Effectiveness of pulmonary rehabilitation at high-altitude compared to sea-level in adults with severe refractory asthma

S B de Nijs; E J M Krop; L Portengen; L H Rijssenbeek-Nouwens; D de Vries; E J M Weersink; H G M Heijerman; D J J Heederik; J W J Lammers

doi:10.1016/j.rmed.2020.106123

Effectiveness of pulmonary rehabilitation at high-altitude compared to sea-level in adults with severe refractory asthma

Respir Med. 2020 Sep:171:106123. doi: 10.1016/j.rmed.2020.106123. Epub 2020 Aug 18.

Authors

S B de Nijs¹, E J M Krop², L Portengen², L H Rijssenbeek-Nouwens³, D de Vries⁴, E J M Weersink⁵, H G M Heijerman⁶, D J J Heederik², J W J Lammers⁷

Affiliations

¹ Department of Respiratory Medicine, University Medical Center Utrecht, the Netherlands; Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
² Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
³ Dutch Asthma Center Davos, Davos, Switzerland.
⁴ Merem Asthma Center Heideheuvel, Hilversum, the Netherlands.
⁵ Department of Respiratory Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands.
⁶ Department of Respiratory Medicine, University Medical Center Utrecht, the Netherlands. Electronic address: H.G.M.Heijerman@umcutrecht.nl.
⁷ Department of Respiratory Medicine, University Medical Center Utrecht, the Netherlands.

PMID: 32846334
DOI: 10.1016/j.rmed.2020.106123

Abstract

Background: Beneficial effects of pulmonary rehabilitation at high-altitude (HAPR) in patients with severe refractory asthma have been reported earlier, but evidence for the effectiveness is limited.

Aim: To investigate the effectiveness of high-altitude pulmonary rehabilitation to comparable treatment at sea-level (LAPR) on patient outcome parameters.

Methods: Adults with severe refractory asthma living in The Netherlands were included. Treatment consisted of a 12-week personalized multidisciplinary rehabilitation program either at high-altitude (Davos Switzerland) (n = 93) or in a tertiary lung center at sea-level in The Netherlands (n = 45). At baseline, after treatment, and during 12 months follow-up asthma related quality of life (AQLQ), asthma control (ACQ), pulmonary function and OCS-dose were assessed. Patients could not be randomized resulting in different asthma populations. Groups were compared using linear regression analysis (ANCOVA) adjusted for baseline values, in addition to age, atopy, smoking history, BMI and gender.

Results: After treatment, and at 12 months follow-up, improved AQLQ(0.92,p < 0.001 and 0.82,p = 0.001, respectively), ACQ(-0.87,p < 0.001 and -0.69,p = 0.008, respectively) and lower maintenance OCS dose (Unadjusted linear regression analysis-5.29 mg, p = 0.003 and Crude Odds Ratio-1.67, p = 0.003, respectively) were observed in the HAPR-group compared to the LAPR group. Patients receiving HAPR also had less asthma exacerbations (≥1 exacerbation: 20% vs 60%,p < 0.001) and showed improvement in lung function (%predFEV₁ 3.4%,p = 0.014) compared to the LAPR group, but at 12 months no differences between groups were observed.

Conclusion: HAPR resulted in a larger improvement in patient outcome parameters compared to LAPR, on the long run the improvement in patient reported symptoms and lower maintenance OCS-dose persists. Underlying factors that explain this observed effect need to be investigated.

Keywords: Asthma; Pulmonary rehabilitation; Refractory; Rehabilitation; Severe.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Altitude*
Asthma / physiopathology
Asthma / rehabilitation*
Disease Progression
Exercise Therapy / methods*
Female
Follow-Up Studies
Forced Expiratory Volume
Humans
Linear Models
Lung / physiopathology*
Male
Middle Aged
Netherlands
Quality of Life
Severity of Illness Index
Switzerland
Time Factors
Treatment Outcome
Young Adult