High-altitude treatment in atopic and nonatopic patients with severe asthma

Abstract

The beneficial effects of high-altitude treatment in asthma have been attributed to allergen avoidance. Recent evidence shows that this treatment also improves airway inflammation in nonallergic patients. We hypothesised that high-altitude treatment is clinically equally effective in patients with severe refractory asthma, with or without allergic sensitisation.In a prospective observational cohort study, 137 adults with severe refractory asthma (92 with allergic sensitisation), referred for high-altitude (1,600 m) treatment in Davos, Switzerland, were consecutively included. We measured asthma control (Asthma Control Questionnaire (ACQ)), asthma-related quality of life (Asthma-Related Quality of Life Questionnaire (AQLQ)), sino-nasal symptoms (Sino-Nasal Outcome Test (SNOT-20)), medication requirement, postbronchodilator (post-BD) forced expiratory volume in 1 s (FEV1), 6-min walking distance (6MWD), total immunoglobulin (Ig)E, blood eosinophils and exhaled nitric oxide fraction (FeNO) at admission and after 12 weeks.Sensitised and nonsensitised patients showed similar improvements in ACQ (-1.4 and -1.5, respectively; p50.79), AQLQ (1.6 and 1.5, respectively; p50.94), SNOT-20 (-0.7 and -0.5, respectively; p50.18), post-BD FEV1 (6.1% and 5.8% pred, respectively; p50.87), 6MWD (+125 m and +147 m, respectively; p50.43) and oral steroids (40% versus 44%, respectively; p50.51). Sensitised patients showed a larger decrease in total IgE, blood eosinophils and FeNO.High-altitude treatment improves clinical and functional parameters, and decreases oral corticosteroid requirement in patients with severe refractory asthma, irrespective of allergic sensitisation.

The Prevalence of Allergic Diseases and Associated Risk Factors in School-Age Children and Adults in Erzurum, Turkey

“…It has been suggested that this can result from the immunomodulatory and anti-inflammatory effects of low air pollution, low amounts of allergens-eg, house dust mite, pollen, and fungal spores-and high ultraviolet light exposure [19,20].…”

Associations among high altitude, allergic rhinitis, and bronchial hyperreactivity

“…The 6-min walk test, the sinonasal outcome test, and the asthma quality-of-life test were performed; the total IgE level, the postbronchodilator FEV1, medication requirements, the exhaled nitric oxide fraction (FeNO), and the serum eosinophil level were assessed at the beginning of the study and 12 weeks later. [17] After 12 weeks, the asthma symptoms were controlled and all of the quality-of-life, sinonasal symptoms, the FEV1, and the 6-min walk test score improved. The total IgE level and the requirement for oral corticosteroids also decreased.…”

“…No other parameter differed between HDM-sensitized and non-sensitized patients. [17] In another study, patients in whom asthma persisted despite the use of inhaled steroids underwent 10 weeks of HA therapy. The quality-of-life, lung function, adenosine- and histamine-aggravated bronchial hyperresponsiveness and the urinary eosinophil, leukotriene E4, and 9a11b prostaglandin F2 (U-9a11b PGF2) levels improved significantly after HA therapy (all p values <0.05).…”

“…Thus, the severity of chronic allergic respiratory disease is potentially decreased. [17] A study performed in Davos (1560 m) on 16 children with allergic asthma showed that airway inflammation decreased at altitude. The FEV1 provoked by AMP improved significantly and the peak flow variability was reduced after 1 month at HA.…”

“…All of these effects render breathing easier. [17] The Alps enjoy abundant sunshine, allowing photosynthesis of vitamin D and effective regulation of the immune system. Thus, the severity of chronic allergic respiratory disease is potentially decreased.…”