Effect of pulmonary rehabilitation in an allergen safe outdoor environment on children and adolescents with mild to moderate persistent allergic asthma

Environmental interactions are very complex in childhood asthma, and we hypothesized that even a short-term exposure to an allergy safe outdoor environment (AllSOE) combined with pulmonary rehabilitation program (PRP) could exert significant beneficial effects. Our aim was to test the effects of 2-week PRP provided in an AllSOE in children with mild to moderate asthma.

110 children (aged 7.5–17 years, 46% girls), with partially or totally controlled asthma, attended the PRP at the Island of Lošinj (Croatia) supervised by a multidisciplinary team (pediatric pulmonologist, sports medicine specialist, physiotherapist and kinesiologist). Each child had an adjusted intensity of physical activity with at least 2 h of exercise per day. Body height and weight, spirometry, fraction of exhaled nitric oxide (FeNO), running distance during free running test (FRT) and the decline in lung function after FRT (exercise-induced bronchoconstriction- EIB) were measured at baseline and after PRP.

A significant improvement in running distance (from 903 ± 272 m to 968 ± 289 m; p < 0.001), a decrease of FeNO (from 37 ± 32 ppb to 25 ± 17 ppb; p < 0.001) were determined after PRP. There were no significant changes in lung function and EIB, except EIB in the fourth quartile (significant EIB at baseline) where EIB significantly decreased (p < 0.001) after PRP.

Two weeks of PRP in an AllSOE significantly improved exercise capacity and reduced airway inflammation and airway hyperreactivity showing that even a short-term PRP within a proper environment could be effective and affordable management strategy for children and adolescents with mild to moderate asthma.