Page 86 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 4
largely diminished. Thus, in patients with high IgE levels, even if already treated with high doses of anti-inflammatory medications, objective improvement in systemic inflammation can be obtained by high altitude climate therapy.
In our study, more pronounced weight reduction was associated with lower fatigue scores at baseline, indicating that patients with more vitality had more possibilities to reduce weight by physical activity. Many studies have shown that weight reduction improves clinical outcomes in patients with asthma [29;30] but it is not always easy to achieve a significant weight reduction in patients with asthma and obesity with lifestyle modification and physical exercise at sea level. Our study suggests that physical activity might be facilitated in a clean air environment with multidisciplinairy support and therefore might help patients with severe asthma to improve their physical condition and subsequently reduction of BMI.
This study has a few potential limitations to be addressed. Firstly, some patient characteristics that could also have influenced treatment outcomes have not been addressed, such as stressful psychosocial conditions, hormonal changes (adrenal gland activation) [31] and unknown exposures to sensitizing agents. In particular anxiety and depression might have been important predictors of beneficial response, since it has been shown that these are important contributors to asthma severity [32]. If so, our data suggest that high altitude climate therapy could have had a beneficial effect on these psychological stressors as well.
Secondly, altitude itself could have influenced the partial pressure of gases such as FeNO with potential overestimation of FeNO levels [33]. However, we believe that this did not influence our findings since change in FeNO was not used as an outcome, and baseline FeNO was included as a continuous variable in the regression analyses.
Thirdly, this study was a one-center intervention and though previous studies on high altitude climate therapy in children and adults showed similar improvements [15-17], extrapolation of our results to other high altitude centers cannot be easily done.
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