D2.97 - “Can Do, Do Do“ in patients with severe uncontrolled asthma referred for pulmonary rehabilitation in the alpine climate

Reduced physical capacity (PC) and physical activity (PA) are common in patients with severe asthma, but represent different aspects of physical functioning. Pulmonary rehabilitation programs for severe asthma may use this concept to further individualize treatment goals. This study aims to determine the distribution of patients with severe uncontrolled asthma over the PC – PA quadrants and to explore differences in clinical characteristics between the quadrants.

Patients with severe, uncontrolled asthma referred for alpine altitude climate treatment between 2022 to 2024 were divided among the quadrants. Decreased PC (Can’t Do) was defined as <70% predicted value of baseline ISWT or 6MWD, decreased PA (Don’t Do) as ≤4 out of 9 training activities in the first week of the program. Asthma control (ACQ6), health-related quality of life (AQLQ), sinonasal outcomes (SNOT), spirometry (forced expiratory volume in one second (FEV₁) %predicted, FeNO, asthma phenotype, and medication use (ICS; OCS and biologics) were assessed at the start of rehabilitation. Independent samples Kruskall Wallis and Chi square tests were done to compare the quadrants, P<0.05 was considered statistically significant.

From 2022 to 2024, 253 patients (73% female), with a median(IQR) age of 48(37;56) years and ACQ6 of 3.0(2.5;3.7) were included in the final analysis. Decreased PC was found in 82% and decreased PA in 35% of patients. The distribution over the quadrants was as follows: Can’t Do, Do Do: 52%, Can’t Do, Don’t Do: 30%, Can Do, Do Do: 13%, Can Do, Don’t Do: 5%. Patients with reduced PC at baseline (Can’t Do) demonstrated significantly higher BMI, less asthma control, lower asthma related quality of life, more sino nasal symptoms, and used significantly more often daily OCS compared to patients with regular PC (all p<0.05, Table 1). Sex, age, asthma phenotype, FEV₁, FeNO, ICS and biologics use was similar among the quadrants.

The number of patients with a significantly reduced PC suggests late referral for pulmonary rehabilitation. Patients with reduced PC also demonstrated significantly worse asthma related outcomes. Future research should determine the effectiveness of pulmonary rehabilitation among the different degrees of PC and PA.