Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper

Abstract

Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro‐immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.

A positive effect of a short period stay in Alpine environment on lung function in asthmatic children

“…All these changes can have a positive effect on asthma. 7 Lung function represents one of the main feature for the diagnosis and the determination of asthma severity and asthma control, 2 and its improvement has been previously reported after a stay at altitude of at least 2 weeks. 8 On the other hand, to the best of our knowledge, no information is currently available in the literature about changes in respiratory function in the first week as well as no data is available for this frame of time about small airways' evaluation during a stay at altitude, even though peripheral airways impairment, as determined by oscillometry, is common also in children with well-controlled asthma.…”

“…Mountain climate is characterized by the reduction of the barometric pressure, air density, relative temperature, and humidity; moreover, aeroallergen burden (both pollen and Dermatophagoides) and pollution are also reduced. All these changes can have a positive effect on asthma 7 …”

Relationship between aeroallergen sensitization pattern and clinical features in adult asthmatics

“…Located at sea level, the eastern Black Sea region has high humidity from heavy rains throughout the year [ 12 ]. In a recent study, an alpine altitude climate was found to be associated with good asthma control owing to reduced aeroallergens and less air pollution [ 24 ].…”

Organ‐specific allergen challenges in airway allergy: Current utilities and future directions

“…6 Interventions to decrease the allergen burden can sometimes control respiratory symptoms (e.g., alpine altitude climate treatment). 7 Moreover, the recognition of the allergic triggers of these conditions can be paramount to decide on patient's life choices (place of residence, hobbies, pet keeping habit, etc.). 8 Finally, some therapeutic interventions (e.g., allergen immunotherapy (AIT) or anti-IgE treatment) are recommended by the clinical guidelines only for allergic individuals.…”