Pulmonary Rehabilitation Reduces Airway Inflammation in Asthma Patients with High FeNO Levels
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Dovepress
Abstract
Purpose: Pulmonary rehabilitation (PR) is a well-established non-pharmacological intervention for patients with asthma. While PR
improves asthma control and exercise capacity, its impact on airway inflammation remains unclear. Fractional exhaled nitric oxide
(Fe NO ) is a biomarker of type 2 airway inflammation, yet its response to PR has not been extensively studied. Therefore, aim of this
study was to investigate diurnal variations in Fe NO and how Fe NO develops during PR in asthmatic patients with different levels of
Fe NO .
Patients and Methods: This prospective, single-center study investigated Fe NO changes in asthma patients undergoing
a comprehensive three-week inpatient PR program. The study observation period covered 15 consecutive days of FeNO measure-
ments. Patients were divided into three subgroups according to their initial FeNO measurement: low (<25 ppb), intermediate (25–50
ppb) and high (>50 ppb). Fe NO was measured three times a day, along with assessments of asthma control, lung function, blood
eosinophils and exercise capacity before and after PR.
Results: Sixty-two patients were included. Only patients in the high Fe NO group (n=22) showed a significant 40% decrease in Fe NO
from pre to post PR (93±29 ppb to 56±27 ppb, p<0.001), independent of medication changes. Fe NO levels of patients with low (17±8
ppb to 16±10 ppb) and intermediate levels (39±12 ppb to 30±10 ppb) remained unchanged. Asthma control and exercise capacity
improved across all three subgroups, with the greatest gains observed in patients with initially high Fe NO . No significant FeNO changes
occurred in the low and intermediate Fe NO groups.
Conclusion: PR significantly reduced Fe NO levels in asthma patients with high baseline Fe NO , suggesting an anti-inflammatory effect
beyond pharmacological treatment. These findings highlight the role of PR as a complementary strategy in asthma management,
particularly for patients with persistent airway inflammation despite optimized medication. Further randomized trials are needed to
confirm these results and explore long-term effects.
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