Rijssenbeek-Nouwens, LH; Fieten, KB; Bron, AO; Weersink, EJM; Sterk, PJ; Bel, EH
RATIONALE: Patients with severe allergic asthma have been shown to improve during treatment at high altitude (Grootendorst, Clin Exp Allergy 2001). For decades, such improvement at high altitude has been attributed to house dust mite (HDM) allergen avoidance (Spieksma, BMJ 1971). However, recent reports have challenged this concept, by showing similar improvements in asthmatic children who were not allergic to house dust mite (Huss-Marp JACI 2007).
HYPOTHESIS: We postulated that high altitude treatment has similar beneficial effects in allergic and non-allergic patients with severe asthma.
AIM: To compare the improvement in clinical, functional, immunological and inflammatory markers during high altitude treatment between non-allergic and allergic patients with severe asthma, with or without sensibilisation to house dust mite.
METHODS: In 126 patients (13-81 years, 83 female, 61 oral steroid-dependent) with severe asthma, who were consecutively included in a 12 weeks, multidisciplinary treatment program at the Dutch Asthma Centre Davos, changes from baseline Asthma Control (Juniper ACQ), Asthma related Quality of Life (Juniper AQLQ), total IgE, postbronchodilator (pb) FEV1%pred., exhaled Nitric Oxide (FENO), and daily dose of oral corticosteroids (prednisone equivalent) were measured. The differences between the 3 groups were analyzed by One Way ANOVA.
RESULTS: In the group as a whole there were significant improvements in ACQ, AQLQ, pbFEV1, FENO, total IgE and oral steroid dose (p<0.01). The changes in all parameters, except total IgE, were not significantly different between the 3 groups (see Table).
*table in pdf
CONCLUSION: High altitude treatment for 12 weeks showed significant improvements in clinical, functional, immunological and inflammatory markers in patients with severe asthma. Improvements were not different between allergic and non-allergic patients with or without sensibilisation to house dust mite.
IMPLICATION: These data suggest that high altitude treatment can be considered a treatment option for patients with severe refractory asthma irrespective of allergic status.
