Feasibility of a pulmonary rehabilitation program for patients with severe/difficult-to-treat asthma

Asthma is a chronic respiratory disease characterized by inflammation of the airways. Symptoms may vary in intensity and frequency over time. In patients with severe or difficult-to-treat asthma, disease control often remains unsatisfactory despite optimal therapy. This results in a significant impact on patients’ quality of life and a high burden on healthcare resources. Recent evidence highlights the potential role of pulmonary rehabilitation (PR) in enhancing asthma control, improving functional capacity, and quality of life. PR can also promote psychosocial well- being and alleviate symptoms associated with disease. However, the availability of structured PR programs dedicated to severe asthma remains limited and poorly standardized. This study aims to investigate the feasibility of implementing a pulmonary rehabilitation program specifically for patients with severe or difficult-to-treat asthma. It provides a detailed description of the proposed rehabilitation program. The study also proposes an implementation model that can be adapted to various healthcare settings within the Veneto Region. The work included a review of international literature, analysis of regulatory context, and program design—covering assessment, physical training, education, follow-up, and maintenance. It estimated expected clinical and economic benefits and used a SWOT analysis to support the implementation model. The program integrates evidence-based aerobic and resistance exercises, Inspiratory Muscle Training, and educational interventions into an 8-week pathway with follow-ups at 3, 6, and 12 months. Expected outcomes include improvements in clinical control, functional capacity, quality of life, and a reduction in exacerbations and costs. Developed tools include resource analysis, KPI definitions, and a SWOT assessment. In conclusion, implementing a pulmonary rehabilitation program dedicated to severe and difficult-to- treat asthma is both feasible and innovative. This program offers clear benefits for patients as well as the healthcare system. Future clinical studies will eventually confirm the effectiveness and long-term sustainability of the proposed model.