Dutch Asthma Centre Davos, Davos, Switzerland.
Eur Respir J. 2012 Dec;40(6):1374-80. doi: 10.1183/09031936.00195211. Epub 2012 Mar 22.
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 (FEV(1)), 6-min walking distance (6MWD), total immunoglobulin (Ig)E, blood eosinophils and exhaled nitric oxide fraction (F(eNO)) at admission and after 12 weeks. Sensitised and nonsensitised patients showed similar improvements in ACQ (-1.4 and -1.5, respectively; p = 0.79), AQLQ (1.6 and 1.5, respectively; p = 0.94), SNOT-20 (-0.7 and -0.5, respectively; p = 0.18), post-BD FEV(1) (6.1% and 5.8% pred, respectively; p = 0.87), 6MWD (+125 m and +147 m, respectively; p = 0.43) and oral steroids (40% versus 44%, respectively; p = 0.51). Sensitised patients showed a larger decrease in total IgE, blood eosinophils and F(eNO). High-altitude treatment improves clinical and functional parameters, and decreases oral corticosteroid requirement in patients with severe refractory asthma, irrespective of allergic sensitisation.
高海拔治疗对哮喘的有益影响归因于过敏原回避。最近的证据表明，这种治疗方法也能改善非过敏性患者的气道炎症。我们假设高海拔治疗在伴有或不伴有过敏致敏的严重难治性哮喘患者中具有相同的临床疗效。在一项前瞻性观察队列研究中，连续纳入了 137 名因严重难治性哮喘（92 名有过敏致敏）而在瑞士达沃斯接受高海拔（1600 米）治疗的成年人。我们测量了哮喘控制（哮喘控制问卷（ACQ））、哮喘相关生活质量（哮喘相关生活质量问卷（AQLQ））、鼻-鼻窦症状（鼻-鼻窦炎结局测试（SNOT-20））、药物需求、支气管扩张后（post-BD）1 秒用力呼气量（FEV1）、6 分钟步行距离（6MWD）、总免疫球蛋白（Ig）E、血嗜酸性粒细胞和呼气一氧化氮分数（F（eNO））在入院时和 12 周后进行测量。致敏和非致敏患者的 ACQ 评分（分别为-1.4 和-1.5，p=0.79）、AQLQ 评分（分别为 1.6 和 1.5，p=0.94）、SNOT-20 评分（分别为-0.7 和-0.5，p=0.18）、post-BD FEV1（分别为 6.1%和 5.8%预测值，p=0.87）、6MWD（分别为+125m 和+147m，p=0.43）和口服类固醇（分别为 40%和 44%，p=0.51）的改善相似。致敏患者的总 IgE、血嗜酸性粒细胞和 F（eNO）下降幅度更大。高海拔治疗可改善严重难治性哮喘患者的临床和功能参数，并降低口服皮质类固醇的需求，无论是否存在过敏致敏。
