Key messages 

- We found that people with asthma who take part in supervised programmes of exercise and education (known as pulmonary rehabilitation) are likely to get fitter (can walk further) and have better wellbeing immediately after completing these programmes compared to those who receive usual care. However, we are not certain if these benefits persist up to one year later.

- Due to a lack of evidence, the effects of pulmonary rehabilitation on outcomes such as rates of asthma attacks or hospitalisations, anxiety and depression, or physical activity levels is unclear. 

- Larger, well-designed studies are needed to better estimate the true benefit of pulmonary rehabilitation for adults with asthma.

What is asthma?

Asthma is a common lung disease where the breathing tubes can become inflamed and narrowed and may produce extra mucus. People with asthma can experience cough, wheezing, chest tightness, and breathlessness, with those most severely affected experiencing difficulty going about their everyday lives. 

Asthma cannot be cured, but symptoms can be controlled. Different medications can help keep symptoms under control, whilst physical exercise can also help. However, some people with asthma may find it challenging to undertake comprehensive exercise programmes.

What is pulmonary rehabilitation?

Supervised programmes of exercise and education (called pulmonary rehabilitation) are commonly used for people with chronic lung conditions and help improve breathing, fitness, and wellbeing. These programmes may be based at hospitals, outpatient clinics, or even at home. 

Pulmonary rehabilitation is a recommended standard of care for many chronic lung conditions; however, its effects in adults with asthma are less clear.

What did we want to find out?

We wanted to see how pulmonary rehabilitation affects physical fitness, control of asthma symptoms, and wellbeing of adults with asthma compared to usual clinical care involving no pulmonary rehabilitation. We also wanted to learn how it affects the rate of severe asthma attacks/hospitalisations, mental health (anxiety and depression), muscle strength, physical activity levels, and markers of inflammation (in sputum or blood). Finally, we wanted to see whether it is associated with any unwanted effects. 

What did we do?

We searched for studies that compared pulmonary rehabilitation to usual care in adults with asthma. Treatment must have lasted at least four weeks (or eight or more sessions) and must have included aerobic exercises (such as walking or cycling) and education or self-management. 

We compared and summarised findings across all eligible studies and rated our confidence in the evidence based on factors such as study methods and size.

What did we find?

- We found 10 studies involving 894 adults with asthma. 

- The studies ranged in size from 24 to 412 people. 

- Most studies were conducted in Europe. 

- Where reported, most study participants were female, with the average age ranging from 27 to 54 years. 

- One study specifically included people with severe forms of asthma. Another study specifically included people who had a condition involving overlapping features of both asthma and chronic obstructive pulmonary disease (COPD).

- The way pulmonary rehabilitation was delivered varied across studies. Inpatient programmes lasted 3 to 4 weeks, whilst outpatient programmes lasted 8 to 12 weeks.

- The specific nature of exercise or education components amongst the included studies varied widely.

Main results

- Pulmonary rehabilitation probably causes a large increase in physical fitness immediately after completion of the programme, resulting in an ability to walk an average of 80 metres further in 6 minutes than in people who receive usual care. There may be little to no effect on physical fitness measured up to one year later.

- Pulmonary rehabilitation may result in small improvements in or little to no impact on asthma control immediately after completion of the programme or up to one year later compared to usual care. 

- Pulmonary rehabilitation probably causes a large improvement in wellbeing as measured by the St George’s Respiratory Disease Questionnaire immediately after completion of the programme. Results may differ slightly according to different quality of life instruments. The effects potentially last up to one year, but results are very uncertain.

- Little to no effect on wellbeing was observed after programme completion or up to nine months follow-up when the Asthma Quality of Life Questionnaire was used. 

- There was very limited evidence to determine the effect of pulmonary rehabilitation on rates of asthma attacks/hospitalisations, measures of anxiety and depression, limb muscle strength, levels of physical activity, or markers of inflammation in the blood or sputum. 

- Data from one study suggested pulmonary rehabilitation resulted in no direct unwanted or harmful effects.

Limitations of the evidence 

Our confidence in the evidence relating to outcomes such as physical fitness, wellbeing, and asthma control is limited due to concerns regarding unclear methods in some studies, the potential for participants or assessors (or both) to have influenced outcomes due to the awareness of assigned treatments, and the varied ways in which pulmonary rehabilitation was delivered.

The evidence is up-to-date to May 2021.

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