Eugen Bersuch1,2, Florian Gräf1,3, Ellen D Renner1,4,5, Andreas Jung4,6, Claudia Traidl-Hoffmann1,5, Roger Lauener1,7, Caroline Roduit1,6. 1. CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland. 2. Department of Dermatology, Allergy Unit, Zurich University Hospital, Zurich, Switzerland. 3. Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany. 4. Hochgebirgsklinik Davos, Davos, Switzerland. 5. Chair and Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Zentrum, München, Germany. 6. Children's University Hospital Zurich, Zurich, Switzerland. 7. Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
Abstract
BACKGROUND: Rehabilitational programs at moderate altitude (1500-2500 m) showed improvement of lung function and reduction in 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 (1590 m) with at least 14 days between admission and discharge, were analyzed in association with atopic sensitization (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 in predicted FEV1 , MEF25 , and MEF75 of 7.7%, 9.9%, and 12.7%, respectively (P < .001). FeNO decreased by 36.9 ppb for uncontrolled, by 26.9 ppb for partly controlled, and by 11.8 ppb for controlled asthmatics. In uncontrolled subjects, pulmonary improvement was comparable between patients with and without house dust mites (HDM) sensitization. Pulmonary improvements of pollen-sensitized patients were not dependent on the season of the sojourn. For the group with constant ICS level, the absolute increase in FEV1 was 4.9% (P < .001) with a FeNO decreased by 32.7 ppb (P < .001). When the ICS dose was elevated by one GINA level, the absolute increase in FEV1 was slightly higher (6.6%, P < .001), with a FeNO decrease of 31.4 ppb (P < .001). CONCLUSION: Inpatient rehabilitation at moderate altitude improved pulmonary conditions in asthmatic children and adolescents independent of sensitization status to HDM or pollen. A positive effect was also observed in patients without change in medication.
BACKGROUND: Rehabilitational programs at moderate altitude (1500-2500 m) showed improvement of lung function and reduction in 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 (1590 m) with at least 14 days between admission and discharge, were analyzed in association with atopic sensitization (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 in predicted FEV1 , MEF25 , and MEF75 of 7.7%, 9.9%, and 12.7%, respectively (P < .001). FeNO decreased by 36.9 ppb for uncontrolled, by 26.9 ppb for partly controlled, and by 11.8 ppb for controlled asthmatics. In uncontrolled subjects, pulmonary improvement was comparable between patients with and without house dust mites (HDM) sensitization. Pulmonary improvements of pollen-sensitized patients were not dependent on the season of the sojourn. For the group with constant ICS level, the absolute increase in FEV1 was 4.9% (P < .001) with a FeNO decreased by 32.7 ppb (P < .001). When the ICS dose was elevated by one GINA level, the absolute increase in FEV1 was slightly higher (6.6%, P < .001), with a FeNO decrease of 31.4 ppb (P < .001). CONCLUSION: Inpatient rehabilitation at moderate altitude improved pulmonary conditions in asthmatic children and adolescents independent of sensitization status to HDM or pollen. A positive effect was also observed in patients without change in medication.
Authors: J Bousquet; C A Akdis; C Grattan; P A Eigenmann; K Hoffmann-Sommergruber; P W Hellings; I Agache Journal: Clin Transl Allergy Date: 2018-11-27 Impact factor: 5.871
Authors: Karin B Fieten; Marieke T Drijver-Messelink; Annalisa Cogo; Denis Charpin; Milena Sokolowska; Ioana Agache; Luís Manuel Taborda-Barata; Ibon Eguiluz-Gracia; Gerrit J Braunstahl; Sven F Seys; Maarten van den Berge; Konrad E Bloch; Silvia Ulrich; Carlos Cardoso-Vigueros; Jasper H Kappen; Anneke Ten Brinke; Markus Koch; Claudia Traidl-Hoffmann; Pedro da Mata; David J Prins; Suzanne G M A Pasmans; Sarah Bendien; Maia Rukhadze; Mohamed H Shamji; Mariana Couto; Hanneke Oude Elberink; Diego G Peroni; Giorgio Piacentini; Els J M Weersink; Matteo Bonini; Lucia H M Rijssenbeek-Nouwens; Cezmi A Akdis Journal: Allergy Date: 2022-02-15 Impact factor: 14.710