• Konrad Schultz, Michael Wittmann, Rupert Wagner, Nicola Lehbert, Larissa Schwarzkopf, Boglárka Szentes, Dennis Nowak, Hermann Faller, and Michael Schuler.
• Clinic Bad Reichenhall, Center for Rehabilitation, Pneumology and Orthopedics, of Deutschen Rentenversicherung Bayern Süd, Bad Reichenhall, Germany; Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M) - member of the German Center for Lung Research (DZL); Institut und Poliklinik für Arbeits-, Sozialund Umweltmedizin, Klinikum der Universität München, Comprehensive Pneumology Center Munich (CPC-M) - member of the German Center for Lung Research (DZL); Institute for Clinical Epidemiology and Biometry, Universität Würzburg; Chair of Rehabilitation Science, Universität Würzburg, Germany; IFT - Institut für Therapieforschung GmbH, München, Germany.
• Dtsch Arztebl Int. 2021 Jan 22; 118 (3): 233023-30.

BackgroundDespite the availability of effective pharmaceutical treatment options, many patients with asthma do not manage to control their illness. This randomized trial with a waiting-list control group examined whether a 3-week course of inpatient pulmonary rehabilitation (PR) improves asthma control (primary endpoint) and other secondary endpoints (e.g., quality of life, cardinal symptoms, mental stress). The subsequent observational segment of the study investigated the long-term outcome after PR.MethodsAfter approval of the rehabilitation´ by the insurance providers (T0), 412 adults with uncontrolled asthma (Asthma Control Test [ACT] score < 20 points) undergoing rehabilitation were assigned to either the intervention group (IG) or the waiting-list control group (CG). PR commenced 1 month (T1) after randomization in the IG and 5 months after randomization (T3) in the CG. Asthma control and the secondary endpoints were assessed 3 months after PR in the IG (T3) as an intention-to-treat analysis by means of analyses of covariance. Moreover, both groups were observed for a period of 12 months after the end of PR.ResultsAt T3 the mean ACT score was 15.76 points in the CG, 20.38 points in the IG. The adjusted mean difference of 4.71 points was clinically relevant (95% confidence interval [3.99; 5.43]; effect size, Cohen's d = 1.27). The secondary endpoints also showed clinically relevant effects in favor of the IG. A year after the end of rehabilitation the mean ACT score was 19.00 points, still clinically relevant at 3.54 points higher than when rehabilitation began. Secondary endpoints such as quality of life and cardinal symptoms (dyspnea, cough, expectoration, pain) and self-management showed moderate to large effects.ConclusionThe trial showed that a 3-week course of PR leads to clinically relevant improvement in asthma control and secondary endpoints. Patients who do not achieve control of their asthma despite outpatient treatment therefore benefit from rehabilitation.

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