Effects of Drinking Hot Water, Cold Water,

and Chicken Soup on Nasal Mucus Velocity

and Nasal Airflow Resistance*

Kiumars Saketkhoo, M.D.; Adolph Januszkiewicz, B.S.; and

MarvinA. Sackner, M.D., F.C.C.P.

Nasal mucus velocity and nasal airflow resistance were velocity from 7.3 to 4.5 mm per mm.
were no There
measured in 15 healthy subjects before and at S and 30 significant changes from baseline in nasal
airflow re-
minutes after drinking hot water by sip or straw, hot sistance S and 30 minutes following the above treatments.
chicken soup by sip or straw, and cold water by sip. A We conclude that drinking hot fluids transiently increases
sham drinking procedure with straw was also employed. nasal mucus velocity in part or totally through the nasal
Hot water by sip increased nasal mucus velocity from inhalation of water vapor. Hot chicken soup, either
6.2 to 8.4 mm per mm, hot chicken soup by sip from through the aroma sensed at the posterior nares or
6.9 to 9.2 mm per mm, and chicken soup by straw from through a mechanism related to taste, appears to possess
6.4 to 7.8 mm per mm five minutes after administra- an additional substance for increasing nasal mucus
lion. These increases were statistically significant com- velocity. Finally, hot liquid might be superior to cold
pared to cold water, hot water by straw and sham. All liquids in the management of fluids in upper respiratory
values returned to their baseline at 30 minutes except tract infections.
cold water which significantly decreased the nasal mucus

r_1,
he annals of medical history are replete with folk inadequate course of chicken soup with subsequent
remedies in use long before the scientific demon- clinical relapse. Soffer,6 the editor of Chest where
stration of effectiveness. Thus, ingestion of various this article appeared, indicated that the intention of
plants containing ascorbic acid and, Cinchina bark, this article was to point out that rational scientific
foxglove and Rauwolfia root, with active ingredients treatment (rather than empirical therapy) became
of quinine, digitalis and reserpine, respectively, were possible when studies changed from anecdotal
used hundreds of years prior to their introduction documentation to prospective randomized con-
into clinical medicine.1 The smoking of the plant trolled double blind studies. We decided to assess
species Datura, which contains stramonium, a para- whether chicken soup might have a therapeutic ra-
sympatholytic agent, has been employed to treat tionale other than its good taste. We measured nasal
bronchial asthma for over 150 years.2 For over 400 mucus velocity, since transport of nasal secretions
years, Europeans have bathed in the warm waters of serves as a first line of host defense in removal of
spas for the treatment of heart disease,3 but only pathogens. It was not possible to design a double
recently has it been shown that warm water immer- blind study because the placebo could be distin-
sion increases cardiac output, and effects a water guished by taste from chicken soup, but we did
and sodium diuresis.4 randomize the various treatments.
Chicken soup ( designated by
the lay public as
Jewish penicillin, bohbymycetin, Bobamycin) has MATERIAL AND METHODS
long been advocated by Jewish mothers for the
treatment of upper respiratory ailments. The twelfth Subjects

century philosopher and physician, Moses Maimo- Fifteen normal young nonsmokers, who were free of upper
nides, wrote that chicken soup was excellent as a respiratory tract infection, were enrolled in the study. There
food and medication. In a spoof on uncontrolled were six men and nine women; their mean age was 29 years
scientific studies, Caroline and Schwartz5 reported a with a range from 23 and 41 years. They gave informed
consent and received financial remuneration for their partici-
case of pneumococcal pneumonia treated with an
pation.
#{176}FromThe Division of Pulmonary Disease, Department of
Medicine, Mount Sinai Medical Center, Miami Beach. Methods
Supported in part by Grant HL-17836 from the National
Heart, Lung and Blood Institute. The subject sat in a dental chair with his head positioned
Manuscript received February 20; revision accepted April 6.
Reprint requests: Dr. Sackner, Mount SIrWA Medical Center, so that the hard palate was in the horizontal plane. Nasal
4300 Alton Road, Miami Beach 33140 mucus velocity was estimated by a method which has been

408 SAKETKHOO, JANUSZKIEWICZ, SACKNER CHEST, 74: 4, OCTOBER, 1978

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 described previously. Briefly, Teflon discs rendered radio- Table 1-Effect of Chicken Soup, Hot Water, Cold Water
paque by mixture with 50 percent bismuth trioxide by and Shtfm on Nasal Mucus Velocity
volume were gently deposited above the inferior turbinate by
dropping them through a 3 mm diameter polyethylene cathe- Nasal Muc us Velocity m m p
ter connected to a 10 ml plastic syringe. The discs were 1 mm 5 mm after 30 mm after
in diameter, 0.8 mm in thickness and 1.8 mg in weight. The Treatment Baseline drinking drinking
nasal passage was visualized in. its lateral projection with a
television monitor ( Conrac Corporation, Avina, ,
Cal ) con-
Hotwatersip
Hot water straw
6.2 (2.6)
5.5 (2.0)
t8.4 (3.6)

5.9 (2.9)
6.2 (2.1)
5.5 (2.0)
nected to a portable image intensifier unit ( Toshiba model
SXT6, Toykyo ). Also displayed on the monitor was the Hotchickensoupsip 6.9 (1.8) 9.2 (2.8) 5.9 (1.8)
output of a digital clock ( Vicon Industries, Framingdale,
NY ) . Disc motion was recorded on videotape ( International Hotchickensoupstraw 6.4 (2.6) (4.3) 6.0 (2.4)
Video Corp., Sunnydale, Cal) which was replayed to identify Cold water sip 7.3 (3.8) 5.3 (3.6) t4.5 (2.5)
the distance traveled by each disc; a 1 cm length of radio-
Sham straw 6.1 (1.1) 5.7 (1.8) 5.6 (1.4)
paque Teflon tape placed on the cheek served as a calibrat-
ing image. The axial motion of 5-10 Teflon discs not greater 5Mean(SD); 55P<.05; tP<.01; P<.001
than 0.5 cm superior to the middle portion of the hard palate
was measured. The nasal mucus velocity was computed from and each treatment response was compared with sham re-
the distance travelled by each disc divided by a standard unit sponse by a Student paired t-test. A P value less than .05 was
of time, generally one minute. considered statistically significant. Analysis of variance was
Nasal airflow resistance was obtained by posterior rhinom- performed on the treatments causing a statistically significant
etry.1#{176} An airtight rubber scuba diving mask covered the rise in nasal mucus velocity to evaluate the significance of
nose and the eyes. A pneumotachograph ( Fleisch No. 2, response differences.
Godart, Holland ) was mounted on the plastic shield of the
mask and the pressure difference across the pneumotacho- RESULTS
graph was measured with a variable differential reluctance There were no
statistically significant changes
gauge (model P7D 0 - .2 PSID, Whittaker Corp. Cal)
among the baseline nasal mucus velocity values,
and calibrated to flow by a rotameter. A polyethylene tube of
6 mm diameter was held firmly between the subjects lips; which ranged from 5.5 to 7.3 mm per mm. Five
the distal tip projected along the upper surface of the tongue minutes after drinking hot chicken soup by sip,
7 to 9 cm inside the mouth cavity. This tube was connected mean nasal mucus velocity rose by 2.3 mm per
to a second variable reluctance differential gauge ( model minute over baseline, after drinking hot chicken
P7D 0 - .2 PSID, Whittaker Corp, Cal) along with
another tube connected to the other side of the transducer
soup by straw by 1.4 mm per minute, and after hot
from the mask. The electrical outputs of the pneumotacho- water by sip by 2.2 mm per minute; all changes were
graph and posterior pharyngeal pressure transducers were significantly different from sham (Table 1 ). Neither
displayed on a cathode ray oscilloscope (Tektronix Model hot water by straw nor cold water by sip significant-
5103N, Beaverton, Or ) . The screen was calibrated so that
ly affected nasal mucus velocity at this time. All of
a 1 cm deflection on the horizontal axis was produced by a
flow of 0.4 L/sec and 1 cm deflection on the vertical axis the treatments which increased nasal mucus velocity
corresponded to a pressure of 0.5 cmHO. The subject was returned to baseline at 30 minutes. At the 30-minute
instructed to breathe solely through his nose and the inspira- point, the drinking of cold water produced a fall of
tory nasal airway resistance was measured over the flow rate 2.8 mm per mm in nasal mucus velocity compared
of 0.4 L/sec where it was approximately linear. Five sequen-
to baseline.
tial measurements were obtained and the screen image
photographed on a single Polaroid print so that the mean There were no statistically significant changes
value could be computed. among the baseline nasal airway resistance values
which ranged from 1.4 to 1.6 cmH2O/liter/sec (Ta-
Procedure
ble 2). There were no significant changes in any of
The study was performed on six separate days. On each
day, baseline nasal mucus velocity and nasal airway resis- Table 2-Effect of Chicken Soup, Hot Water, Cold Water
tance were obtained using the toss of a coin for the selection and Sham on Nasal Airflow Resistance
of the nostril to be used for measurement of nasal mucus
velocity. Then the subject drank 200 ml of one of several Nasal Airflow Resistance
randomly selected liquids through a straw with the cup cm 1120 per Liter X second
covered or by continuously sipping directly from the cup.
5 mm after 30 mm after
Nasal mucus velocity in the same nostril and nasal airflow
Treatment Baseline drinking drinking
resistance was measured 5 minutes after drinking the liquid
and 30 minutes later. The liquids tested were: 1 ) chicken Hotwatersip 1.5 (0.4) 1.7 (0.6) 1.8 (0.8)
soup 65#{176} C by sip; 2) chicken soup 65#{176} C by straw; 3)
Hotwaterstraw 1.5 (0.3) 1.5 (0.4) 1.7 (0.5)
water 65#{176} C by sip; 4) water 65#{176} C by straw; 5) water 4#{176} C
by sip. The chicken soup was obtained from a food specialty Hot chicken soup sip 1.5 (0.4) 1.4 (0.3) 1.9 (0.7)
market. In addition, a sham procedure was carried out in
Hot chicken soup straw 1.5 (0.4) 1.6 (0.5) 1.8 (0.5)
which the subject sucked on a straw placed into an empty
cup. Cold water sip 1.4 (0.4) 1.5 (0.4) 1.7 (0.5)
Sham straw 1.6 (0.4) 1.6 (0.4) 1.6 (0.3)
Statistical Analysis
The data were analyzed in terms of change from baseline Mean (SD)

CHEST, 74: 4, OCTOBER, 1978 NASAL MUCUS VELOCITY AND NASAL AIRFLOW RESISTANCE 409

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 the treatments compared to sham at 5 and 30 mm- change was less than we previously observed after
utes after drinking the liquids. administration of nebulized alpha adrenergic agon-
ists which amounted to 5.5 mm/mm over baseline. It
DiscussioN might be speculated that the rise in nasal mucus
Bang and associates11 reported a significant in- velocity after drinking chicken soup through a straw
crease in nasal mucus velocity of normal volunteers could be related to an aromatic compound acting on
immediately after drinking approximately 500 ml of the nasal mucosa via the posterior pharynx or
hot tea. In our study, the drinking of 200 ml of hot through a mechanism related to taste. The effect of
water by sipping increased the nasal mucus velocity chicken soup was rather short lived, less than 30
five minutes later, but not when the cup was covered minutes, and might not be clinically important al-
and a straw utilized for drinking. The latter proce- though patients with common colds could display a
dure prevented hot water vapor from penetrating different response. An increase of nasal mucus
the anterior nares. In this regard, Bang et aP1 also velocity should be beneficial in acute rhinitis since
showed that saline solution instilled into the nose the contact time of a pathogen on the nasal mucosa
increased mucus velocity. Therefore, the sipping of would be shortened, thereby minimizing its penetra-
hot water might increase nasal mucus velocity in tion and multiplication. However, this point has not
part or totally through the nasal inhalation of water been established in experimental rhinovirus infec-
vapor. With regard to local changes in body tern- tion in man.3 Finally, the delayed suppression of
perature, Ralston and Kerr12 showed that imrner- nasal mucus velocity 30 minutes after drinking cold
sion of the feet both in hot or cold water produced water suggests that hot rather than cold liquids
an immediate fall in nasal temperature suggesting a might be preferable in the recommendations for
primary vasoconstriction reflex. Several minutes fluid intake in patients with upper respiratory tract
later, while the hot stimulus was still being applied, infections.
there was a gradual rise in nasal temperature in
many but not all subjects suggesting the gradual REFERENCES
development of vasodilatation. They further found
1 Kreig MB: Green Medicine; The Search For Plants That
from measurement of the volume of a nasal space by Heal . . .,Chicago, Rand McNally, 1964, pp 163, 165-206,
a plethysmographic system, that both increase and 207-222, 317-339
decrease in the volume could occur independently of 2 Bloomfield AL: A Bibliography of Internal Medicine:
Selected Disease. Chicago, University of Chicago Press,
change in nasal temperature or type of thermal
1960, p 263
stimulus. Whether heating of the nasal passages in 3 German Health Resorts; Official Handbook of the German
our experiments is an analogous situation to the Health Resorts Association. Bonn, Deutcher Baderver-
experiments of Ralston and Kerr12 can only be con- band EV, 1953, pp 79
sidered conjectural. Nevertheless, the lack of con- 4 Epstein M : Cardiovascular and renal effects of headout
water immersion in man. Circ Res 39:619-628, 1976
sistent changes in nasal airflow resistance in our
5 Caroline NL, Schwartz H : Chicken soup rebound and
study would be predicted from their findings of relapse of pneumonia: report of a case. Chest 67:215-216,
variability of nasal volume in the face of local vaso- 1975
constriction. Previous investigations from our lab- 6 Soffer A: Chicken soup, Sippy milk diets and bed rest for
oratory indicate that nasal inhalation of nebulized hepatitis. Chest 67:214-215, 1975
7 Yergin BM, Saketkhoo K, Michaelson E, et al: A roent-
alpha adrenergic agonists, which cause local vaso-
genographic method for measuring nasal mucous velocity.
constriction, increased nasal mucus velocity to a J Appi Physiol ( in press)
greater extent than drinking hot water.8 The nasal 8 Saketkhoo K, Yergin BM, Januszkievicz A, et al: The
vasoconstriction induced by thermal or pharmaco- effect of nasal decongestants on nasal mucus velocity. Am
Rev Respir Dis (in press)
logic stimuli may be associated with increase of the
9 Solomon WR, McLean JA, Cookingham C, et al: Mea-
transport of nasal mucus due either to a more favor-
surement of nasal airway resistance. J Allergy 36:62-69,
able alteration of the rheologic properties of mucus, 1965
an increase in ciliary beating frequency, or both. Our 10 Taylor C, Shivalkar PR: Changes in nasal resistance on
experimental method does not permit separation of antigenic challenge in allergic rhinitis. Clin Allergy 1:63-
73, 1971
these two mechanisms.
11 Bang BC, Mukherjee AL, Bang FB: Human nasal
Drinking hot chicken soup either by sipping or by mucous flow rates. Johns Hopkins Med J 121:38-48,
straw increased nasal mucus velocity compared to 1967
the sham procedure. In the case of sipping, the 12 Ralston HJ, Kerr WT : Vascular responses of the nasal
absolute increase was similar to hot water. The straw mucosa to thermal stimuli with some observation on skin
temperature. Am J Physiol 144:305-310, 1945
method gave a lesser yet still significant rise. There
13 Andersen I, Jensen PL, Reed SE, et al: Induced rhino-
was no statistically significant difference among the virus infection under controlled exposure to sulfur diox-
three treatments. In all three instances, the absolute ide. Arch Environ Health 31 : 120-126, 1977

410 SAKETKHOO,JANUSZKIEWICZ, SACKNER CHEST, 74: 4, OCTOBER, 1978

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