When can high-altitude treatment be considered?
In patients with all phenotypes of serious asthma, eosinophilic and non-eosinophilic, allergic and non-allergic, therapy-resistant, unclear and complex.
- Adequate asthma control cannot be achieved despite maximum treatment
- There is a burden of high disease, in which several possible factors play a part
- Biologicals are considered or are not effective
We are happy to help map all in a multi-disciplinary factors in the patient’s health profile and establish a personal treatment plan based on this for the patient, or give this to the referring physician.
Checklist for high-altitude treatment:
Patient has serious asthma as per the NVALT serious asthma guideline and even with a high dosage of ICS and LABA, still has:
- Poor asthma control (ACQ ≥ 1.5 or C-ACT < 19) and
- ≥ 2 exacerbations/year, treated with systemic steroids or
- requires systemic steroids for maintenance for ≥ 6 months/year or
- whose movement/exercise options are limited because of serious asthma
As described in the NVALT guidelines, the following conditions are also met:
- Inhalation technique is optimised
- Therapy compliance is optimised
- Exposure to exogenous irritants is minimised
- Any comorbidity is given maximum treatment
- Patient does not smoke or has not smoked for ≥ 6 months
- Patient has been treated by pneumonologist and specialised nurse for at least 6 months
If, despite maximum treatment in the Netherlands under the leadership of the Pneumonologist, patients cannot get their asthma under control, the search for the influence of various factors is an important step. Focused intervention, based on these specific factors, provides opportunities to achieve control over asthma.
For patients with serious asthma that is difficult to treat, a combination of an irritant-poor environment and multi-disciplinary expert treatment, based on the asthma phenotype and the patient’s own state of health, provides more options. This combination offers relevant and clinically effective intervention with focus on non-medicinal factors.
High-altitude treatment is effective among patients with allergic and non-allergic asthma for:
- Asthma control and quality of life
- Problems with the upper airways
- Tolerance to exertion
- Lung function
- Inflammation of airways
- Use of oral steroids
The effectiveness of treatment in the high-altitude location is described in several studies.
You can find an overview of it in High altitude treatment, a therapeutic option?
Reference: L. Rijssenbeek-Nouwens, ERJ 2012;40:1374-80, CEA 2011;41:775-782.
The success factors in high-altitude treatment
- The healthy environment, free of allergens and air pollution
- Interdisciplinary assessment of patient and factors linked to environment
- Customised cared based on the specific asthma phenotype and the patient’s own state of health
Avoiding the relevant allergic and non-allergic irritants is not easy for patients. In particular, whenever uncontrolled asthma co-occurs with indications of increased inflammation of the airways, it is important to track down the factors that irritate and maintain the asthmatic process. Alleviating these factors remains an important step in asthma management, both with patients with allergic as well as non-allergic asthma. In addition to allergic and non-allergic irritants, individual sensitivity to irritants, personal possibilities for avoiding irritants and the perception of the illness also play a role.
Inter-disciplinary assessment of the asthma phenotype, the integral state of health and factors that influence asthma.
A treatment plan tailored to the patient and the asthma phenotype, based on all domains of the state of health with personal consultants, interactive provision of health information and training sessions.
The objective is to get the asthma under control and keep it under control with a personal asthma plan when back in the Netherlands.
In addition to classical clinical treatment of 10-12 weeks and treatment of adolescents/young adults, short-term assessment as well as treatment advice is possible.
The place of high-altitude treatment is described in the NVALT seriousinternational and Dutch asthma guideline. In the centre, the guideline for serious asthma is followed, as are guidelines from physiotherapists, nursing staff, psychologists and psychomotor therapists.
Patient is registered by the referring physician.
You can refer your patient via our website. Click here for the secure link to the referral form. This includes the conditions set by health care insurance providers for high-altitude treatment cover.
In addition, we ask that you include your medical correspondence. If you have any questions regarding referrals, Lous Rijssenbeek is happy to discuss them with you by telephone, 0041814178000, or by e-mail [email protected] [email protected].