High-altitude treatment

The favourable effect of the high-altitude climate on asthma was initially observed in Davos in 1879. At that time, patients with tuberculosis would go to Davos to recover. Among these patients there were also asthma sufferers for whom there was no medication available. The asthma improved and patients felt less impeded by their condition.

Since then asthma patients have been referred to Davos and many studies have been carried out which showed the curative effect on asthma control, the sensitivity of the airways, the seriousness of bronchial and pulmonary inflammation and the use of prednisolone in children and adults with asthma.

The high-altitude Davos area:
The high-altitude location (1600 m above sea level) is characterised by relatively low humidity with greatly reduced concentrations of dust mites, pollen and spores. Located far away from industrial urban areas, Davos has much lower levels of air pollution. In addition, the mountain climate also has high exposure to UV light, with may also enhance the body’s own immunity. The distance from the Netherlands also provides freedom from psycho-social stress.

What is the explanation for the curative effect of high-altitude treatment?
Excessive sensitivity of the airways, the so-called hyper-reactivity to irritants, is a characteristic of asthma, and not just of allergic asthma, but of all types of asthma phenotypes.
An irritant-free location such as Davos is therefore effective for both allergic and non-allergic patients. Fewer irritants mean less irritation and inflammation, fewer symptoms of breathlessness and coughing, and a greater possibility for movement and exercise. The objective improvement in the capacity for exercise after high-altitude treatment is a strong indication of this.

Generally it is accepted that, in particular through the low exposure to irritants in the mountain climate, sensitivity and chronic inflammation of the airways can ease, so that the asthma can be brought under control. Research has shown that ongoing exposure to irritants often leads to increased sensitivity of the airways and inflammation and infection.

In addition, it is assumed that exposure to two or more irritants are key to the development of more serious bronchial and pulmonary conditions. According to this “multiple-hit hypothesis”, avoiding these irritants can reduce the progression of the underlying illness and restore control over asthma.

Such mechanisms help us understand why irritant-poor environments like Davos can reduce damage to the airway mucosa in both allergic and non-allergic patients, so that the asthma can be brought back under control.

What is high-altitude treatment?
High-altitude treatment combines the irritant-poor healthy environment with customised treatment. The intensive treatment by a multi-disciplinary team of experts in medical, nursing, physiotherapy, exercise and psychological fields is based on the asthma phenotype and the patient’s own integral state of health.

When is high-altitude treatment feasible?
If, despite maximum treatment in the Netherlands under the supervision of pneumonologist, the patient continues to suffer through poor asthma control, it is advisable to consider high-altitude treatment. When asthma is not under control, the investigation into the influence of various factors is an important step. Targeted intervention, based on these specific factors, provides the opportunity to regain control of the asthma in patients whose asthma is serious and difficult to treat.

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