For ASTHMA, butterbur extract effectively reduces wheezing, cough and sputum, and eases tight chest and shortness of breath, also improving exercise capacity. Research shows that it decreases the number, duration, and severity of attacks due to its anti-inflammatory and bronchodilation actions. Asthma is a chronic respiratory condition marked by inflammation and spasms in the bronchi of the lungs: The active compounds in butterbur, particularly iso-S-petasin, act as bronchodilators, relaxing and widening the airways. Butterbur extract is widely recognized for its ability to improve lung function in patients with chronic asthma and chronic bronchitis.

What is butterbur

Butterbur is a perennial shrub that grows well in the marshy terrain of Europe, Asia, and North America. The variant Petasites hydridus is found in colder, northerly regions of Russia and Europe. An equally effective medicinal species called Petasites frigidus is found in the northern United States and Canada. With its large, parasol-like leaves, Butterbur’s botanical name Petasites is thought to derive from the Greek word “petasos,” referring to the Thessalian sun hat worn by the ancient Greeks. Its common name may also stem from its use to wrap butter; the large heart-shaped leaves help to prevent butter from melting in warm weather.

Butterbur has a long history of traditional use stretching back at least 2,000 years where it was used to soothe headaches, ease digestive symptoms, and relieve asthma attacks. Butterbur’s medicinal use was recorded by the famous Greek physician, pharmacologist, botanist, and author Dioscorides in 65 A.D., who recommended it for skin ulcers and gastrointestinal complaints.

In the Middle Ages and into the 17th century, butterbur root was a traditional medicine used to treat headaches, coughs, asthma, and skin wounds. In the 16th century, butterbur was dried, powdered, and mixed with wine to fight the plague and other infectious diseases. Nicholas Culpeper wrote in his book “The English Physician” in 1652, that butterbur root was “very available against the plague, and pestilential fevers, by provoking sweat.”

The active constituents of butterbur root extract are called petasins which give butterbur its pharmacologic activity, including pain-relieving and anti-inflammatory actions. Petasins are a group of bitter-tasting compounds in a class of natural molecules called sesquiterpenes. S-petasin, the main sesquiterpene and its isoform, iso-S-petasin, have been shown to be the effective ingredients in Butterbur, especially for asthma relief.

How does butterbur impact asthma?

Asthma is a chronic respiratory condition defined by inflammation and spasm in the lungs’ airways, known as the bronchi. The bronchodilator action (opening airways) of butterbur extract is not a single mechanism, but a combination of effects. Petasins help through two primary actions: they have been shown to inhibit both inflammatory and allergic airway reactions.

1. They directly relax the airway muscles by blocking calcium channels: When the lungs are faced with allergens, compounds in butterbur, known as petasins, act as bronchodilators, substances that widen the airways, primarily by functioning as calcium channel blockers. When the smooth muscles in your airways receive an influx of calcium ions, they contract. Petasins, particularly a compound called iso-S-petasin, block the channels that allow this calcium to enter the muscle cells. By preventing the bronchial tube muscles from contracting, petasins allow the muscles to relax, which leads to the widening of your airways.¹
2. Petasins indirectly contribute to bronchodilation by reducing the inflammatory response that causes muscle spasm and swelling. Lung inflammation is mediated through phosphodiesterase activity and ovalbumin (OVA)-induced action respectively. Phosphodiesterases (PDE) are enzymes that ultimately modulate a variety of inflammatory cell functions that contribute to their anti-inflammatory actions in respiratory diseases like chronic obstructive pulmonary disease (COPD) and asthma. OVA-induced asthma occurs with acute allergic response including excessive mucus production and airway hyperresponsiveness which is an exaggerated response of the airways resulting in airway obstruction. Scientists were able to show how S-petasin suppressed all types of inflammatory cells examined, including total inflammatory cells, lymphocytes, neutrophils and eosinophils, and the inhibition of allergen-induced mast cell proliferation that is responsible for airway reactivity and symptoms.²

The science behind butterbur and asthma

Butterbur extract has over 30 years of use in Europe as a therapeutic spasmolytic agent — an agent that is able to relieve smooth muscle spasms — for asthmatic attacks. Its high efficacy has boosted interest in the use of plant extracts for the treatment of many chronic diseases, including asthma and other allergic diseases.³˒⁴

An open-trial study involving 64 adults and 16 adolescents tested the efficacy and tolerability of a butterbur extract over four months, allowing subjects to continue their normal asthma medication. The results showed that 83% of patients using butterbur reported greater symptom improvement. Treatment with butterbur led to a decrease in the number, duration, and severity of asthma attacks, improved lung function, peak flow and forced expiratory volume (FEV1), plus it reduced other symptoms like coughing and wheezing. Additionally, over 40% of the participants were able to reduce their intake of other asthma medications by the end of the study.⁵

In another 2004 study, 16 asthmatic patients were given a combination of butterbur extract (25 mg twice daily for one week) and inhaled corticosteroids. The results for those taking butterbur showed a greater reduction in inflammation compared to those treated with corticosteroids alone. Patients using butterbur showed a significant improvement in bronchial hyperresponsiveness compared to steroids alone that caused a 20% reduction in forced expiratory volume (FEV1). The data indicated that butterbur helps to make the airways less sensitive to triggers. The butterbur treatment also led to a significant reduction in key markers of inflammation, including exhaled nitric oxide (a marker of airway inflammation), serum eosinophil cationic protein, and peripheral blood eosinophil counts. The researchers concluded that chronic dosing with butterbur conferred a complementary anti-inflammatory effect in atopic asthmatic patients who were already being maintained on inhaled corticosteroids. This suggests that butterbur may target different inflammatory pathways than corticosteroids, making it a useful add-on therapy.⁶

The active compounds in butterbur also help suppress the central causes of asthma symptoms, bronchoconstriction (airway tightening), increased mucus, and airway swelling, by blocking the production of potent inflammatory biochemicals like leukotrienes and prostaglandins. These mediators are released during an allergic or inflammatory response. By reducing the production of these inflammatory agents, butterbur extract helps lessen asthma symptoms. This mechanism is similar to the action of certain prescription asthma medications, known as leukotriene antagonists.

Additionally, some research shows that butterbur may block histamines triggered by allergens. Histamine is released by your immune system when it encounters an irritant that it identifies as a threat, such as a virus or bacteria. In people with allergies, the body mistakes a harmless substance (like pollen, pet dander, or dust mites) for a threat and releases histamine, triggering an allergic reaction. Butterbur’s antihistamine-like effect can help to alleviate symptoms associated with allergic asthma.

Petasins also act as bronchodilators, widening airways, through their antimuscarinic action. Muscarinic receptors are involved in the nervous system control of smooth muscle contraction. By blocking these receptors, petasins may reduce the signals that cause the airways to constrict.⁷

Our patients’ experience with butterbur

In our clinic, overall, we see significantly better results for asthma from a formula including nutrients and botanicals that enhance the actions of butterbur root alone. The potency of butterbur is magnified by combining it with vitamin B2 (riboflavin), the mineral magnesium, the botanicals ginger and feverfew, and the amino acid 5-Hydroxytryptophan in a formula, which are also helpful in their own right for asthma:

• Magnesium: The mineral magnesium is a known bronchodilator that relaxes the bronchial muscles and expands the airways, allowing more air to flow in and out of the lungs to relieve asthma symptoms such as shortness of breath and acute flare-ups. Chronic magnesium deficiency may provoke more allergic reactions. We know that magnesium deficiency can cause an increase in histamine levels in the blood after being exposed to allergens. Conversely, taking magnesium can reduce levels in the body of biochemical mediators that trigger asthma.
• Vitamin B2 (riboflavin): Studies show that Vitamin B intake correlates with a lower risk of developing allergies and, in combination with magnesium, is associated with improvements in bronchial asthma control.⁸
• Ginger: The botanical root ginger is a potent anti-inflammatory compound that is helpful in reducing asthma symptoms. Its naturally occurring oil contains active chemical compounds, such as gingerols and shogaols, that induce bronchodilation in airway smooth muscle by modulating intracellular calcium.⁹
• Feverfew: This herb is a traditional remedy for relieving asthma symptoms. Feverfew has an excellent anti-inflammatory action via its active ingredient, parthenolide. Research also supports the action of parthenolide to relieve spasms in smooth muscle tissue, including the bronchial muscle tightening that is responsible for shortness of breath and acute asthma flare-ups.¹⁰
• 5-Hydroxytryptophan: Several studies have found 5-HTP to be effective at reducing leukocyte recruitment and allergic inflammation, making it a novel potential remedy for allergy and asthma.⁸ In addition, 5-HTP encourages optimal neurotransmitter levels and healthy brain chemistry while raising serotonin levels in the brain.¹¹

Our patients taking butterbur extract for 3 to 6 months or longer report major improvements for asthma, with less wheezing, coughing, and shortness of breath, less sputum, better stamina for exercise, and a reduction in the overall number and intensity of asthma attacks.

Recommendation: Butterbur root extract, 50 to 100 mg taken twice daily between meals, particularly an extract of the rhizome of Petasites hybridus standardized to contain 5 to 7.5 mg (10%) of petasine per dose, or as directed by your healthcare provider.

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