Towards a paradigm shift in Severe Asthma Management: deep analysis of the effect of suBmaximal Aerobic training (SAMBA)

<bold>Background:</bold> Severe asthma is a high-burden disease with a diversity of driving mechanisms. Despite expensive targeted therapies, 70% of severe asthmatics have persistent asthma symptoms and activity limitation. Aerobic training could play an important role in improving exercise tolerance and well-being in severe asthmatics. <bold>Methods:</bold> In SAMBA, 55 patients with severe asthma were randomized either in a 12-week submaximal aerobic training program (N=35, 3 times/week) or breathing exercise (N=20) after deep phenotyping using exhaled biomarkers (exhaled nitric oxide (FeNO), Volatile organic compounds (VOCs)) and blood biomarkers, in University Hospital of Liège. The 75 minutes aerobic training session was divided in 5 min of warm-up, 60 min of aerobic training (including 20 minutes on three ergometers: bicycle, treadmill and rower/elliptical trainers) and 10 min of cool-down. <bold>Results:</bold> We found a significant improvement in asthma control (Asthma Control Questionnaire -0.99 pts, Asthma Control Test +4.3pts), quality of life (Asthma Quality of Life Questionnaire +1.07pts) and anxiety and depression (HAD -4.01pts) in the aerobic training group but not in the breathing exercise group. We found a significant increase in VO₂ max (+3.44ml/kg/min) and in Maximal Aerobic Power (+32W) in the training group. There was no effect on lung function, FeNO or systemic inflammation. <bold>Conclusion:</bold> Submaximal aerobic training is as beneficial as biologicals in improving asthma symptoms and quality of life. Training was associated with improvement in exercise tolerance. The absence of anti-inflammatory effect has to be confirmed in a larger cohort.