Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

Chronic respiratory diseases (CRDs)—diseases of the lungs and airways—are a growing global health problem, estimated to affect over half a billion people. Including asthma and chronic obstructive pulmonary disease (COPD), CRDs are among the leading causes of morbidity and mortality worldwide. (Soirano 2020)

Asthma is a chronic inflammatory disease of the airways, leading to symptoms such as wheezing, shortness of breath, chest tightness, and coughing. Globally, it is estimated that asthma affects over 300 million people, although this may actually be higher due to underdiagnosis. On a public health level, asthma that goes undertreated contributes substantially to healthcare utilization, lost school and work days, and in severe cases, mortality. (Nunes 2017) 

COPD is a group of progressive lung diseases due to airway inflammation and structural lung damage, leading to chronic breathing difficulties. Nearly 600 million people are projected to be living with COPD by 2050, representing a 23% increase in the number of cases compared with 2020. COPD poses a significant economic burden on healthcare systems and is a leading cause of mortality worldwide, responsible for 5% of global deaths annually. (Boers 2023)(WHO 2024)

Priorities for a suitable treatment plan for patients with CRDs include reducing inflammation, addressing comorbidities, and optimizing pulmonary efficiency. The ingredients presented below have shown promising results to assist in managing CRDs.

Ingredients

Probiotics

Dosing: 26 billion colony-forming units (CFU)—including Lactobacillus plantarum RSB11®, Lactobacillus acidophilus RSB12®, and Lactobacillus rhamnosus RSB13®—daily for at least one month (Wenger 2023)(Nicola 2024)

Supporting evidence:

  • In rat models exposed to lipopolysaccharide (LPS), Lactobacillus probiotics decreased neutrophil recruitment and inflammatory biomarkers (including matrix metalloproteinase 9 [MMP-9], myeloperoxidase [MPO], and C-reactive protein [CRP]) in bronchoalveolar lavage fluid, serum, and lung tissue compared to untreated mice, suggesting that certain probiotic strains can modulate pulmonary inflammation and injury-induced tissue remodeling. (Wenger 2022)
  • Results from a one-month, randomized, open-label clinical trial suggest that oral probiotics may support lung health through modulation of the gut-lung axis. Twenty-two participants, who were either healthy or had stable asthma, received a Lactobacillus probiotic blend twice daily for four weeks. Among participants with asthma, pulmonary function improved compared to baseline, as measured by forced expiratory volume in one second (FEV1). In addition, of the patients who smoked, had asthma, or smoked and had asthma, 36% noted overall improvements in health, 43% reported less frequent coughing, 43% experienced reduced shortness of breath, and 29% reported fewer sleep disturbances related to breathing. (Wenger 2023)
  • In a 12-week, double-blind, placebo-controlled trial of adults with COPD or non-cystic fibrosis bronchiectasis (n=37), a probiotic and herbal blend was associated with significant improvements in respiratory symptoms via anti-inflammatory actions. In patients taking the supplement, symptom scores on the St. George’s Respiratory Questionnaire (SGRQ) decreased by 5.4 points, while sputum MMP-9 decreased by 47%, serum CRP by 48%, and serum interleukin-6 (IL-6) by 43%. (Nicola 2024)
Probiotics in the Fullscript catalog

Vitamin C

Dosing: 400–1,500 mg, total per day of ascorbic acid, for a minimum of two weeks (Nadi 2012)(Tecklenburg 2007)(Lei 2022)

Supporting evidence:

  • A 2023 cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data (n=3,487, age >40) showed that higher serum vitamin C levels were associated with a lower risk of COPD. (Zheng 2023) 
  • A 2022 systematic review and meta-analysis of ten randomized controlled trials (RCTs) (n=487) found that vitamin C supplementation (>400 mg per day) in patients with COPD led to statistically significant improvements in FEV1 as a percentage (FEV1%) and the ratio of FEV1 and forced vital capacity (FEV1/FVC), as well as increased serum antioxidant levels (vitamin C and glutathione). (Lei 2022)
  • In a double-blind clinical trial with 60 patients with chronic stable asthma, the mean vitamin C leukocyte level increased after one month of supplementing with vitamin C. However, no change was observed in spirometry measures. (Nadi 2012)
  • When given with corticosteroids, vitamin C decreased the inhaled corticosteroid dose by 49 mcg, compared to 11 mcg in the placebo group, in adults with asthma. (Fogarty 2006)
  • In a small randomized, placebo-controlled, double-blind crossover trial, eight patients with asthma were administered either ascorbic acid or a placebo daily for two weeks. Then they initiated a vitamin C-enriched diet after a one-week washout period. Vitamin C significantly improved FEV1, asthma symptom scores, and post-exercise scores in patients with exercise-induced bronchoconstriction. (Tecklenburg 2007) 
Vitamin C in the Fullscript catalog

Magnesium

Dosing: 300–340 mg, total per day of magnesium citrate, for a minimum of six months (Kazaks 2010)( Zanforlini 2022) 

  • Note: Oral magnesium supplementation evidence is limited, while nebulized and intravenous (IV) interventions are more common. (Reddel 2023) 

Supporting evidence: 

  • Treatment of acute asthma attacks with magnesium is typically given via IV or nebulized. When comparing the two therapies, IV magnesium improves pulmonary function in children and adults, while nebulized magnesium seems to be effective only in adults. (Shan 2013)
  • A systematic review and meta-analysis of nine RCTs demonstrated with low-certainty evidence that IV magnesium sulfate, when administered to children alongside first-line treatment with inhaled/nebulized short-acting beta-2 agonist and systemic steroids during acute asthma exacerbations, results in lower hospitalization rates and less need for non-invasive ventilation. (Hamud 2025)
  • Higher dietary magnesium intake is significantly and positively correlated with better pulmonary function, including higher forced vital capacity (FVC), forced expiratory volume (FEV), FEV1/FVC, peak expiratory flow (PEF), and forced expiratory flow between 25 and 75% of FVC (FEF25–75%)—especially in men aged 40–79 years. (Tan 2024)
  • A double-blind RCT suggests oral magnesium citrate supplementation in patients with stable COPD (n=49) may have anti-inflammatory effects (indicated by lower CRP levels), but does not significantly improve lung function or quality of life. (Zanforlini 2022)
  • According to a systematic review and meta-analysis of eight RCTs including 917 children and adults (ages 6–60 years), mild-to-moderate asthma benefited from oral magnesium supplementation as demonstrated by improved FEV1. (Abuabat 2019)
Magnesium in the Fullscript catalog

Omega-3 Fatty Acids 

Dosing: 3.1 g (1.8 g eicosapentaenoic acid [EPA] and 1.3 g docosahexaenoic acid [DHA]) per day for at least three weeks (Williams 2017)

Supporting evidence:

  • Supplemental long-chain EPA and DHA omega-3 polyunsaturated fatty acids (PUFAs) achieved reductions in bronchoconstriction (as measured by FEV1 after hyperpnea challenge) and airway inflammation markers in eight adult males with asthma. (Williams 2017)
  • Higher plasma levels of DHA are associated with a slower decline in lung function and a lower incidence of airway obstruction. Specifically, each 1% increase in DHA corresponds to a slowed age-related decline in FEV1 by 1.4 mL/year, in FVC by 2.0 mL/year, and a 7% lower incidence of spirometry-defined airway obstruction. (Patchen 2023)
  • Omega-3s attenuate respiratory inflammation, which in turn may help alleviate symptoms like dyspnea. (Kumar 2016) This idea is supported by observational findings that adults with asthma who have a higher omega-3 index (>8%) require lower maintenance doses of inhaled corticosteroids than those with an omega-3 index below 8%. (Stoodley 2019)
  • The results of a six-month study of children (n=149) demonstrate that higher omega-3 intake is correlated with fewer asthma symptoms triggered by indoor air pollution. Conversely, higher intake of omega-6 PUFAs may be associated with more severe asthma and a lower FEV1/FVC ratio. (Brigham 2019)
Omega-3 Fatty Acids in the Fullscript catalog

Black Cumin Seed (Nigella sativa)

Dosing: 500–1,000 mg twice daily for 4–12 weeks (Koshak 2017)(Salem 2017) 

Supporting evidence:

  • A meta-analysis of four RCTs concluded that Nigella sativa supplementation is associated with improved pulmonary function, as shown by an increase in Asthma Control Test (ACT) scores and FEV1. (He 2020)
  • Findings from an RCT suggest that Nigella sativa oil (NSO) may help improve markers of asthma control. After four weeks, patients who received NSO (n=30) showed greater reductions in blood eosinophil counts (–50 cells/μL) compared to those receiving placebo (–15 cells/μL). Pulmonary function also showed modest improvements, with mean ACT scores of 21.1 in the NSO group versus 19.6 in the placebo group, alongside small, nonsignificant increases in FEV1. (Koshak 2017)
  • An RCT investigated the effects of Nigella sativa supplementation alongside inhaled maintenance therapy in patients with partially controlled asthma. The study found that supplementation with Nigella sativa significantly improved several measures of pulmonary function and inflammation. Specifically, there were notable reductions in fractional exhaled nitric oxide (FeNO) and serum IgE levels, indicating decreased airway inflammation. Additionally, ACT scores improved significantly, and PEF variability was reduced. Furthermore, supplementation was associated with a significant increase in serum interferon-ɣ (IFN-ɣ) levels, suggesting a shift towards a more balanced Th1/Th2 immune response. (Salem 2017)
  • Nigella sativa may be effective for prophylactic asthma treatment, as demonstrated by a decrease in the frequency of asthmatic episodes, chest wheezing, and improved pulmonary function tests, as well as a reduction in the use of inhalers, oral beta-agonists, oral corticosteroids, and oral theophylline. (Boskabady 2007)
Black Cumin Seed (Nigella sativa) in the Fullscript catalog

Cineole (Derived From Eucalyptus)

Dosing: 200 mg three times daily for six months (Worth 2009)(Worth 2012)

Supporting evidence:

  • Cineole modulates key inflammatory pathways, reduces mucus hypersecretion, and attenuates airway hyperresponsiveness in animal and human models. (Juergens 2014)(Yadav 2017)(Juergens 2020)(Kennedy-Feitosa 2020)
  • A recent review concluded that 1,8-cineole shows promise as an alternative or adjunctive treatment for inflammatory respiratory conditions—including asthma, COPD, and chronic sinusitis—based on evidence demonstrating its anti-inflammatory, antioxidant, mucolytic, bronchodilatory, and antimicrobial properties. (Hermanowicz 2025)
  • A double-blind, placebo-controlled trial showed that oral cineole significantly reduced exacerbation frequency, improved lung function, and enhanced quality of life in patients with stable COPD (n=242) compared to placebo. (Worth 2009)
  • In a double-blind, placebo-controlled trial of 247 patients with asthma, adjunctive cineole with standard asthma therapy resulted in significant improvements in lung function (FEV1), asthma symptoms (e.g., dyspnea), and quality of life (as measured by the Asthma Quality of Life Questionnaire [AQLQ]) compared to placebo. (Worth 2012)
Cineole (Derived From Eucalyptus) in the Fullscript catalog

Disclaimer

The Fullscript 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.

View protocol on Fullscript
References
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