Effectiveness of pulmonary rehabilitation in severe asthma: a retrospective data analysis
Zampogna E, Cents R, Negri S, et al.
J Asthma 2019;13:1–7
Pulmonary rehabilitation (PR) has a strong evidence base in the treatment of chronic obstructive pulmonary disease (COPD). However, a paucity of studies have investigated the efficacy of pulmonary rehabilitation in cases of severe asthma where symptoms remain uncontrolled despite intensive pharmacological therapy. Many patients with asthma have comorbid bronchiectasis and/or obstructive sleep apnoea (OSAS), which may contribute to poor asthma control.
The aim of this study was to investigate the effectiveness of PR on functional exercise, dyspnoea and muscle fatigue in a large cohort of patients with severe asthma.
317 patients with severe asthma (as defined by the GINA guidelines) who underwent a multidisciplinary three week rehabilitation program were included in this retrospective analysis. Patients were only included if they had adherence of >80% to PR and were able to complete a Six Minute Walking Test (6MWT). PR was comprised of multiple components, including endurance training, educational meetings, chest physiotherapy, breathing exercises and psychological support. Before and after PR, 6MWT distance and Borg scale scores for dyspnoea and muscle fatigue were recorded.
A total of 371 patients were included in the analysis, of which 39 (10.5%) had bronchiectasis, 163 (43.9%) had OSAS and 17 (4.6%) had both. Following PR, 6MWT distance, Borg dyspnoea and muscle fatigue and mean peripheral capillary oxygen saturation (SpO2) recorded during 6MWT were all significantly improved (p < 0.0001 for all outcomes). Median (interquartile range [IQR]) improvement in 6MWT distance was 33 (14–60) m. In patients with severe asthma and comorbid bronchiectasis and/or OSAS, PR significantly improved 6MWT distance (p < 0.0001) and SpO2 (p < 0.01).
This study is the first evidence in a large sample that a multimodal PR treatment program is effective at improving exercise capacity and symptoms in patients with severe asthma. Furthermore, these health benefits were maintained in patients with comorbid bronchiectasis and/or OSAS.