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.

中文翻译：

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与重度难治性哮喘的成年人相比，高海拔地区肺康复的有效性。

背景

早期已经报道了重度难治性哮喘患者高海拔地区肺康复的有益作用，但有效性的证据有限。

目标

调查高海拔肺部康复对患者预后参数与海平面可比治疗（LAPR）的有效性。

方法

包括居住在荷兰的患有严重难治性哮喘的成人。治疗包括在高海拔地区（达沃斯瑞士）（n  = 93）或在荷兰海平面的第三级肺中心（n  = 45）进行的为期12周的个性化多学科康复计划。在基线，治疗后和12个月的随访期间，评估了与哮喘有关的生活质量（AQLQ），哮喘控制（ACQ），肺功能和OCS剂量。无法将患者随机分组，导致不同的哮喘人群。除年龄，特应性，吸烟史，BMI和性别外，还使用线性回归分析（ANCOVA）对各组进行基线值校正后进行比较。

结果

治疗后和随访12个月时，AQLQ改善（分别为0.92，p <0.001和0.82，p = 0.001），ACQ（分别为-0.87，p <0.001和-0.69，p = 0.008）和较低的维持率与LAPR组相比，在HAPR组中观察到了OCS剂量（未经调整的线性回归分析为5.29 mg，p = 0.003，原油几率为1.67，p = 0.003）。与LAPR组相比，接受HAPR的患者的哮喘急性发作也较少（≥1急性发作：20％vs 60％，p <0.001），并且肺功能有所改善（％predFEV ₁ 3.4％，p = 0.014），但在12个月时两组之间未观察到差异。

结论

与LAPR相比，HAPR可以使患者的预后参数有更大的改善，从长远来看，患者报告的症状可以得到改善，并且维持较低的OCS剂量仍然有效。需要研究解释这种观察到的影响的根本因素。