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Randomized Controlled Trial
. 2020 Nov-Dec;8(10):3418-3427.
doi: 10.1016/j.jaip.2020.05.052. Epub 2020 Jun 9.

A Feasibility Study of a Randomized Controlled Trial of Asthma-Tailored Pulmonary Rehabilitation Compared with Usual Care in Adults with Severe Asthma

Sally Majd  1 , Lindsay Apps  2 , Stacey Chantrell  3 , Nicky Hudson  4 , Elizabeth Eglington  5 , Beverley Hargadon  3 , Anna Murphy  6 , Sally J Singh  1 , Peter Bradding  1 , Ruth H Green  1 , Rachael A Evans  7
Affiliations
Randomized Controlled Trial

A Feasibility Study of a Randomized Controlled Trial of Asthma-Tailored Pulmonary Rehabilitation Compared with Usual Care in Adults with Severe Asthma

Sally Majd et al. J Allergy Clin Immunol Pract. 2020 Nov-Dec.

Abstract

Background: Currently, the acceptability and efficacy of pulmonary rehabilitation for adults with severe asthma is unknown.

Objective: To investigate the feasibility of performing a randomized controlled trial of asthma-tailored pulmonary rehabilitation (AT-PR) versus usual care (UC).

Methods: Adults with severe asthma were recruited and randomized 2:1 to AT-PR and UC. The primary outcomes were recruitment, retention, and serious adverse event rates. Secondary outcome measures included those for a future trial assessing the feasibility of collecting data. Assessments were performed at baseline, 12 weeks, and 9 months including measures of physical performance, health-related quality of life, and asthma control. A recruitment rate of 30% was estimated with 95% CI of ±7%, a retention rate of 75% ± 14% if we recruited 40 patients to AT-PR, and a serious adverse event rate of 2.5%.

Results: Sixty-one (26%) of 238 eligible patients were recruited (38 women; mean age, 54 ± 13 years; body mass index, 32 ± 7 kg/m2; FEV1, 1.9 ± 0.7 L; FEV1/forced vital capacity, 69% ± 11%). Fifty-one patients were randomized to AT-PR (n = 34) and UC (n = 17). The retention rate was 62% for the AT-PR group and 53% for the UC group, with a serious adverse event rate of 3.3% related to the study visits. Overall collection of the outcome measures was feasible. The results of the AT-PR group were suggestive of improvements in exercise performance, health-related quality of life, and asthma control, but the UC group results were either unchanged or worsened.

Conclusions: Both recruitment and retention rates were within the a priori estimated 95% CI. Our results indicate that AT-PR may be efficacious for adults with severe asthma but any future intervention and trial design would need further modifications to improve acceptability and retention rate.

Keywords: Airway inflammation; Exercise; Exercise training; Feasibility study; Pulmonary rehabilitation; Quality of life; Severe asthma.

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