Pulmonary rehabilitation yields long-term sustained improvements in asthma A large group of patients qualifies for this intensive treatment

Pulmonary rehabilitation proves to be effective in individuals with difficult-to-treat or severe asthma. Patients undergoing intensive therapy maintained a higher quality of life and improved pulmonary function a year later, without the need for an increase or change in medication, according to research from Radboud university medical center. These findings underscore the potential of non-pharmacological treatments.

In The Netherlands, individuals with uncontrolled difficult-to-treat or severe forms of asthma are eligible for pulmonary rehabilitation. In this study, researchers analyzed data from 49 participants who had undergone pulmonary rehabilitation. Immediate improvements were observed in asthma symptoms, pulmonary function, and quality of life post-rehabilitation. Patients were re-evaluated six and twelve months after treatment, consistently showing still better scores in all aspects compared to before their treatment. Additionally, they reported fewer asthma exacerbations following pulmonary rehabilitation, and no increase or alteration in medication was required for these lasting improvements. 

According to lead researcher and pulmonologist Bram van den Borst, these results highlight the potential of non-pharmacological treatments: ‘We observe that individuals still perform well at least one year after pulmonary rehabilitation. These individuals did not need to escalate their medication, and none of the participants started on biologicals, an expensive kind of drug.’ The results of this observational study, where researchers analyzed data from the past years, have now been published in The Journal of Allergy and Clinical Immunology: In Practice. 

Suitable for many more people 

In the Netherlands, approximately 600,000 people have some type of asthma. This respiratory condition involves hyperreactive muscles of the respiratory tract and chronic airway inflammation, causing symptoms such as shortness of breath, cough, and wheeze. Some individuals experience asthma exacerbations, acute worsening of respiratory symptoms requiring prednisone or even hospitalization. 

While most individuals have controlled asthma requiring only minimal medication, about 15-20% of people with asthma have a severe or difficult-to-treat type. ‘In the Netherlands, this amounts to about 100,000 people’, says Van den Borst. ‘Often, multiple health issues coexist that negatively impact on their asthma, necessitating comprehensive integrated treatment, such as provided in pulmonary rehabilitation. However, we observe a relatively low referral rate for asthma patients to undergo pulmonary rehabilitation, despite their eligibility. Unfortunately, they remain under the radar, but we would like to identify them so they can receive proper treatment.’ 

Intensive pulmonary rehabilitation 

Pulmonary rehabilitation is a ten-week intensive program that can be offered as either an inpatient or outpatient treatment, depending on individual treatment goals. The program includes group activities such as education, instructions, and exercise components. Individual guidance focuses on coping with chronic respiratory disease. Patients are referred by their treating pulmonologists. 

At Radboud university medical center, pulmonary rehabilitation is carried out by a multidisciplinary team, Van den Borst explains. ‘The team comprises pulmonologists, clinical psychologists, physiotherapists, specialized nurses, dieticians, social workers, psychomotor therapists, and creative therapists. In Radboudumc, the patient is present during meetings with the treatment team to discuss the progress of the process—a great example of personalized care.’

About this publication

This article appeared in The Journal of Allergy and Clinical Immunology: In Practice: One-year sustained and clinically meaningful outcomes following pulmonary rehabilitation in people with difficult-to-treat or severe asthma – Bram van den Borst, Ilvy van Grimbergen, Bas Robberts, Hieronymus W.H. van Hees, Jeanine Antons, Hanneke van Helvoort, Jolanda van Haren-Willems, Jeannette B. Peters, Jan Vercoulen. DOI: https://doi.org/10.1016/j.jaip.2023.10.030.

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