Keywords

3.1 Introduction

Respiratory medicine is a fast-growing field with a vital emphasis and desire for continuous technological developments. The key explanation for this may be pulmonary diseases which are the primary causes of morbidity and death worldwide [1]. World Health Organization (WHO) estimates that some 235 million people are afflicted by asthma found generally in children and about three million people die from Chronic Obstructive Pulmonary Disease (COPD) adding 6% of the world’s total death rate. It is also predicted that COPD will become the third major contributor to death by 2020 [2]. Pollution and low quality of life are the main reasons for the widespread growth of pulmonary diseases. Similarly, lung cancer is now an emerging high-mortality condition. The disease has been identified with approximate mortality of 2.09 million [3]. With the latest COVID-19 pandemic, a respiratory-based disease caused more than 12,00,000 deaths and continuing to increase [4]. This type of current scenario seeks the need to obtain a higher rate of prevention and treatment for pulmonary diseases.

As a compendium of medicinal substances, traditional plants have grown to play a leading role in maintaining human health since ancient times [5, 6]. Good immunomodulatory, anti-oxidant, antibacterial, antidiabetic and anti-cancer functions are known to have been exhibited by several Indian herbal plants [7, 8]. In medicinal drugs, the method of using green extracts and phytoconstituents, each with their known properties, can be of utmost significance. In recent times, several treatment interventions have been adopted for many years in different countries to explain the efficacy and relevance of these medicinal compounds synthesized in the secondary metabolism of the medicinal herb [9]. As per the latest WHO reports, eighty percent of the world’s population relies predominantly on traditional medicines [10]. In Ayurveda, a mixture of different medicinal plants is offered to a person for the treatment of the disease in a specific ratio (a polyherbal formulation). Recently, herbal formulations have gained a lot of significance and increased global interest [11]. In the treatment of asthma, malignant tumors, diabetes mellitus, obesity, etc., different formulations such as Kanchnar guggulu, Chandraprabha vati, and Trayodashang guggulu have been successfully used [12,13,14]. This chapter thus aims to review the broad classification of pulmonary diseases and the advancements in the field of traditional medicine in treating them. Furthermore, the various types of herbal plants, formulations, and phytoconstituents currently being used in the treatment of respiratory ailments would be discussed in detail.

3.2 Classification of Pulmonary Diseases

Pulmonary disease is a type of illness affecting the lungs and other areas of the respiratory system. Lung infections may be caused by microbes, chewing cigarettes, inhaling tobacco smoke, asbestos, or other air pollutants. Chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary embolism, hypertension are some examples of pulmonary diseases [15]. Pulmonary diseases are broadly classified into three categories mainly: (1) lung airway diseases, (2) lung circulatory diseases, and (3) lung tissue diseases.

3.2.1 Lung Airway Diseases

These diseases affect the airway channels that hold oxygen (O2) as well as other gases in and out of the lungs. They typically lead to the airway passage shortening and obstruction. Chronic obstructive pulmonary disease (COPD) is considered a widespread airway disease related to exhalation problems and breathing restriction due to alveoli defects typically caused by greater exposure to harmful particles (e.g. cigarette smoke) [16]. Important variability in symptoms, disease development, pathogenesis, lung pathology, and treatment response are mostly observed in COPD patients (Table 3.1). There are mainly three types of COPD issues which include: (1) asthma, (2) emphysema, and (3) chronic bronchitis.

Table 3.1 Factors responsible for causing variations in chronic obstructive pulmonary disease [17]
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3.2.1.1 Asthma

Asthma is an illness in which the air sacs close and enlarge and can induce mucus in the lungs (Fig. 3.1a). This will make it extremely difficult to breathe, cause cough, wheezing (a howling noise as you exhale), and breathlessness [18]. Asthma is the mainly prevalent debilitating condition in children. It can occur at any age but is probably more frequent in children than in adults. It is important to obtain immediate treatment if the infant begins to develop asthma since it can be potentially fatal [19]. Your physician can advise you on several of the appropriate ways of treating your condition. However, it is a chronic condition lifelong for many individuals. Exposure to numerous allergens and pollutants (e.g. pollen grains, fine dust particles, smoke) that cause allergic reactions can elicit early symptoms of asthma [20].

Fig. 3.1
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(a) Airway of asthma individual (b) Lungs condition during emphysema

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3.2.1.2 Emphysema

Emphysema is a respiratory illness that makes breathing difficult. Airbags in the lungs, i.e., alveoli sacs are impaired in people with emphysema (Fig. 3.1b). The interior walls of the airbags will deteriorate and break (creating wider air gaps instead of many smaller ones) over some time [21]. This decreases the surface area of your lungs in-turn reducing the amount of oxygen that enters your bloodstream. As you exhale, the weakened alveoli will not function properly and old air will become blocked, leaving no space for fresh, oxygen-rich air to inhale inside. Prolonged exposure to airborne allergens is the primary cause of emphysema, which includes dust, chemical smoke, tobacco smoke, and other airborne pollutants [22].

3.2.1.3 Chronic Bronchitis

Chronic bronchitis is an inflammatory disease and discomfort of the bronchial channels. These channels are the airways that take air in and out of the airbags in your lungs. The inflammation of the pathways triggers the secretion of mucus. This mucus and the inflammation of the tubes make it difficult for the lungs to pump in O2 and CO2 out of the body (Fig. 3.2). Chronic bronchitis seems to be a more serious illness that progresses across time rather than occurs unexpectedly [23]. Cigarette smoke is a significant cause of chronic bronchitis. When tobacco smoke is inhaled into the lungs, it irritates the air passages and produces mucus. Individuals who are exposed for a long period to other factors that irritate their lungs, such as toxic fumes, pollen, and other pollutants, can also experience persistent bronchitis [24].

Fig. 3.2
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Diagrammatic representation of mucus secretion in bronchial channels

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3.2.2 Lung Circulatory Diseases

Lung circulatory disease is an illness that damages the blood vessels (e.g. clotting, inflammation) in the path between the heart and the lungs. Blood flows from the heart towards the lungs and back to the heart. This mechanism constantly floods the blood with oxygen, allowing carbon dioxide to be exhaled. Any portion of the blood circulation between the lung and heart may be compromised or blocked, leading to lung circulation diseases [25].

3.2.2.1 Pulmonary Hypertension

Individual sufferings from pulmonary arterial hypertension (PAH) have elevated blood pressure in the arteries that pass from your heart towards the lungs. The small arteries in your lungs are shortened or obstructed in this condition. It is difficult for the blood to flow thereby increasing the blood pressure in the lungs [26]. The heart needs to work harder to pump blood into these vessels and the heart muscle will get sluggish for a while. Eventually, this prolonged condition will lead to a heart attack in severe cases. Chest pain and tiredness are the early symptoms of PAH. Elevated levels of blood pressure in the pulmonary veins (channels carrying blood away from the lungs, to the heart) cause pulmonary venous hypertension (PVH). It is one of the most often caused due to congestive heart failure that damages heart mitral valves [27].

3.2.2.2 Pulmonary Embolism (PE)

A disease in which the arteries in the lungs are impaired by a blood clot. Most of the time, pulmonary embolism is caused by blood clots that migrate from the legs or occasionally other areas of the body also known as deep vein thrombosis. PE develops as deep venous thrombi break and embolize into the circulatory system [28]. Pulmonary vascular occlusion occurs which impairs the exchange and distribution of oxygen. In the lungs, the lower lungs are more commonly affected than the upper lungs, although bilateral lung involvement is normal. Symptoms include shortness of breath, chest pain, and coughing. Prompt surgery to break up the clot dramatically or administration of blood thinners (anti-coagulants) decreases the risk of death [29].

3.2.3 Lung Tissue Diseases

This disease type mainly impacts the composition of the lung tissue. Bruising or inflammation of the tissue renders the lungs unable to completely expand to its full extend. This makes it impossible for the lungs to take oxygen and release carbon dioxide [30]. Examples of certain lung tissue diseases include sarcoidosis and cystic fibrosis.

3.2.3.1 Cystic Fibrosis

An autosomal recessive disorder is cystic fibrosis. It is associated with mutations of the cystic fibrosis transmembrane conductance regulator gene. The most common mutation is the removal of phenylalanine at codon 508, termed as ΔF508. The cells which produce mucus, sweat, and digestive juices are affected by cystic fibrosis [31]. These fluids are induced to become thick and sticky, which blocks the various ducts passages. Symptoms vary, from cough, frequent respiratory infections, weight failure, and heavy stools. You have problems clearing mucus out of your bronchi in the particular individual suffering from this disease which leads to recurrent infection of lungs [32].

3.2.3.2 Sarcoidosis

Sarcoidosis is a condition characterized by the proliferation of any portion of your body with tiny colonies of inflammatory cells (granulomas), most frequently the lungs and lymph nodes. The cause of sarcoidosis is unclear, but doctors agree that it arises from reacting to an unknown material from the body’s immune system [33].

Literature sources indicate that in genetically predisposed persons, infectious agents, contaminants, dust, and a possible pathological response to the body’s proteins (self-proteins) may be responsible for the development of granulomas [34]. The early symptoms of sarcoidosis include fatigue, swollen lymph nodes, and weight loss [35]. The four stages of pulmonary involvement are based on the disease’s radiological detection, which is beneficial for prognosis (Fig. 3.3).

Fig. 3.3
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Different stages of sarcoidosis in radiological detection

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3.2.4 Other Pulmonary Diseases

COVID-19 is a lung disease caused by a novel coronavirus (SARS CoV-2) first identified at the end of 2019. COVID-19 is mainly a lung respiratory disease leading to secretion of fluid in the air sacs restricting their ability to consume oxygen, eventually contributing to symptoms such as breathlessness, cough, etc. [36]. In pneumonia, the lungs are filled with fluid and inflamed, leading to breathing difficulty. For certain patients, respiratory issues can become bad enough to require treatment with oxygen or even a ventilator in the hospital. Although most people recover from pneumonia without significant lung injury, pneumonia associated with COVID-19 can be serious. Also after the illness has passed, lung damage may lead to respiratory problems that can take months to recover [37]. Pneumonia caused by COVID-19 continues to hold in both lungs. Airbags in the lungs are filled with fluid (Fig. 3.4), restricting their capacity to take oxygen completely leading to acute respiratory distress syndrome (ARDS), a form of lung failure [38].

Fig. 3.4
figure 4

Pneumonia associated with COVID-19

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3.3 Indian Herbal Medicine Involved in Treatment of Pulmonary Diseases

3.3.1 Asthma

Aleurites moluccana also known as candlenut tree dispersed in various parts of the country has been traditionally used for the treatment of asthma, pain, fever, and headaches. This can be attributed to its various properties such as anti-nociceptive, anti-viral, anti-microbial, and anti-hypersensitivity [39]. A dried leaf extract prepared from A.moluccana into a semisolid herbal medicine exhibited analgesic, anti-inflammatory, and wound healing effects in the pre-clinical studies shows promise as a phytomedicine which can be used for the treatment of asthma [40]. Nigella sativa (Black cumin) extracts display a wide range of therapeutic properties such as anti-oxidant, anti-inflammatory, antihistaminic, anti-allergic, antitussive, immunomodulatory, and bronchodilatory properties. Clinical studies indicate that administration of N. sativa seed, boiled extract, or oil alleviated asthma symptoms in patients [41]. Aerva lanata (mountain knotgrass) is a common weed abundantly found in the warmer plain terrain in the country. Its ethanol extract shows anti-asthmatic potential through catalepsy and mast cell degranulation [42]. Bacopa monnieri (Brahmi) is another medicinal plant capable of stabilizing mast cells [43]. The extracts obtained from different parts of medicinal plants such as leaves, stem bark, and roots of Cassia sophera (Kasaunda), Casuarina equisetifolia (Whistling Pine), Clerodendrum Serratum (Bharangi), Bauhinia variegate (Rakta Kanchnar) exhibit anti-asthmatic potential against the immune responses such as histamine induced bronchial and trachea constriction, clonidine induced catalepsy, milk induced leukocytosis, and eosinophilia which plays a vital role in aggravating asthma symptoms as tested in animal models [44, 45].

3.3.2 Chronic Obstructive Pulmonary Disease

Solanum nigrum (Manathakkali) has been traditionally used as a Siddha medicine and its leaves and fruits have also been widely consumed as a food ingredient in India. Its leaf extracts can inhibit swelling caused by an inflammatory response. A glycoprotein isolated from S. nigrum was found to inhibit the synthesis of pro-inflammatory compounds by interfering with the DNA binding of NF-kB and AP-1. The ethanolic extract of Boerhavia diffusa (Punarnava) was found to reduce the levels of nitric oxide and superoxide which have a major role in the pathogenesis of COPD. It also exhibits spasmolytic, anti-microbial, and cytoprotective activities [46]. Clinical trials involving the administration of two Indian herbal medicine Vasadi syrup and Shwasaghna dhuma to patients diagnosed with COPD as two trial groups showed vast improvements in their COPD symptoms as well as FEV1%. The constituents of Vasadi syrup are Justicia adhatoda (Vasa), Curcuma longa (Haridra), Coriandrum Sativum (Dhanyaka), Clerodendrum Serratum (Bharangi), Tinospora cordifolia (Guduchi), Zingiber officinale (Shunthi), Solanum virginianum (Kantakari), Piper longum (Pippali) in equal parts. Contents of Shwasaghna dhuma are powder of seeds of Solanum virginianum (Kantakari), dry leaves of Datura stramonium (Dhatura), Trachyspermum ammi (Ajwain), seeds of Hyoscyamus niger (Khurasani ajwain), Potassium Nitrate (Kalmi shora), Curcuma longa (Haridra), and Cannabis sativa (Bhanga) in equal parts [47].

3.3.2.1 Chronic Bronchitis

Ocimum sanctum (Tulsi) traditionally used as a medicine can be used for the treatment of bronchitis as well as bronchial asthma. It displays several therapeutic properties such as anti-microbial, analgesic, antispasmodic, adaptogenic which can be attributed to Eugenol, the active compound present in Tulsi [48]. Clinical studies carried out in bronchitis patients in a double-blind, randomized, placebo-controlled manner by the administration of a mix of thyme fluid extract and primrose root tincture resulted in a decrease in bronchitis symptoms as well as the duration of bronchitis [49]. Hedera helix (Ivy) leaf extract was also found to alleviate the symptoms of chronic bronchitis in some studies [50]. Nigellone, a phytochemical isolated from Nigella sativa (Black cumin) was found to exhibit antispasmodic and facilitating respiratory clearance while thymoquinone another phytochemical did not show the same effect [51].

3.3.2.2 Emphysema

Curcumin isolated from Curcuma longa (Turmeric) was found to alleviate the symptoms of pulmonary inflammation and emphysema induced by cigarette smoking and porcine pancreatic elastase activity in a mice model [52]. Epigallocatechin-3-gallate, a phytochemical which is abundantly found in Camellia sinensis (Green tea) was found to reduce the progression of emphysema by inhibiting the leukocyte elastase activity in a dose-dependent manner [53]. Quercetin, a flavonoid compound was found to attenuate the progression of emphysema by decreasing the level of oxidative stress, pulmonary inflammation and reducing the expression of MMP9 and MMP12 in mice model [54].

3.3.3 Lung Cancer

Curcuma longa (Turmeric) is a commonly used food ingredient throughout India. C. longa extract was found to exhibit cytotoxic property and inhibition of telomerase activity in a dose-dependent manner in an in vitro study carried out in the A549 lung cancer cell line [55]. Conferone, a phytochemical isolated from Ferula species exhibited mild cytotoxic effects against A549 lung cancer cell line [56, 57]. Annona muricata (Mamaphal) also shows the cytotoxicity effect in the A549 lung carcinoma cell line which can be attributed to its constituent compounds annomuricin A and B [58]. Andrographis paniculata (Kiryat) alcoholic extracts were found to show chemopreventive effects by enhancing the levels of DT-diaphorase (DTD), superoxide dismutase (SOD), and catalase in the lungs in a mouse model [59]. Phyllanthus urinaria (Jaramla) extract showed anti-angiogenic potential by inhibiting neovascularization in the tumor cells and also inhibiting the migration of HUVEC in a mice model implanted with Lewis lung carcinoma cells [60]. Other medicinal plants that can be used to alleviate the symptoms of lung cancer include Zingiber officinale (Ginger), Glycyrrhiza glabra (Liquorice), Terminalia chebula (Myrobalan), Ocimum sanctum (Tulsi), and Adhatoda vasica (Malabar nut) [61].

3.3.4 Cystic Fibrosis

Herbal extracts from Phyllanthus acidus (Star gooseberry) play a vital role in epithelial transport by enhancing the levels of cAMP, activating Ca2+, K+ channels, and subsequent cellular signaling pathways as well as activating CFTR thus preventing the progression of cystic fibrosis [62]. Genistein is a phytochemical compound found in several medicinal plants that are capable of regulating various ions channels in CFTR, activates ΔF508 CFTR mutant and enhances the expression of mutant CFTR proteins [63, 64]. Curcumin, a phytochemical isolated from Curcuma longa (Turmeric) responsible for its characteristic yellow color can inhibit the calcium pump in the endoplasmic or sarcoplasmic membrane facilitating the removal of ΔF508 CFTR from the endoplasmic reticulum [65]. Resveratrol, a polyphenolic phytochemical commonly found in grapes and peanuts is capable of significantly elevating the cellular cAMP concentrations by activating adenylate cyclase and inhibition of cAMP phosphodiesterases which in turn leads to an increase in CFTR activity [66].

3.3.5 Pulmonary Hypertension

Allium ursinum (Wild garlic) and its compounds were found to alleviate the symptoms of pulmonary hypertension by decreasing the blood pressure, inhibiting of ACE activity and enhancing right ventricle function in animal models [67]. Administration of Crataegus rhipidophylla (Hawthorn) extract in broiler chickens with pulmonary hypertension induced by high altitude showed an increase in expression of proteins such as albumin and globulin with a simultaneous decrease in the level of enzymes responsible for liver damage such as ALT and AST which occurs as a consequence of pulmonary hypertension progression [68]. Moringa oleifera (Drumstick tree) is abundantly found in the country and its various plant parts are commonly consumed as food ingredients. The alcoholic leaf extract of Moringa oleifera was administered to Wistar rats after inducing induced pulmonary hypertension by treatment with monocrotaline. It was found that the extract inhibited pulmonary hypertension by enhancing vasodilation and through its anti-oxidant properties [69].

3.3.6 Pneumonia

Various medicinal plants from the Verbascum species also known as Mullein have been used for the treatment of pneumonia as part of traditional herbal medicine due to its antibacterial activity. The extract isolated from Verbascum fruticulosum exhibited a high level of antibacterial activity against the multidrug-resistant strain of Streptococcus pneumoniae and can be used for the treatment of pneumonia. Similarly in the same study the extract obtained from Urtica urens (Dwarf nettle) also showed anti-microbial activity against S. pneumoniae although lesser than that of V. fruticulosum [70]. Beta vulgaris (Beetroot) is a commonly consumed vegetable. The alcoholic leaf extracts of B. vulgaris fractionated by n-hexane and chloroform displayed antibacterial activity by an increase in zone of inhibition in a concentration-dependent manner against Klebsiella pneumonia [71]. Other medicinal plants that have been used for the treatment of pneumonia include Ficus racemosa (Gular fig), Nepeta glutinosa (Benth), Ricinus communis (Castor bean), Terminalia chebula (Myrobalan), and Vitex negundo (Chaste tree) [72].

3.3.7 Pleurisy

Ayurvedic medicines such as Praanrakshak can be used for the treatment of pleurisy. It consists of various medicinal plants such as Cinnamomum zeylanicum (Cinnamon), Albizia lebbeck (Shirish), Adhatoda vasica (Malabar nut), Tylophora asthmatica (Anantmool), and Clerodendrum serratum (Bharangi). Cinnamomum zeylanicum was found to exhibit anti-microbial, anti-oxidant, anti-inflammatory, and anti-nociceptive properties [73]. The stem bark extract of Albizia lebbeck exhibits various therapeutic properties such as anti-inflammatory, anti-anaphylactic, and analgesic which can alleviate the symptoms of pleurisy [74]. Vasicine, a phytochemical isolated from Adhatoda vasica showed antibacterial, anti-fungal, and anti-inflammatory activities in an in vitro study [75]. The plant extracts of Tylophora asthmatica exhibited immunosuppressive, anti-inflammatory, inhibition of delayed hypersensitivity response, and expectorant abilities in various clinical studies [76]. Clerodendrum serratum (Bharangi) extracts obtained from its roots and leaves display anti-asthmatic, anti-allergic, anti-inflammatory, anti-cancer, mast cell stabilization effects according to various scientific investigations [77]. All these studies indicate that ayurvedic medicine such as Praanrakshak can be used for the treatment of pleurisy.

3.3.8 COVID-19

The extract of medicinal plants such as Agastache rugosa (Indian mint), Astragalus membranaceus (Katira), Cassia alata (Candlebush), Cullen corylifolium (Scurfy Pea), Gymnema sylvestre (Gurmar), Mollugo cerviana (Carpetweed), Quercus infectoria (Manjakani), Tinospora cordifolia (Gurjo) is capable of inhibiting the action of coronavirus [78]. Various phytochemicals isolated from medicinal plants such as quercetin, curcumin, withaferin A, luteolin, amaranthin, apigenin, gallic acid can also be used as potential drug candidates due to their ability to inhibit the mechanism of action of SARS-CoV-2 by targeting spike protein, the main protease, ACE-2 and its receptor [79]. In a case study, a 43-year-old male with COVID-19 symptoms was treated solely with Ayurvedic medicine and recovered completely. The treatment regimen involved the administration of Sudarsana Churna (for alleviating fever), Talisadi Churna (for loss of taste), and Dhanwantara Gutika (aids in overcoming breathing problems) [80, 81].

3.3.9 Sarcoidosis

Medicinal plants such as Ocimum tenuiflorum (Tulsi), Curcuma longa (Haridra), Phyllanthus emblica (Amalaki), Tribulus terrestris (Gokshura), Asparagus racemosus (Shatavari), Withania somnifera (Ashwagandha), and Commiphora wightii (Guggul) can be used for the treatment of sarcoidosis since they exhibit a wide range of therapeutic potential such as anti-oxidant, anti-inflammatory, anti-angiogenic, anti-microbial, immunomodulatory properties. Ayurvedic medicines that can be used for sarcoidosis treatment include Punarnava mandur and Kanchnar guggul which are capable of boosting the immune system as well as reducing the pain, inflammation, and other symptoms of the disease [82]. A clinical study involving the administration of herbal medicine called Reumaherb made up of three medicinal plants, namely Echinacea purpurea, Harpagophytum procumbens, and Filipendula ulmaria was found to exhibit anti-angiogenic and anti-inflammatory activity in a mice model transplanted with bronchoalveolar lavage (BAL) cells obtained from sarcoidosis patients. This anti-angiogenic potential could play a vital role in preventing the progression of sarcoidosis [83].

3.3.10 Pulmonary Embolism

Selaginella bryopteris (Sanjeevini) plant extract possesses anti-microbial, anti-coagulant, and anti-platelet properties which shows promise as a medicinal plant that can be used for the treatment of pulmonary embolism [84]. The aqueous and ethanolic extracts of the fruit of Terminalia bellirica (Behada) one of the constituent medicinal plants of Triphala churna displayed anti-thrombotic and thrombolytic activity in an in vitro study [85]. The aqueous leaf extract of Leucas indica (Guma) was found to exhibit fibrinolytic, anti-platelet, and anti-coagulant activity by inhibition of thrombin and factor Xa [86]. The polyphenolic extract of Vitis vinifera (Grapeseed) commonly consumed as fruit also showed anti-coagulant and anti-platelet activities in an in vitro model [87]. Fagonia arabica (Dhamasa) is widely distributed throughout the Indian subcontinent and its aqueous extract and fractions displayed thrombolytic, anti-coagulant, and anti-oxidative properties in an in vitro study [88, 89]. The various medicinal plants used currently in the treatment of pulmonary disease ailments have been summarized in Table 3.2.

Table 3.2 Medicinal plants used in the treatment of pulmonary diseases
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3.4 Phytoconstituents Involved in Treatment of Pulmonary Diseases

Phytochemicals are biologically active compounds present in plants with defensive and disease-preventive properties. Important clinical effects against cardiovascular and respiratory disorders have been shown by various phytochemical components like quercetin, resveratrol, triterpenoids, etc., [93]. A few examples of plant-derived compounds that have medicinal value in treating pulmonary diseases are been listed in Table 3.3.

Table 3.3 Phytochemicals used for the treatment of pulmonary diseases
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3.5 Conclusion

This chapter provides a comprehensive review about various Indian herbal medicinal plants and their therapeutic potential in the treatment of several pulmonary diseases. These medicinal plants and their phytochemical constituents exhibit a diverse range of therapeutic properties such as anti-oxidant, anti-inflammatory, anti-angiogenic, anti-coagulant, anti-microbial and immunomodulatory properties. So herbal medicine can be used as a viable alternative for treatment of respiratory ailments due to their efficacy as well as to avoid the side effects caused by various chemical drugs. Although various herbal formulations have been traditionally used in Ayurveda and Siddha for treatment of pulmonary diseases more clinical studies are required to elucidate the mechanisms behind the pharmacological effects of these herbal medicine.