Designing an effective pulmonary rehabilitation program for severe asthma

Background: Despite optimal pharmacological and biologic therapies, many patients with severe asthma (SA) remain symptomatic and functionally impaired, experiencing decreased quality of life and increased healthcare utilization. Whilst physical inactivity can exacerbate symptoms, structured exercise was found to improve functional capacity and immune response in asthmatic patients, highlighting the potential role of pulmonary rehabilitation (PR). The availability of specific, standardized PR protocols for SA patients is nevertheless limited. Objective: We propose a comprehensive, phenotype-informed PR program tailored for patients with SA. This intervention aims to enhance physical function, optimize symptom control, promote self-management, and foster long-term health behaviors. Program overview: The A-R-M (assessment-rehabilitate-maintenance) PR model is articulated as follows: multidisciplinary assessment, 8-week rehabilitation phase, end-program evaluation, longitudinal follow-up. Key components include: (1) assessment: baseline evaluations by a multidisciplinary team using validated instruments for quality of life, disease control, exercise capacity, lung function, mood, and educational needs; (2) rehabilitation (education + exercise): education: eight sessions covering topics such as asthma pathophysiology, pharmacological treatment, self-management strategies, nutrition and satisfaction assessment. Exercise prescription: an individualized, physiotherapist-supervised regimen incorporating aerobic exercise, strength training, and inspiratory muscle training; and (3) maintenance and monitoring: personalized plans to support sustained physical activity and behavior change. Expected outcomes include significant improvement in exercise capacity, symptom control and quality of life, along with reduced use of oral corticosteroid, exacerbation's numbers and unplanned specialist visits. Conclusion: The A-R-M program offers a practical, evidence-based approach to improve outcomes of SA patients by addressing symptoms, function, and self-management, ultimately reducing healthcare costs and enhancing patients' wellbeing.