¹Leicester Biomedical Research Centre, University of Leicester, Leicester, UK

²Respiratory Department, Glenfield Hospital, Leicester, UK

³Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK

⁴Centre for Exercise Rehabilitation Science, Glenfield Hospital, Leicester, UK

Introduction There is limited evidence regarding the acceptability and efficacy of pulmonary rehabilitation (PR) for patients with severe asthma. We investigated the feasibility of performing a randomised controlled trial of asthma-tailored pulmonary rehabilitation (AT-PR) versus usual care (UC).

Method Patients with severe asthma were recruited and randomised 2:1 to AT-PR or UC. The primary outcome was recruitment, retention and adverse event rates. Secondary outcome measures were assessed before and after a 12 week intervention period and included the incremental shuttle walk test (ISWT), two cardiopulmonary exercise tests on a treadmill (ITM) and cycle-ergometer (ICE), quadriceps muscle strength, the asthma control questionnaire (ACQ), chronic respiratory questionnaire (CRQ), asthma quality of life questionnaire (AQLQ), hospital anxiety and depression scale (HADS) and measures of airway inflammation (sputum eosinophil count and fractional exhaled nitric oxide [FeNO]). Analysis of covariance adjusting for baseline differences was used to compare the effect of ATPR compared to UC. By recruiting 60 patients, a recruitment rate of 30% was estimated with a 95% CI of ±7%.

Results 61 out of 235 eligible patients were recruited (26%): 38 females, mean (SD) age 54 (13) yr, BMI 32 (7) kg/m², FEV₁1.95 (0.74) L, FEV₁/FVC 69 (11)% and 51 were randomised to AT-PR (n=34) or UC (n=17). The retention rates for AT-PR and UC were 62% and 53%, respectively. There were 7 serious adverse events but none related to the AT-PR sessions. The Results for the secondary outcome measures are shown in Table 1.

Conclusion AT-PR may be effective for patients with severe asthma but any future trial design would need to be modified to improve retention rate. In this small study, changes in airway inflammation were similar between AT-PR and usual care.