Non-pharmacological pulmonary rehabilitation in the alpine altitude climate as add-on corticosteroid-sparing treatment for uncontrolled severe asthma patients

<bold>Background:</bold> Severe asthma management remains challenging. Despite the availability of biologicals, effective add-on corticosteroid-sparing strategies remain important for patients with severe asthma. This study aims to evaluate the corticosteroid-sparing effects of alpine altitude climate treatment (AACT) in patients with uncontrolled severe asthma. <bold>Methods:</bold> In this prospective cohort, clinical data from Dutch patients with uncontrolled severe asthma were collected between 2018-2022, before and after AACT. Outcome measures included ability to stop maintenance oral corticosteroids (OCS), OCS dose reduction, change in asthma control (ACQ6) and health-related quality of life (AQLQ). <bold>Results:</bold> At baseline, 42% of 375 patients (70% female, 35% late-onset, median(IQR) age 49(20)) were using maintenance OCS, 26% were using a biological, while 27% of the patients had previously used a biological. Stopping maintenance OCS was possible in 52% of patients, irrespective of current or previous biological use. Significantly reducing OCS dose (≥2.5 mg per day) was possible in another 32% of patients currently or previously using biologicals. AACT resulted in significantly improved asthma outcomes in the whole cohort median(IQR) ACQ 3.0 (1.2) to 1.5 (1.5) and AQLQ 4.0(1.3) to 5.5(1.3). <bold>Conclusion:</bold> This prospective cohort study demonstrates that non-pharmacological, multidisciplinary pulmonary rehabilitation in the alpine altitude climate (AACT) is an effective add-on corticosteroid-sparing treatment option, while resulting in improved asthma control for patients with uncontrolled severe asthma, irrespective of biological use.