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Asthma-tailored pulmonary rehabilitation for adults with severe asthma – are we there?

Published Online: June 9, 2020

The high burden of disability and healthcare costs for asthma originates predominantly in those with severe disease. Symptoms persist despite new pharmacological therapies for asthma, in part due to co-morbidities such as obesity, cardiac disease and mental health disorders. Exercise can improve symptoms and lower future risk of heart disease and diabetes but is it safe in adults with severe asthma? Could an adapted model of pulmonary rehabilitation improve symptoms, quality of life and asthma control in adults with severe asthma? Would it be cost-effective?

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice Dr Rachael A Evans and colleagues performed a feasibility randomized controlled trial of asthma-tailored pulmonary rehabilitation (AT-PR) versus usual care in adults with severe asthma. The main aims were to find out if a larger multi-center trial was feasible, so the primary outcomes were recruitment and completion rate and severe adverse events for safety. Patients were recruited with the help of physicians caring for adults with severe asthma and were eligible if they reported limiting breathlessness on exertion despite optimal management. However, they were excluded if they had been recently admitted to hospital or admitted to intensive care in the previous year.

Patients were randomized 2:1 to asthma-tailored rehabilitation or usual care. Rehabilitation consisted of a 12-week supervised program of exercise, education and self-management. The exercise program included 2 supervised sessions of individually prescribed high intensity aerobic training and strength training and a home program. The education program consisted of multi-disciplinary education but also individualized sessions with a health psychologist to support behavior change. Assessments were performed at baseline, 3 months, and 9 months and included measures of physical performance, health-related quality of life (HRQL), and asthma control.

61/238 (26%) eligible patients were recruited: 38 were females, the average age was 54, and the majority of patients were overweight or obese. 51 participants were randomized, 34 to asthma-tailored pulmonary rehabilitation and 17 to usual care. 62% of patients completed rehabilitation, but only 52% of patients stayed in the study if they were in the usual care arm. The severe adverse event rate was 3.3% which related to study visits, not the rehabilitation. Overall, collection of the outcome measures was feasible. The results suggested improvements in exercise performance, health-related quality of life, and asthma control with rehabilitation compared to usual care. These results indicate that rehabilitation may be efficacious for adults with severe asthma, but any future intervention and trial design would need further modifications to improve acceptability and completion rate.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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