Potential role of adjuvant micronutrient therapy in the management of respiratory tract infections: a narrative review


  • Pratyusha P. Gaonkar Respiratory Division, Department of Medical Affairs, Lupin Limited, Mumbai, Maharashtra, India
  • Vinay Purohit Respiratory Division, Department of Medical Affairs, Lupin Limited, Mumbai, Maharashtra, India




Micronutrients, Respiratory tract infections, Vitamins, Zinc, COVID-19


Respiratory tract infections (RTIs) are highly prevalent and variable in nature, and are accountable for considerable morbidity and mortality. Acute respiratory tract infections (ARIs) are the third leading cause of death worldwide and the most common cause of antibiotic prescription among adults. It is common knowledge that inappropriate or overuse of antibiotics for RTIs is a crucial contributing factor with respect to the emergence of microbes that are resistant to the drug’s effects. Overuse of antibiotics and antibiotic resistance is a global issue that is becoming a serious concern. There is a growing need for novel approaches and adjuvant therapies for such infections, particularly in the setting of worsening antibacterial resistance. The strategy of supporting the immune system of the host in advance of infection exposure would decrease the number and severity of infections and thus decrease antibiotic use. Micronutrients have varied roles throughout every stage of the immune system and help in strengthening and maintaining immune function. Deficiencies of micronutrients are associated with varied health outcomes and can impact both innate and adaptive immunity profoundly, causing immunosuppression and thus leading to increased susceptibility to infections. Moreover, in view of the COVID-19 pandemic situation, the factors that help the proper functioning of the immune system have garnered much interest and hence the maintenance of an optimal status of certain micronutrients could be particularly beneficial.


File TM. The epidemiology of respiratory tract infections. Semin Respir Infect. 2000;15(3):184-94.

Derbyshire EJ, Calder PC. Respiratory Tract Infections and Antibiotic Resistance: A Protective Role for Vitamin D? Front Nutr. 2021;8:652469.

Jain N, Lodha R, Kabra SK. Upper respiratory tract infections. Indian J Pediatr. 2001;68(12):1135-8.

Driel ML, Beller EM, Thielemans E, Deckx L, Price HE, Clark J, et al. Oral vitamin C supplements to prevent and treat acute upper respiratory tract infections. Cochrane Database Syst Rev. 2019;(3).

Centre for Clinical Practice at NICE (UK). Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care. London: National Institute for Health and Clinical Excellence (UK); 2008.

Zoorob R, Sidani MA, Fremont RD, Kihlberg C. Antibiotic use in acute upper respiratory tract infections. Am Fam Physician. 2012;86(9):817-22.

Ruopp M, Chiswell K, Thaden JT, Merchant K, Tsalik EL. Respiratory Tract Infection Clinical Trials from 2007 to 2012. A Systematic Review of ClinicalTrials.gov. Ann Am Thorac Soc. 2015;12(12):1852-63.

Llor C, Bjerrum L. Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 2014;5(6):229-41.

Chong HX, Yusoff NAA, Hor YY, Lew LC, Jaafar MH, Choi SB, et al. Lactobacillus plantarum DR7 improved upper respiratory tract infections via enhancing immune and inflammatory parameters: A randomized, double-blind, placebo-controlled study. J Dairy Sci. 2019;102(6):4783-97.

Maggini S, Pierre A, Calder PC. Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients. 2018;10(10):1531.

Abioye AI, Bromage S, Fawzi W. Effect of micronutrient supplements on influenza and other respiratory tract infections among adults: a systematic review and meta-analysis. BMJ Glob Health. 2021;6(1):3176.

Pecora F, Persico F, Argentiero A, Neglia C, Esposito S. The Role of Micronutrients in Support of the Immune Response against Viral Infections. Nutrients. 2020;12(10):3198.

Juhn YJ. Risks for infection in patients with asthma (or other atopic conditions): is asthma more than a chronic airway disease? J Allergy Clin Immunol. 2014;134(2):247-57.

Holm Wackerhausen LM, Georg Hansen J. Risk of infectious diseases in patients with COPD. Open Infect Dis J. 2012;6:52-9.

Up To Date. COVID-19: Management in hospitalized adults, 2021. Available at: https://www.uptodate.com/contents/covid19manantin-hospitalized-adults. Accessed on 30 October 2021.

Miravitlles M. Exacerbations of chronic obstructive pulmonary disease: when are bacteria important? Eur Respir J Suppl. 2002;36:9-19.

Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 2007;29(6):1224-38.

Xepapadaki P, Papadopoulos NG. Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers. Eur Respir J. 2010;36(2):438-45.

Saraya T, Kurai D, Ishii H, Ito A, Sasaki Y, Niwa S, et al. Epidemiology of virus-induced asthma exacerbations: with special reference to the role of human rhinovirus. Front Microbiol. 2014;5:226.

Morais AHA, Aquino JS, Maia JK, Vale SHL, Maciel BLL, Passos TS. Nutritional status, diet and viral respiratory infections: perspectives for severe acute respiratory syndrome coronavirus 2. Br J Nutr. 2021;125(8):851-62.

Mizgerd JP. Respiratory infection and the impact of pulmonary immunity on lung health and disease. Am J Respir Crit Care Med. 2012;186(9):824-9.

Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11):1211.

Wang MX, Koh J, Pang J. Association between micronutrient deficiency and acute respiratory infections in healthy adults: a systematic review of observational studies. Nutr J. 2019;18(1):80.

Fernandes SL, Ferreira AL, Soriano E, Silvestre SC, Almeida CA, Junior NI, et al. The role of micronutrients on COVID-19 treatment for adults, children and elderly. Res Soc Dev. 2021;10:7010212259.

Aslam MM, John P, Bhatti A, Jahangir S, Kamboh MI. Vitamin D as a Principal Factor in Mediating Rheumatoid Arthritis-Derived Immune Response. Biomed Res Int. 2019;2019:3494937.

Biesalski HK. Vitamin D deficiency and co-morbidities in COVID-19 patients–A fatal relationship?. NFS Journal. 2020;20:10-21.

Chung C, Silwal P, Kim I, Modlin RL, Jo EK. Vitamin D-cathelicidin axis: at the crossroads between protective immunity and pathological inflammation during infection. Immune Netw.2020;20:12.

Zakić T, Budnar M, Kalezić A, Korać A, Janković A, Korać B. Vitamin C biochemistry: From scurvy to COVID-19 treatment. Hrana I Ishrana. 2020;61:59-70.

Skalny AV, Rink L, Ajsuvakova OP, Aschner M, Gritsenko VA, Alekseenko SI, et al. Zinc and respiratory tract infections: Perspectives for COVID‑19 (Review). Int J Mol Med. 2020;46(1):17-26.

Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68(2):447-63.

Wintergerst ES, Maggini S, Hornig DH. Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. Ann Nutr Metab. 2006;50(2):85-94.

Mossad SB, Macknin ML, Medendorp SV, Mason P. Zinc gluconate lozenges for treating the common cold. A randomized, double-blind, placebo-controlled study. Ann Intern Med. 1996;125(2):81-8.

Prasad AS, Fitzgerald JT, Bao B, Beck FW, Chandrasekar PH. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;133(4):245-52.

Johnston CS, Barkyoumb GM, Schumacher SS. Vitamin C supplementation slightly improves physical activity levels and reduces cold incidence in men with marginal vitamin C status: a randomized controlled trial. Nutrients. 2014;6(7):2572-83.

Hemilä H. Vitamin C supplementation and respiratory infections: a systematic review. Mil Med. 2004;169(11):920-5.

Hunt C, Chakravorty NK, Annan G, Habibzadeh N, Schorah CJ. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res. 1994;64(3):212-9.

Sasazuki S, Sasaki S, Tsubono Y, Okubo S, Hayashi M, Tsugane S. Effect of vitamin C on common cold: randomized controlled trial. Eur J Clin Nutr. 2006;60(1):9-17.

Charan J, Goyal JP, Saxena D, Yadav P. Vitamin D for prevention of respiratory tract infections: A systematic review and meta-analysis. J Pharmacol Pharmacother. 2012;3(4):300-3.

Richardson DP, Lovegrove JA. Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: a UK perspective. Br J Nutr. 2021;125(6):678-84.

Keflie TS, Biesalski HK. Micronutrients and bioactive substances: Their potential roles in combating COVID-19. Nutrition. 2021;84:111103.

Murni IK, Prawirohartono EP, Triasih R. Potential Role of Vitamins and Zinc on Acute Respiratory Infections Including Covid-19. Glob Pediatr Health. 2021;8:233379.

Thomas S, Patel D, Bittel B, Wolski K, Wang Q, Kumar A, et al. Effect of High-Dose Zinc and Ascorbic Acid Supplementation vs Usual Care on Symptom Length and Reduction Among Ambulatory Patients With SARS-CoV-2 Infection: The COVID A to Z Randomized Clinical Trial. JAMA Netw Open. 2021;4(2):210369.

Cámara M, Mata MC, Ruiz V, Cámara RM, Cebadera E, Domínguez L. A Review of the Role of Micronutrients and Bioactive Compounds on Immune System Supporting to Fight against the COVID-19 Disease. Foods. 2021;10(5):1088.

Khatiwada S, Subedi A. A Mechanistic Link Between Selenium and Coronavirus Disease 2019 (COVID-19). Curr Nutr Rep. 2021;10(2):125-36.

Shakoor H, Feehan J, Mikkelsen K, Dhaheri AS, Ali HI, Platat C, et al. Be well: A potential role for vitamin B in COVID-19. Maturitas. 2021;144:108-11.

Tang CF, Ding H, Jiao RQ, Wu XX, Kong LD. Possibility of magnesium supplementation for supportive treatment in patients with COVID-19. Eur J Pharmacol. 2020;886:173546.




How to Cite

Gaonkar, P. P., & Purohit, V. (2021). Potential role of adjuvant micronutrient therapy in the management of respiratory tract infections: a narrative review. International Journal of Basic & Clinical Pharmacology, 11(1), 74–79. https://doi.org/10.18203/2319-2003.ijbcp20214893



Review Articles