Pulmonary rehabilitation in an asthma clinic.

For a small proportion of patients with respiratory disorders, the regular medical care provided by general practitioners and chest physicians does not result in control of respiratory symptoms. In the Dutch Asthma Center, Davos, Switzerland, two conditions not available in routine medical settings are instrumental in treating patients with severe respiratory illness. The treatment center is located at 1560 m above sea level in a high altitude climate (low air humidity, low allergen concentration) which helps stabilize respiratory symptoms. Second, an interdisciplinary treatment plan encompasses optimal medical care and psychological interventions (patient education, self-management training). In this treatment facility, we carry out a cohort study on the determinants of the course of respiratory disorders in the adult patients. At admission, at discharge, and at 6-month follow-up, patient are assessed on medical, psychological, and medical outcome variables. At 6-month follow-up, 35% of the patients were readmitted to a hospital for exacerbations of respiratory symptoms. Multivariate analyses point out that both pulmonary function and psychological factors (particularly state anxiety and agoraphobia) predicted admission. Additional data will be presented and the implications for the multidisciplinary treatment will be discussed.