Effectiveness of rehabilitation interventions in adults with moderate-to-severe asthma: an extended systematic review

Physical deconditioning is common in adults with moderate-to-severe asthma, negatively affecting respiratory function, disease control and quality of life (QoL). Pulmonary rehabilitation may improve both functional and psychological outcomes.

This systematic review aimed to evaluate the effectiveness of rehabilitative interventions in moderate-to-severe asthma and to assess the methodological quality of the included studies.

A systematic search was conducted in MEDLINE (via PubMed), CINAHL, PEDro, SCOPUS, and Web of Science following PRISMA guidelines. Eligible designs included randomized controlled trials (RCTs), quasi-experimental and observational studies. Risk of bias was assessed using PEDro scale and Risk of bias-2 (RoB2) for RCTs, ROBINS-E/ROBINS-I for non-randomized and observational studies.

Thirteen studies (n. 1094 participants) were included. Outcome measures comprised Lung Function, Six-Minute Walking Test (6MWT), Asthma Quality of Life Questionnaire (AQLQ), and Asthma Control Questionnaire (ACQ). Aerobic training combined with breathing techniques improved exercise tolerance (6MWT: 39.62 m; 95% CI 18 to 123 m) and QoL; Inspiratory muscle training (IMT) showed additional functional benefits. Overall methodological quality ranged from low to moderate, with limitations related to heterogeneity and small sample sizes.

Aerobic training with breathing techniques appears beneficial for moderate-to-severe asthma. Further high-quality, large-scale RCTs are needed to confirm these findings.

www.crd.york.ac.uk/prospero identifier is CRD420251024215.