Delivery of Clinical Care: Table of Holistic Therapeutics by: Monique Ramirez, NURS 660, 11/9/14

Project Instructions: Using the template provided, develop a comprehensive, holistic therapeutics table for a typical patient in your chosen
population [at least 20 therapeutics] and scientific, evidence-based rationale. The following should be included in this document: traditional &
integrative pharmacologic and non-pharmacologic interventions, physiologic explanation of rationale, and potential adverse effects for which patients
should be monitored. References should include current national standards of care for this population and best practice literature. All references
should be current within the past 5 years. Formatting for table and narrative is single-spaced.
Please include the following:
Introduction to the Table of Therapeutics for the chosen population addressing the goals of care and integration of holistic interventions.
10-15 pharmacologic interventions [traditional, including oxygen and integrative]
5-10 non-pharmacologic interventions
Perspectives from 2 or more interprofessional colleagues
Summary of application of holistic therapeutics to health of chosen population and expected optimal outcomes of care.
Introduction to Patient Population: COPD is the fourth leading cause of death in the world with the most common risk factor being tobacco
smoking (GOLD, 2010, p. XI). Many efforts have been placed in the education and prevention of COPD. Treatment and management of patients is
based on disease severity as measured by the classification system. Stages I and II involved prevention of risk factors to prevent progression of
disease and may involve pharmacological options to control symptoms (GOLD, 2010, p. 32). Stage III and IV required pharmacological support and
integration of various therapies for symptoms management along with the support of the healthcare team as the disease progresses (GOLD, 2010, p.
32). The most common patient demographics in COPD patients include non-hispanic white women ages 65-74, lower income unemployed, retired, or
widowed, with a history of smoking or are current smokers, and asthma (Centers for disease control and prevention [CDC], 2013). Various factors
need to be taken into account when deciding which treatment option is most beneficial for the patient.
Population-specific Goals of Care: Disease prevention is the ultimate goal, however once diagnosed the main goals are symptom relief, prevention
of disease progression, improving exercise tolerance, health status, prevention and treatment of complications and exacerbations, and reducing
mortality risk. Because of multiple comorbidities, COPD patients often have side effects from treatment regimens. An effort should be placed on
achieving these goals with minimal side effects and adverse reactions. In establishing a treatment plan factors such as benefit versus risk, cost, social,
and community must be considered for the best possible outcomes (GOLD, 2010, p. 32).
References:
Centers for disease control and prevention. (2013). What is COPD? Retrieved from http://www.cdc.gov/copd/
NURS660: Clinical Systems Leadership Immersion

Page 1

Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy for the diagnosis, management, and prevention of chronic
obstructive pulmonary disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf

Name of
Therapeutic
+Route
+Safe Dose
[maximum 24hr
dose; daily dosing;
onset/ peak/
duration]
Classification of
Therapeutic
[therapeutic and
pharmacologic OR
category of nonpharmacologic]

1. Smoking
Cessation

General
Mechanism
of Action
[paraphrase in
your own
words the
physiologic
and/or
psychological
basis for
therapeutic
action using
current
evidence]

Elimination of
irritants to the
The 5 step program lungs
decreases the
for intervention
inflammatory
Education
response and
mucous

Specific
Indication
for this
patient
population
[explain in
your own
words the
specific
benefits for
health and
wellness
using
current
evidence]

Outline
patient
safety issues
associated
with this
therapy

References
[use in-text APA style references including personal communication as
appropriate]

[adverse
drug
reactions,
drug-drug
and drugfood
interactions]
Outline
potential
contraindic
ations for
the therapy

Eliminatin
g irritants
decreases
the
harmful
effects and
decreases
exacerbatio

NURS660: Clinical Systems Leadership Immersion

None. Social
support,
skills
training, and
pharmacothe
rapy are
important for
smoking

National Guideline Clearinghouse (NGC). Guideline summary: Diagnosis and

management of chronic obstructive pulmonary disease (COPD). In: National
Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for
Healthcare Research and Quality (AHRQ); [cited 2014 Nov 5]. Available:
http://www.guideline.gov/content.aspx?id=44345&search=copd.

Page 2

production.

2. Albuterol

Decreases
inflammation
Inhalation
in lung
Onset 5-15minutes, pathways by
peaks 30minacting on the
2hours, lasts 2-6
muscle tone of
hours.
the
Dosage is 180mcg bronchioles. It
stimulates the
(2 inhalations)
every 4-6 hours for Beta 2
adrenergic
a maximum dose
receptors and
of
causes an
1080mcg/24hours
increases in
Beta 2-agonist
cAMP and
prevent
(ClinicalKey,
bronchoconstr
2014)
iction.

ns. Allows cessation.

for lungs to
heal and
stops
further
lung
damage.
The use of
this
medication
helps to
decrease
symptom
severity of
shortness
of breath,
improves
quality of
life, and
helps
patients
continue
with
activities
for
prevention.

NURS660: Clinical Systems Leadership Immersion

Albuterol
has the
potential to
induce sinus
tachycardia
in patients. It
can also
cause
hypokalemia
when
combined
with thiazide
diuretics.
Older
patients may
experience
somatic
tremors with
higher doses
(ClinicalKey
, 2014).

ClinicalKey (2014). Albuterol [Monograph]. Retrieved from

https://www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-11
Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf

Page 3

3. Fluticasone
(Flovent diskus)

Inhibits the
release of
mediators
Inhalation
including IgE
100mcg twice a
synthesis,
day. Maximum
promotes
dose 1000mcg/day. vasoconstricti
Onsets and peaks
on, and
instantly and can
decrease the
last up to 24 hours. inflammatory
response (R.
Corticosteroid
Basken,
personal
communicatio
n, November
5, 2014)
.

4. Influenza
Vaccine

The influenza
vaccine
initiates the
Intramuscular
production of
Injection
antibodies that
Recommendations protects
are for 1 vaccine of against the
0.5ml every year.

Regular
treatment
with
inhaled
corticoster
oids (ICS)
improves
symptoms,
lung
function,
quality of
life, and
exacerbatio
n episodes
in patients
with
FEV1 <
60% of
predicted
(R.
Basken,
personal
communic
ation,
November
5, 2014)

To be used
(R. Basken, personal communication, November 5, 2014)
with caution ClinicalKey (2014). Fluticasone [Monograph]. Retrieved from
in patients
https://www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-263
with
allergies to
medication,
oral thrush is
a concern
and oral
hygiene is
encouraged.
Drug-drug
interactions
care not
common
with inhaled
medication
(R. Basken,
personal
communicati
on,
November 5,
2014)

It protects
high risk
COPD
patients
against
influenza
that may

Allergy list
must be
reviewed to
ensure
patient is not
allergic to
eggs or

NURS660: Clinical Systems Leadership Immersion

Centers for Disease and Control. (2014). Vaccine information statement:

Inactivated influenza vaccine. Retrieved from
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf

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It peaks are 2
virus.
weeks and lasts
several months to 1
year.

exacerbate
their
COPD
symptoms.

vaccine.

Specific
indications
include
low
oxygen
levels
measured
by Sa O2
of less than
88% or
PaO2 less
than
55mmHg
for patients
on multiple
therapies
(Bope &
Kellerman,
2014).
Supplemen
tal oxygen
allows for
oxygen
delivery to
other
organs and
improves

Oxygen can
cause
oxygen
toxicity and
carbon
dioxide
retention.
Oxygen
toxicity can
cause free
radicals in
prolonged
oxygen
therapy
causing
decreased
lung
compliance,
reduced
inspiratory
airflow,
decreased
diffusion
capacity, and
small airway
dysfunction.
Oxygen can

Vaccine can be
live attenuated or
inactivated
5. Oxygen

Supplemental
oxygen
Inhalation-Nasal
delivers more
Cannula
concentrated
Continuous oxygen oxygen to into
delivery via nasal
the lungs to be
cannula up to 5
absorbed by
Liters/minute
the red blood
Peaks instantly and cells at the
lasts for as long the capillaries and
oxygen is delivered supplies
oxygen to
Oxygen Therapy
body organs.

NURS660: Clinical Systems Leadership Immersion

Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf
Bope, E. T., & Kellerman, R. D. (2014). Treatment. In Conns current therapy
2014. Retrieved from
https://www.clinicalkey.com/#!/topic/chronic%20obstructive%20pulmonary%20
disease?scrollTo=%23hl0007326
American Thoracic Society. (2014). Hazards of oxygen. Retrieved from
http://www.thoracic.org/clinical/copd-guidelines/for-healthprofessionals/management-of-stable-copd/long-term-oxygen-therapy/hazards-ofoxygen.php

Page 5

6. Roflumilast

It inhibits the
actions of
Oral
phosphodieste
Usual dose is
rase-4 which
500mcg/day. Max results
dose is
accumulation
500mcg/day. Peaks of cAMP and
at 30minutes-2
decreases
hours, and lasts 4- inflammation.
13 hours.
phosphodiesterase4 (PDE4) inhibitor

shortness
of breath
symptoms.

also lead to
respiratory
drive
depression
and
hypercapnia
that causes
respiratory
acidosis
(American
Thoracic
Society
[ATS],
2014).

It helps to
reduce
inflammati
on in the
lungs and
reduces
moderate
to severe
exacerbatio
ns in
patients
with severe
to very
severe
COPD.
Treatments
is almost
always
combined

Because its
metabolized
by the liver,
it is
contraindicat
ed in
patients with
liver disease.
Combination
therapy with
aminophylli
ne or
theophylline
is not
recommende
d as they
both have
effects on
cAMP.

NURS660: Clinical Systems Leadership Immersion

ClinicalKey (2011). Roflumilast [Monograph]. Retrieved from

https://www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-3518
National Guideline Clearinghouse (NGC). Guideline summary: Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); [cited 2014 Nov
14]. Available: http://www.guideline.gov/content.aspx?id=43794.

Page 6

7. Tiotropium

Blocks
muscarinic
Inhalation (dry
cholinergic
powder or
M1, M2, and
inhalation spray)
M3 receptors.
Dry powder
M1 receptors
18mcg/day. Max
helps
18mcg/day
cholinergic
neurotransmis
Inhalation spray
sion via
5mcg/day. Max
parasympathet
5mcg/day
ic ganglia, M2
Onset starts at in
regulates
30 minutes,
negative
duration lasts 24
feedback for
hours. Peaks at 1 to acetylcholine
4 hours.
release, M3
acts on the
Anticholinergics
smooth
(NCD)
muscle
mucosal
gland. The
combination
M1, M2, and
M3 receptors
slows
neurotransmitt
ers leading to
bronchodilatio

with a
long-acting
bronchodil
ator
(NCG).

Adverse
reactions
include
insomnia,
anxiety, and
depression.

The effects
of this
medication
relieves
symptoms
of COPD
by
bronchodil
ation and
creating
lasting
effects. It
is indicated
for all
stages of
COPD
with
varying
symptoms.

Should not
be used for
acute
bronchospas
ms. Caution
should be
used in
patients with
history of
allergy to
atropine and
in patients
with
glaucoma. It
should not
be
administered
with any
other
anticholinerg
ic
medication.

NURS660: Clinical Systems Leadership Immersion

ClinicalKey (2014). Tiotropium [Monograph]. Retrieved from

https://www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2675
National Guideline Clearinghouse (NGC). Guideline summary: Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); [cited 2014 Nov
14]. Available: http://www.guideline.gov/content.aspx?id=43794.

Page 7

n lasting 24
hours.
8. Pneumovax
(PPSV23)

The
inactivated
viruses cause
antibodies that
protect against
23 types of
pneumonia
bacteria.

Helps
prevent
infection in
high risk
COPD
patients.
Minimizin
g the risk
of
infection
decreases
the risk for
COPD
exacerbatio
n (NCG).

Anyone with
an allergy to
the vaccine
should not
get it, or if
the patient is
moderately
to severely
ill, they can
be asked to
wait until
they recover
to have the
vaccine.

Centers for Disease and Control. (2014). Vaccine information statement:

Pneumococcal polysaccharide vaccine: What you need to know. Retrieved from
http://www.cdc.gov/vaccines/hcp/vis/vis-statements/ppv.pdf

It includes
exercise
Pulmonary
training,
rehabilitation
nutrition,
Recommended 20- counseling,
30 minutes 2-5
and education.
times a week.
It increases
Rehabilitation is
peak
tailored to the
workload by
individual based on 18%, oxygen
key assessment
consumption
date of functional
by 11% and
status, motivation, endurance by
smoking status,
78%. I
and symptoms
severity.

Rehabilitat
ion helps
to reduce
symptoms
leading to
increased
quality of
life and an
increase in
physical
daily
activities.

Patients with
increased
levels of
shortness of
breath may
not benefit
from
therapy.
Patients also
need to be
motivated
and cannot
be a current
smoker to
get the
maximum
benefits

Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf

Intramuscular
injection
0.5ml every 5
years, peaks at 2-3
weeks and last up
to 5 years.
Vaccineinactivated

9. Rehabilitation

NonNURS660: Clinical Systems Leadership Immersion

National Guideline Clearinghouse (NGC). Guideline summary: Diagnosis and

management of chronic obstructive pulmonary disease (COPD). In: National
Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for
Healthcare Research and Quality (AHRQ); [cited 2014 Nov 5]. Available:
http://www.guideline.gov/content.aspx?id=44345&search=copd.

Mason, R. J., Broaddus, C., Martin, T. R., King, T. E., Schraufnagel, D. E.,
Murray, J. F., & Nadel, J. A. (2010). Pulmonary rehabilitation. In J. F. Murray, &
J. A. Nadel (Eds.), Textbook of respiratory medicine (pp. 2180-2193). Retrieved
from https://www.clinicalkey.com/#!/content/book/3-s2.0B9781416047100000948

Page 8

pharmacological

from the
therapy.

(Mason et al.,
2010)
10. Fluticasone and The
Salmeterol
fluticasone
(Advair)
acts on the
neutrophils,
Inhalation
CD8+, t250/50mcg twice
lymphocytes,
day, duration last
and
12 hours.
macrophages
Maximum dose is
in the lungs to
same.
decrease
Long acting beta 2 inflammation.
agonist and
Salmeterol
corticosteroid
helps with the
conversion of
(R. Basken,
ATP to
personal
cAMP.
communication,
November 5, 2014) Increased
levels of
cAMP cause
smooth
muscle
relaxation in
the
bronchioles
and block
hypersensitivit
y from mast
cells.

In clinical
trials
patient
have been
found to
have
improveme
nt in lung
function
when
compared
to placebo,
fluticasone
, and
salmeterol
alone.
There is
also a
decrease in
moderate
and severe
exacerbatio
ns in a 3
year study.

NURS660: Clinical Systems Leadership Immersion

Should not
be used in
combination
with P450
3A4
inhibitors as
it can
increase the
risk of
systemic
corticosteroi
d and
cardiovascul
ar affects.
Side effects
to watch for
are steroid
psychosis,
weight gain,
increase in
blood sugar,
and oral
candidiasis.
(R. Basken,
personal
communicati
on,
November 5,
2014)

(R. Basken, personal communication, November 5, 2014)

GlaxoSmithKline (2014). Advair medication guide. Retrieved from
https://www.gsksource.com/gskprm/htdocs/documents/ADVAIR-DISKUS-PIMG.PDF#nameddest=MG

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Oral
prednisone is
Oral
the for the
5-60mg daily for 2 acute
weeks than taper,
management
peaks at 1 hour,
of
duration 24 hours. exacerbations.
Max dose
Stops
60mg/day.
leukocyte
Glucocorticosteroi infiltration at
the location of
d
inflammation.
(E. Crawford,
Prednisone
personal
also controls
communication,
lipocortins
November 6, 2014) that affect
prostaglandins
and
leukotrienes
and stop
arachidonic
acid
(ClinicalKey,
2014).

In the
acutely ill
patient,
relieving
the
inflammati
on will
help to
relieve
symptoms
faster and
will last
longer in
the body to
help
maintain a
steady
level as
other
medication
s are used
to help
sustain the
effects.

Patients
(E. Crawford, personal communication, November 6, 2014)
blood sugars
must be
ClinicalKey (2014). Prednisone [Monograph]. Retrieved from
monitored
https://www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-505
and should
be taken
with food. It
may
decrease
affect with
rifampin
Dilantin.
Oral care is
encouraged
to decrease
the
possibility of
oral
candidiasis.
Because this
medication
may weaken
the immune
system,
monitoring
for infection
is
recommende
d.

12. Theophylline

It
suppresses
symptoms
by

This
medication
can cause
jitters,

11. Prednisone

Oral
Usual dose in
10mg/kg/day and

Block
phosphodiaste
rate which
increases

NURS660: Clinical Systems Leadership Immersion

(E. Crawford, personal communication, November 7, 2014)

Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
Page 10

should not exceed

900mg/day, peaks
at 1-2 hours, and
last 24 hours,
therapeutic max,
dosed based on
blood level.

cAMP and
causes
bronchodilatio
n and also
prevents
airway
stimulation.

bronchodil
ation and
also
prevent
irritation
by
decreasing
the
sensitivity
of lungs to
stimuli.

tachycardia, http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf
arrhythmias,
nausea and
vomiting,
diarrhea, and
has narrow
therapeutic
range thus
toxicity must
be
monitored.
Should not
be taken
with
caffeine. To
be used with
caution
when
combined
with other
medication
such Advair
(GOLD,
2010)

Decreases the
work of
inspiratory
Inhalation
breathing by
Continuous
surpassing the
positive airway
threshold of
pressure (CPAP) to intrinsic
reach a tolerated
positive and
level as measured
expiatory
by PEEP that can
pressure.
be initiated at 4cm PEEPi is at

Helps to
oxygenate
the patient
in patients.
It is used
in patient
with an
acute
exacerbatio
n with
moderate

It decreases
quality of
life in
patients,
may cause
skin
irritation
along the
delivery
system, dry
mouth,

Methylxanthines

13. Ventilatory
Support

NURS660: Clinical Systems Leadership Immersion

Chaturvedi, R. K., & Zidulka, A. (2011). March 7. Continuous Positive Airway

Pressure versus continuous negative pressure around the chest for patients with
acute exacerbations of chronic obstructive pulmonary disease in the intensive
care unit: A pilot study, 53, 141-144. Retrieved from
http://119.18.57.69/~vpciorg/uploads/file/j-2011-Article-1.pdf
National Heart, Lung, and Blood Institute. (2011). What are the risks of cpap?
Retrieved from U.S. Department of Health & Human Services:
http://www.nhlbi.nih.gov/health/health-topics/topics/cpap/risks.html

Page 11

H2O.

atmospheric
(Struik et al., 2014) pressure
which
decreased the
work of
breathing
(Chaturvedi &
Zidulka,
2011).

to severe
COPD
(GOLD,
2010)

14. Physical
activity

It improves
peripheral
Ranges from daily muscle
function and
to weekly, 10
improves
minutes to 45
bioenergetics
minutes per
of the muscles
session, and can
which reduces
reach 50% peak
the amount of
oxygen
consumption to the lactate
maximum tolerated produced
during
by the patient.
exercise
Nonleading to a
pharmacological
reduction in
symptoms.

Help to
lower risk
for hospital
admissions
and risk of
all-cause
mortality.

Exercise
needs to be
tailored to
the persons
functional
capacity.

National Guideline Clearinghouse (NGC). Guideline summary: Global strategy

for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. In: National Guideline Clearinghouse (NGC) [Web site]. Rockville
(MD): Agency for Healthcare Research and Quality (AHRQ); [cited 2014 Nov
14]. Available: http://www.guideline.gov/content.aspx?id=43794.

15. Feldenkrais
Methos

It allows
for
minimal
effort in
movement

Can be used
as an
alternative
therapy in
patient with

Ramli, A., Leonard, J. H., & Harun, R. (2013, September). Preliminary evidence
on the feldenkrais method as an alternative therapy for patients with chronic
obstructive pulmonary disease. Focus on alternative and complementary
therapies, 18(3), 126-132. http://dx.doi.org/10.111/fct.12050

Cutaneous
An 8 week

It is a mindbody-spirit
interaction
movement
technique that

bloating,
congestion,
or sinusitis
(NIH, 2011).

Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf
Struik, F. M., Sprooten, R., Kerstjens, H., Bladder, G., Zijnen, M., Asin, J., ...
Wijkstra, P. J. (2014, April 10). Nocturnal non-invasive ventilation in COPD
patients with prolonged hypercapnia after ventilatory support for acute
respiratory failure: A randomized, controlled, parallel-group study. Thorax, 0, 19. http://dx.doi.org/10.1136/thoraxjnl-2014-205126

NURS660: Clinical Systems Leadership Immersion

Garcia-Aymerich, J., Lange, P., Benet, M., Schnohr, P., & Anto, J. M. (2006,
May 31). Regular physical activity reduces hospital admission and mortality in
chronic obstructive pulmonary disease: A population based cohort study. Thorax,
61, 772-778. http://dx.doi.org/10.1136/thx.2006.060145

Page 12

program that is
were taught over a
series of lessons
with gradual
progression
towards patients
comfort level.

is based on
sensory motor
awareness and
cognitive
perception.

with
maximum
efficiency
in patients
with
excertional
shortness
of breath
or other
symptoms.
Movement
awareness
and mindbodybehavior
interaction
s helps to
regulate
emotional,
mental,
social, and
behavioral
factors that
affect
health.

reduced
function and
exercise
intolerance.

The herbal
and medicinal
properties of
the herbs
work in
combination
to relieve
symptoms and
at the cellular

Therapy
has shorter
frequency
and
duration of
exacerbatio
n, higher
FEV1
levels,
quality of

Drug
interactions
with western
medicine to
treat COPD
is a concern.
Reports of
abdominal
distention,
palpitations,

Alternative/comple
mentary therapy

16. Traditional
Chinese Medicine
oral
Bu-Fei Jian-Pi
granules 3.83 g,
Bu-Fei Yi-Shen
granules 4.25 g.,
and Yi-Qi Zi-Shen
granules 5.16 g.

NURS660: Clinical Systems Leadership Immersion

Li, S., Li, J., Wang, M., Xie, Y., Yu, X., Sun, Z., ... Pan, Y. (2012, October 29).
Effects of comprehensive therapy based on traditional Chinese medicine patterns
in stable chronic obstructive pulmonary disease: A four-center, open-label,
randomized, controlled study. BMC Complementary and Alternative Medicine,
12, 1-11. http://dx.doi.org/http://www.biomedcentral.com/1472-6882/12/197

Page 13

3 doses, twice a
day. No peak or
duration.

level.

life
increases
over time.

constipation,
thirst, and
insomnia are
common
adverse
effects with
other
medications.

A surgical
procedure to
remove part of
the lung to
reduce
hyperinflation
and causes the
respiratory
muscles to be
more effective
and improves
mechanical
efficiency.

Patients
have better
work
capacity
and health
related
quality of
life,
reduced
frequency
of
exacerbatio
n and
increased
the amount
of time
until their
first
exacerbatio
n.

Patient
selection is
limited to
those with a
higher
exercise
capacity
prior to
treatment.
This form of
treatment is
expensive
compared to
others.

Global Initiative for Chronic Obstructive Lung Disease. (2010). Global strategy
for the diagnosis, management, and prevention of chronic obstructive pulmonary
disease. Retrieved from Global Initiative for Chronic Obstructive Lung Disease:
http://www.goldcopd.org/uploads/users/files/GOLDReport_April112011.pdf

Manual
approach
performed by
osteopathic
Cutaneous
practitioner to
45 minute sessions, improve

Treatment
has shown
to improve
functional
capacity in
patients

Treatment
needs to be
tailored to
the
individual
and an initial

Zanotti, E., Berardinelli, P., Bizzarri, C., Civardi, A., Manstretta, A., Rossetti, S.,
& Fracchia, C. (2012, February/April). Osteopathic manipulative treatment
effectiveness in severe chronic obstructive pulmonary disease: A pilot study.
Complementary Therapies in Medicine, 20(1-2), 16-22.
http://dx.doi.org/10.1016/j.ctim.2011.10.008

Nonpharmacologic
17. Lung volume
reduction surgery
Surgical

18. Osteopathic
manipulative
treatment (OMT)

NURS660: Clinical Systems Leadership Immersion

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once a week, for 4

weeks, tailored to
fit the needs of the
individual
Nonpharmacological

19. Neuromuscular
release massage
therapy (NRMT)
Cutaneous
24 weekly sessions
Nonpharmacologic

physiologic
function and
support an
equilibrium
that has been
disturbed by a
somatic
dysfunction.
Manual
examination
of thoracic
outlet, spine,
rib cage,
thoracic and
pelvic
diaphragm,
tentorium
cerebelli, and
a craniosacrum.

when used
in
conjunctio
n with
pulmonary
rehabilitati
on. OMT
decreases
tissue
resistance,
increases
joint
motion,
and
promotes
better
function of
the
diaphragm.

assessment
is necessary
to establish
joint
mobility and
safety
throughout
the
treatment.
Studies show
it is most
effective
when paired
with
pulmonary
rehabilitatio
n.

Assessment of
the tissues and
accurate
trigger points
to increase
blood flow
and
circulation.
Also releases
pain related to
muscle
spasms.
Pressure to the
diaphragm
under the

Patients
have
increased
energy,
decreased
dyspnea,
and
improveme
nt in heart
rate and
oxygen
saturation.

Cost is a
factor for
some patient
who cannot
afford the
therapy.

NURS660: Clinical Systems Leadership Immersion

Donesky, D. M. (2012). Integrative therapies for people with chronic obstructive

pulmonary disease. In L. Chlan, & M. I. Hertz (Eds.), Integrative therapies in
lung health and sleep (pp. 63-101). http://dx.doi.org/10.1007/978-1-61779-5794_4

Caution
should be
used in
patients with
joint disease
or other
musculoskel
etal
Page 15

sternum, left
and right rib
cage is
applied while
the patient
exhales into
the therapist
hands.
20. Hydrotherapy

Breathing
exercises as
15minute to 45
minute sessions per the patient
week. Can be done stand in warm
mineral water
weekly
and inhales
Nonand then
pharmacological
exhales into
the water.

disorders.

Studies
have
shown
breathing
exercised
to improve
FEV/FVC1
and
decrease
pCO2
levels.
There is
also an
increase in
exercise
performanc
e and
quality of
life
measures.
Cardiac
output
increases
as a result
of
increased
venous

NURS660: Clinical Systems Leadership Immersion

Some patient
experience
transient
dyspnea and
fear during
the first
introductory
sessions.
The patients
ability to
swim also
needs to be
taken into
consideratio
n.

Donesky, D. M. (2012). Integrative therapies for people with chronic obstructive

pulmonary disease. In L. Chlan, & M. I. Hertz (Eds.), Integrative therapies in
lung health and sleep (pp. 63-101). http://dx.doi.org/10.1007/978-1-61779-5794_4

Page 16

return
which
increases
preload
and
decreases
afterload
as an effect
of the
weightless
ness of the
water.

Summary: Patients with COPD can be at various stages of disease with varying symptoms. The integration of therapies is essential for maximum
health benefits. With various options available for treatment, treatment plans should include different aspects of health goals. Non-pharmacologic
strategies can be used in conjunction with medications to optimize symptom management or can be used as an alternative if patients are unable to
tolerate traditional western medicine. For COPD patients, symptoms have a major effect on functional capacity and quality of life. Integrating
pharmacological treatments can control symptoms by alternative mechanism of action creating lasting effects. Barriers to combining treatment plans
are the possible drug-drug interactions and adverse/side effects of medications. Optimizing medications and holistic approaches for COPD
management can reach patient population health goals with minimal effects on quality of life, adverse reactions, and drug-drug and drug-food
interactions.

NURS660: Clinical Systems Leadership Immersion

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