fibrosis. American journal of respiratory and critical care medicine, 2011. 184(1): p. 75-81.
  7. Girón Moreno RM, García-Clemente M, Diab-Cáceres L, Martínez-Vergara A, Martínez-García MA, Gómez-Punter RM, Treatment of pulmonary disease of cystic fibrosis: A comprehensive review. Antibiotics, 2021. 10(5): p. 486.
  8. Turcios, N.L., Cystic fibrosis lung disease: an overview. Respiratory care, 2020. 65(2): p. 233-251.
  9. Ahmed, N.N. and P.R. Durie, Nonpulmonary manifestations of cystic fibrosis, in Kendig & Chernick's Disorders of the Respiratory Tract in Children. 2012, Elsevier. p. 781-795.
  10. Konstan MW, Pasta DJ, Wagener JS, VanDevanter DR, Morgan WJ, BMI fails to identify poor nutritional status in stunted children with CF. Journal of Cystic Fibrosis, 2017. 16(1): p. 158-160.
  11. Qi Q, Li T, Li JC, Li Y, Association of body mass index with disease severity and prognosis in patients with non-cystic fibrosis bronchiectasis. Brazilian Journal of Medical and Biological Research, 2015. 48: p. 715-724.
  12. Mogayzel Jr PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB, Lubsch L, Hazle L, Sabadosa K, Marshall B; Pulmonary Clinical Practice Guidelines Committee, Cystic fibrosis pulmonary guidelines: chronic medications for maintenance of lung health. American journal of respiratory and critical care medicine, 2013. 187(7): p. 680-689.
  13. Eakin, M.N. and K.A. Riekert, The impact of medication adherence on lung health outcomes in cystic fibrosis. Current opinion in pulmonary medicine, 2013. 19(6): p. 687.
  14. Tanase, A. and R. Zanni, The use of complementary and alternative medicine among pediatric cystic fibrosis patients. The Journal of Alternative and Complementary Medicine, 2008. 14(10): p. 1271-1273.
  15. Mark, J.D. and Y. Chung, Complementary and alternative medicine in pulmonology. Current opinion in pediatrics, 2015. 27(3): p. 334-340.
  16. Sadr S, Kaveh S, Choopani R, Bayat H, Mosaddegh M, Efficacy and safety of Iranian poly herbal formulation (compound honey syrup) in pediatric patients with mild to moderate asthma: A randomized clinical trial. Galen Medical Journal, 2017. 6(4): p. 291-301.
  17. Podlogar, J.A. and E.J. Verspohl, Antiinflammatory effects of ginger and some of its components in human bronchial epithelial (BEAS‐2B) cells. Phytotherapy Research, 2012. 26(3): p. 333-336.
  18. Hong JW, Yang GE, Bum Kim Y, Hyun Eom S, Lew JH, Kang H, Anti-inflammatory activity of cinnamon water extract in vivo and in vitro LPS-induced models. BMC complementary and alternative medicine, 2012. 12(1): p. 1-8.
  19. Cohen HA, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel Y, Kozer E, Pomeranz A, Efrat H, Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics, 2012. 130(3): p. 465-471.
  20. AAHiA, I., Al Qanoun fe Al teb Al elmy al matbouat Institute. 2005, Lebanon.
  21. Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin Jr CM, Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Archives of pediatrics & adolescent medicine, 2007. 161(12): p. 1140-1146.
  22. Eccles, R., Mechanisms of the placebo effect of sweet cough syrups. Respiratory physiology & neurobiology, 2006. 152(3): p. 340-348.
  23. Muhamad R, Draman N, Aziz AA, Abdullah S, Jaeb MZM, The effect of Tualang honey on the quality of life of patients with chronic obstructive pulmonary disease: a randomized controlled trial. Journal of Taibah University Medical Sciences, 2018. 13(1): p. 42-50.
  24. Townsend EA, Siviski ME, Zhang Y, Xu C, Hoonjan B, Emala CW, Effects of ginger and its constituents on airway smooth muscle relaxation and calcium regulation. American journal of respiratory cell and molecular biology, 2013. 48(2): p. 157-163.
  25. Hosseinzadeh H, Ghenaati J, Evaluation of the antitussive effect of stigma and petals of saffron (Crocus sativus) and its components, safranal and crocin in guinea pigs. Fitoterapia, 2006. 77(6): p. 446-448.
  26. Khan, A.-u., Q.J. Khan, and A.-H. Gilani, Pharmacological basis for the medicinal use of cardamom in asthma. ||| Bangladesh Journal of Pharmacology, 2011. 6(1): p. 34-37.
  27. Hamad A, Alifah A, Permadi A, Hartanti D, Chemical constituents and antibacterial activities of crude extract and essential oils of Alpinia galanga and Zingiber officinale. International Food Research Journal, 2016. 23(2).
  28. Ahui MLB, Champy P, Ramadan A, Pham Van L, Araujo L, André KB, Diem S, Damotte D, Kati-Coulibaly S, Atté Offoumou M, Dy M, Thieblemont N, Herbelin A, Ginger prevents Th2-mediated immune responses in a mouse model of airway inflammation. International immunopharmacology, 2008. 8(12): p. 1626-1632.
  29. Corren J, Lemay M, Lin Y, Rozga L, Randolph RK, Clinical and biochemical effects of a combination botanical product (ClearGuard™) for allergy: a pilot randomized double-blind placebo-controlled trial. Nutrition Journal, 2008. 7: p. 1-8.
  30. Ose R, Tu J, Schink A, Maxeiner J, Schuster P, Lucas K, Saloga J, Bellinghausen I, Cinnamon extract inhibits allergen‐specific immune responses in human and murine allergy models. Clinical & Experimental Allergy, 2020. 50(1): p. 41-50.
  31. Roussel AM, Hininger I, Benaraba R, Ziegenfuss TN, Anderson RA, Antioxidant effects of a cinnamon extract in people with impaired fasting glucose that are overweight or obese. Journal of the American College of Nutrition, 2009. 28(1): p. 16-21.
  32. Hosseini, A., B.M. Razavi, and H. Hosseinzadeh, Pharmacokinetic properties of saffron and its active components. European Journal of Drug Metabolism and Pharmacokinetics, 2018. 43: p. 383-390.
  33. Seo JW, Cho SC, Park SJ, Lee EJ, Lee JH, Han SS, Pyo BS, Park DH, Kim BH, 1′-Acetoxychavicol acetate isolated from Alpinia galanga ameliorates ovalbumin-induced asthma in mice. PloS one, 2013. 8(2): p. e56447.
  34. Stallings VA, Stark LJ, Robinson KA, Feranchak AP, Quinton H; Clinical Practice Guidelines on Growth and Nutrition Subcommittee; Ad Hoc Working Group, Evidence-based practice recommendations for nutrition-related management of children and adults with cystic fibrosis and pancreatic insufficiency: results of a systematic review. J Am Diet Assoc, 2008. 108(5): p. 832-9.
  35. Park SH, Jung SJ, Choi EK, Ha KC, Baek HI, Park YK, Han KH, Jeong SY, Oh JH, Cha YS, Park BH, Chae SW, The effects of steamed ginger ethanolic extract on weight and body fat loss: a randomized, double-blind, placebo-controlled clinical trial. Food science and biotechnology, 2020. 29(2): p. 265-273.
  36. Abedimanesh N, Bathaie SZ, Abedimanesh S, Motlagh B, Separham A, Ostadrahimi A, Saffron and crocin improved appetite, dietary intakes and body composition in patients with coronary artery disease. Journal of cardiovascular and thoracic research, 2017. 9(4): p. 200.
  37. Erejuwa O, Ezeokpo B, Nwobodo N, Asika EC, Nwadike KI, Uwaezuoke NJ, Nwachukwu D, Ude UN, Abdul Wahab MS, Sulaiman SA.“Effect of Honey on Body Weight, Body Mass Index and Adiposity in High-Fat Diet Fed Wistar Rats”. EC Pharmacology and Toxicology, 2017. 3: p. 03-12.