Journal of Asthma and Allergy (Sep 2024)

Immediate and One-Year Outcomes of an Asthma-Tailored Pulmonary Rehabilitation Programme in Overweight and Obese People with Difficult-to-Treat Asthma

  • Ricketts HC,
  • Sharma V,
  • Steffensen F,
  • Mackay E,
  • MacDonald GW,
  • Buchan DS,
  • Lean M,
  • Chaudhuri R,
  • Cowan DC

Journal volume & issue
Vol. Volume 17
pp. 911 – 928

Abstract

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Helen Clare Ricketts,1 Varun Sharma,1 Femke Steffensen,2 Elaine Mackay,3 Gordon Wallace MacDonald,4 Duncan S Buchan,5 Michael Lean,6 Rekha Chaudhuri,7 Douglas C Cowan4 1College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK; 2Glasgow Clinical Research Facility, Glasgow Royal Infirmary, Glasgow, UK; 3Pulmonary Rehabilitation Team, Glasgow Royal Infirmary, Glasgow, UK; 4Respiratory Department, Glasgow Royal Infirmary, Glasgow, UK; 5Division of Sports and Exercise, University of the West of Scotland, Glasgow, UK; 6School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK; 7Respiratory Department, Gartnavel General Hospital, Glasgow, UKCorrespondence: Douglas C Cowan, Email [email protected]: Management of difficult-to-treat asthma is particularly challenging in people with elevated body mass index (BMI). Our randomised controlled trial of pulmonary rehabilitation (PR) showed improved outcomes at 8 weeks. Here we assess immediate and one-year effects of asthma-tailored PR in participants with difficult-to-treat asthma and BMI ≥ 25 kg/m2, and identify response predictors.Methods: A prospective observational study of PR, tailored to asthma, comparing outcomes at baseline (V1), immediately after 8 weeks of PR (V2), and at 1 year (V3). Baseline characteristics were compared in responders/non-responders defined by achievement of minimum clinically important difference (MCID) for asthma control questionnaire (ACQ6) (0.5) at 8 weeks and 1 year.Results: Of 92 participants, 56 attended V2 and 45 attended V3. Mean age was 60 (SD 13) years, 60% were female, and median (IQR) BMI was 33.8 (29.5– 38.7) kg/m2. At V1, V2, and V3, respectively, there were significant differences in ACQ6 (mean (95% CI): 2.5 (2.1– 2.9), 2.2 (1.8– 2.5), and 2.3 (1.9– 2.7), pMCID for ACQ6 at V2 and 16 (33%) at V3. Participants with higher ACQ6 scores at baseline (suggesting poorer asthma control) were more likely to achieve MCID. Baseline BMI, within the range studied, was not predictive.Conclusion: Pulmonary rehabilitation induced improvements in asthma-related outcomes including perception of breathlessness, asthma control, and exacerbation frequency at 1 year. Those with poorer baseline asthma control were more likely to benefit.Keywords: asthma, difficult-to-treat asthma, obesity, pulmonary rehabilitation

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