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Lung function improvement and airways inflammation reduction in asthmatic children after a rehabilitation program at moderate altitude.

Lung function improvement and airways inflammation reduction in asthmatic children after a rehabilitation program at moderate altitude.
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Bersuch E, Gräf F, Renner ED, Jung A, Traidl-Hoffmann C, Lauener R, Roduit C,


Bersuch E, Gräf F, Renner ED, Jung A, Traidl-Hoffmann C, Lauener R, Roduit C, (click to view)

Bersuch E, Gräf F, Renner ED, Jung A, Traidl-Hoffmann C, Lauener R, Roduit C,

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Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2017 10 05() doi 10.1111/pai.12808
Abstract
BACKGROUND
Rehabilitational programs at moderate altitude (1500m to 2500m) showed improvement of lung function and reduction of airways inflammation in asthmatic adults. Allergen avoidance was postulated as the major cause of these improvements.

METHODS
Spirometries of 344 and fractional exhaled nitric oxide measurements (FeNO) of 124 asthmatic children and adolescents, staying in a rehabilitation hospital in Davos (1590m) with at least 14 days between admission and discharge, were analysed in associations with atopic sensitisation (skin-prick testing and/or specific IgE), level of asthma control, and inhalative corticosteroid (ICS) dose.

RESULTS
Pulmonary conditions improved significantly on average during the sojourn. Uncontrolled asthmatics benefited most with an absolute increase of predicted FEV1, MEF25 and MEF75 of 7.7, 9.9 12.7%, respectively (p<0.001). FeNO decreased by 36.9ppb for uncontrolled, by 26.9ppb for partly-controlled and by 11.8ppb for controlled asthmatics. In uncontrolled subjects, pulmonary improvement was comparable between patients with and without house dust mites (HDM)-sensitisation. Pulmonary improvements of pollen sensitised patients were not dependent on the season of the sojourn. For the group with constant ICS level the absolute increase of FEV1 was 4.9% (p<0.001) with a FeNO decreased by 32.7ppb (p<0.001). When the ICS dose was elevated by one GINA-level, the absolute increase of FEV1 was slightly higher (6.6%,p<0.001), with a FeNO decrease of 31.4ppb (p<0.001). CONCLUSION
Inpatient rehabilitation at moderate altitude improved pulmonary conditions in asthmatic children and adolescents independent of sensitisation status to HDM or pollen. A positive effect was also observed in patients without change in medication. This article is protected by copyright. All rights reserved.

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