Respiratory Care Protocol: A Resource for Practitioners


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by Fullscript’s Integrative Medical Advisory Team

According to the Centers for Disease Control, asthma is a chronic inflammatory respiratory condition, affecting approximately 8% of the population in the U.S. (6) Asthma and its symptoms, such as wheezing and airflow limitation, can range from mild to severe. In some cases, flare-ups may be life-threatening, making the management of asthma essential. (8)

What is asthma?

Asthma is a respiratory condition characterized by chronic airway inflammation and smooth muscle hyper-responsiveness. (1) A variety of changes in the airway may result in airflow limitation, such as airway edema, bronchoconstriction, and airway remodeling. (13)

Several types of asthma with various pathophysiologies have been identified, such as:

  • Allergic asthma, which often presents in childhood and is associated with a family history of allergic disease
  • Non-allergic asthma, where asthma is not due to allergy
  • Adult-onset asthma, where asthma symptoms first present during adulthood
  • Occupational asthma, which occurs as a result of exposure to allergens in the workplace
  • Asthma with persistent airflow limitation, where airflow limitation becomes persistent or irreversible
  • Asthma with obesity, where some obese patients experience airflow limitation with little inflammation (8)
Auscultation of a child’s lungs by a doctor.

Allergic asthma is associated with a family history of allergic disease and often presents in childhood.

Signs, symptoms, and complications

The airflow limitation and symptoms of asthma can vary over time. (8) Signs and symptoms of asthma include:

  • Coughing
  • Wheezing
  • Chest tightness (1)
  • Shortness of breath (8)

Causes, risk factors, and triggers

While the definitive cause of asthma has not been established, (13) risk factors may include:

  • Genetic predisposition (3)
  • Family history of allergic disease (e.g., allergic rhinitis, eczema)
  • Low dietary intake or deficiency of certain nutrients (e.g., magnesium, (10) omega-3 fatty acids, antioxidants) (13)
  • Gender: adult-onset asthma is seen particularly in women (13)
  • Obesity (4)

The “hygiene hypothesis” stipulates that the balance between Th1 and Th2 immune cell response plays a role in the development of asthma. Early childhood exposure to factors such as infections, exposure to other children, and less frequent use of antibiotics are said to be associated with the Th1 immune response that fights infection. An absence of these factors may be associated with a greater Th2 immune response and subsequent elevated rates of asthma. (13)

Certain environmental factors may also trigger or exacerbate symptoms, including:

  • Irritants (e.g., smoke, strong scents, car exhaust fumes)
  • Allergen exposure
  • Exercise
  • Weather changes
  • Viral respiratory infections (8)
  • Food additives and preservatives
  • Certain medications (e.g., nonsteroidal anti-inflammatory drugs, beta-blockers) (13)

Integrative protocol for respiratory care

An integrative treatment approach to asthma may involve administering medications and/or dietary supplements, reducing exposure to environmental triggers, and weight loss interventions for obese patients. (4)(8)

Assortment of nutrients

Magnesium is found in high amounts in foods such as pumpkin seeds, almonds, beans, spinach, and cocoa powder.

Magnesium

Magnesium is an essential mineral used as a cofactor in over three hundred enzymatic reactions in the body. It is involved in energy production, nerve function, muscle contraction, and many other body processes. Research suggests that nearly two-thirds of individuals in Western countries may be magnesium deficient. Magnesium deficiency may result from taking certain medications, consuming diets high in processed foods, or cooking produce which diminishes magnesium content. (14)

Furthermore, several conditions have been associated with magnesium deficiency, including asthma, depression, and epilepsy. (1) In certain vulnerable individuals, magnesium insufficiency may be associated with severe bronchospasm experienced with asthma. (14)

Research findings:

  • Magnesium has shown to improve forced expiratory volume (FEV1) (1)(10)
  • The simultaneous long-term administration of magnesium citrate and drug (bronchodilator) in asthmatic children has been shown to be beneficial in the management of asthma (2)
  • Bronchial reactivity induced by methacholine was decreased by magnesium oral supplementation. It was also shown that magnesium provided better management of the symptoms in pediatric patients with moderate asthma (9)
  • Peak expiratory flow rate (PEFR) increased by 5.8% in addition to an improvement in asthma quality of life (AQLQ) and asthma control questionnaire (ACQ) (10)

US: Search for Magnesium citrate in the Fullscript catalog.
CAN: Search for Magnesium citrate in the Fullscript catalog.

Fish oil

Fish oil supplements provide eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), long-chain omega-3 polyunsaturated fatty acids. As asthma involves inflammatory processes, researchers have examined the anti-inflammatory effects of these fatty acids in individuals with the condition. (18) Oral supplementation of EPA and DHA may increase the omega-3 fatty acid content of cells involved in the inflammatory process, favorably influencing the production of inflammatory mediators, such as cytokines and adhesion molecules. (5)

Research findings:

  • EPA and DHA alter the 15-LOX pathway and the subsequent metabolic profile (11)
  • Omega-3 polyunsaturated fatty acids (PUFAs) decreased airway inflammation markers, such as 9α and 11β-PGF2 (17)
  • The introduction of PUFAs reduced the prevalence of pediatric asthma (18)

US: Search for Omega 3 fatty acids in the Fullscript catalog.
CAN: Search for Omega 3 fatty acids in the Fullscript catalog.

Glass bottle of fish oil and a bowl of fish oil softgels on a table.

Omega-3 supplements are commonly produced from various fish oils, including sardines, anchovies, mackerel, herring, and cod liver.

Vitamin C

Vitamin C is an antioxidant and water-soluble vitamin commonly found in foods such as citrus fruit (e.g., oranges, grapefruit, lemons), papayas, broccoli, and Brussels sprouts. (16) Some researchers have observed a correlation between disease severity and the presence of reactive oxygen species (ROS) in patients with asthma. Acting as a hydrogen donor, vitamin C may reduce oxidation in the body, a process associated with airway inflammation. Further, higher dietary vitamin C may reduce the risk of developing asthma. (12)

Research findings:

  • A protective effect was observed in exercise-induced asthma patients (7)(15)
  • An improvement in post-exercise FEV1, LTC4-E4, 9α, 11β-PGF2 and fraction of exhaled nitric oxide (FENO) concentrations were observed in addition to an amelioration in asthma symptom scores (15)

US: Search for Vitamin C in the Fullscript catalog.
CAN: Search for Vitamin C in the Fullscript catalog.

The bottom line

Clinical research suggests that magnesium, fish oil, and vitamin C supplementation may benefit individuals with asthma. A protocol using natural supplements can be used therapeutically on its own or as an adjunct to existing treatment. If you are not an integrative healthcare provider, we recommend speaking with one to learn whether supplementing these nutrients are ideal for your wellness plan.

If you are a practitioner, consider signing up to Fullscript. If you are a patient, talk to your healthcare practitioner about Fullscript!

To see our full protocol library, click here!


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Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

  1. Abuabat, F., AlAlwan, A., Masuadi, E., Murad, M. H., Jahdali, H. A., & Ferwana, M. S. (2019). The role of oral magnesium supplements for the management of stable bronchial asthma: A systematic review and meta-analysis. NPJ Primary Care Respiratory Medicine, 29(1), 4.
  2. Bede, O., Surányi, A., Pintér, K., Szlávik, M., & Gyurkovits, K. (2003). Urinary magnesium excretion in asthmatic children receiving magnesium supplementation: A randomized, placebo-controlled, double-blind study. Magnesium Research, 16(4), 262-70.
  3. Bijanzadeh, M., Mahesh, P. A., & Ramachandra, N. B. (2011). An understanding of the genetic basis of asthma. The Indian Journal of Medical Research, 134(2), 149–161.
  4. Boulet, L. P. (2013). Asthma and obesity. Clinical & Experimental Allergy, 43(1), 8-21.
  5. Calder, P. C. (2010). Omega-3 fatty acids and inflammatory processes. Nutrients, 2(3), 355–374.
  6. Centers for Disease Control and Prevention. (n.d.). FastStats – Asthma. Retrieved from https://www.cdc.gov/nchs/fastats/asthma.htm
  7. Cohen, H. A. (1997). Blocking effect of vitamin C in exercise-induced asthma. Archives of Pediatrics & Adolescent Medicine, 151(4), 367.
  8. Global Initiative for Asthma. (2019). Global strategy for asthma management and prevention. Retrieved from https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf
  9. Gontijo-Amaral, C., Ribeiro, M. A. G. O., Gontijo, L. S. C., Condino-Neto, A., & Ribeiro, J. D. (2006). Oral magnesium supplementation in asthmatic children: A double-blind randomized placebo-controlled trial. European Journal of Clinical Nutrition, 61(1), 54–60.
  10. Kazaks, A. G., Uriu-Adams, J. Y., Albertson, T. E., Shenoy, S. F., & Stern, J. S. (2010). Effect of oral magnesium supplementation on measures of airway resistance and subjective assessment of asthma control and quality of life in men and women with mild to moderate asthma: A randomized placebo controlled trial. Journal of Asthma, 47(1), 83–92.
  11. Lundström, S. L., Yang, J., Brannan, J. D., Haeggström, J. Z., Hammock, B. D., Nair, P., … Wheelock, C. E. (2013). Lipid mediator serum profiles in asthmatics significantly shift following dietary supplementation with omega-3 fatty acids. Molecular Nutrition & Food Research, 57(8), 1378–1389.
  12. Nadi, E., Tavakoli, F., Zeraati, F., Goodarzi, M. T., & Hashemi, S. H. (2012). Effect of vitamin C administration on leukocyte vitamin C level and severity of bronchial asthma. Acta Medica Iranica, 50(4):233-8.
  13. National Heart, Lung, and Blood Institute. (2006). Guidelines for the diagnosis and management of asthma. Retrieved from https://www.nhlbi.nih.gov/files/docs/guidelines/asthsumm.pdf
  14. Schwalfenberg, G. K., & Genuis, S. J. (2017). The importance of magnesium in clinical healthcare. Scientifica, 2017, 4179326.
  15. Tecklenburg, S. L., Mickleborough, T. D., Fly, A. D., Bai, Y., & Stager, J. M. (2007). Ascorbic acid supplementation attenuates exercise-induced bronchoconstriction in patients with asthma. Respiratory Medicine, 101(8), 1770–1778.
  16. USDA. (n.d.) USDA Food Composition Databases. Retrieved from https://ndb.nal.usda.gov/ndb/
  17. Williams, N. C., Hunter, K. A., Shaw, D. E., Jackson, K. G., Sharpe, G. R., & Johnson, M. A. (2017). Comparable reductions in hyperpnoea-induced bronchoconstriction and markers of airway inflammation after supplementation with 6·2 and 3·1 g/d of long-chain n-3 PUFA in adults with asthma. British Journal of Nutrition, 117(10), 1379–1389.
  18. Yang, H., Xun, P., & He, K. (2013). Fish and fish oil intake in relation to risk of asthma: A systematic review and meta-analysis. PloS one, 8(11), e80048.