Effectiveness of pulmonary rehabilitation on severe asthma outcomes: a pre-post study

<bold>Background:</bold> In severe asthma, pulmonary rehabilitation (PR) is effective for improving exercise capacity and quality of life but its effect on asthma control, risk of severe exacerbations and glucocorticoids exposure is unknown. <bold>Objective:</bold> To investigate the effect of PR on asthma control, rate of severe exacerbations and glucocorticoids use as well as hyperventilation, anxiety and depression symptoms in severe asthma. <bold>Methods:</bold> In a retrospective study, we included all patients with severe asthma referred for a PR program. Changes in the Asthma Control Test (ACT), Nijmegen questionnaire and Hospital Anxiety and Depression scale (HADs) from baseline (M0) to end of PR (M2), 6 and 12 months after PR (M8 and M14) were evaluated using a mixed linear model or pairwise Wilcoxon signed rank tests in case of non-Gaussian distribution. The annual rate of severe exacerbations and the annual cumulative dose of glucocorticoids were compared between the year after and before PR. <bold>Results:</bold> We included 50 patients (78% women, age 59 [46-65] years, FEV1 53% [38.5-86]). Median ACT score increased from 11 [8-16] to 13.5 [10-18.5] at M2 (p<0.001), 14 [10-18] at M8 (p=0.021), and 15 [9.5-19] at M14 (p=0.045). In the year following PR, the median rate of severe exacerbations decreased from 3 [1-6] to 1.5 [0-4.5] (p=0.007) and the median cumulative dose of glucocorticoids from 2240mg [250-5040] to 1200mg [0-4290] (p=0.001). <bold>Conclusion:</bold> Our results suggest an improvement of severe asthma control in a substantial number of patients and a reduction of future risks after PR, advocating that PR could be a part of the treatment of severe asthma beyond the management of respiratory disability.