Medically reviewed by Dr. Samuel Sarmiento, M.D., MPH on August 3, 2023
Regular exercise for 6 months reduces the regular inhaled corticosteroid dose without limiting asthma.
Inhaled corticosteroids (ICS) are the primary form of asthma treatment currently in use. These powerful anti-inflammatory drugs improve asthma control, maintain lung function, and prevent exacerbations by reducing airway inflammation. However, ICS can cause systemic and localized side effects. Thus, they should be used at the lowest dose that doesn’t worsen asthma symptoms.
It’s uncertain if exercise reduces ICS reliance, although it improves asthma control. This randomized control trial, published in The Journal of Allergy and Clinical Immunology, aimed to determine if supervised exercise lowers the requirement for ICS in asthmatic patients.
Study Design and Participants
The study was conducted in Denmark and included 150 treated adults with symptomatic asthma. Participants were untrained and were randomly allocated to either 6 months of supervised exercise three times weekly or a lifestyle-as-usual control group while taking inhaled corticosteroid medication. The percentage of patients whose ICS dose had decreased by at least 25% after 6 months was used as the primary outcome, and the daily microgram dose of ICS was among the secondary outcomes.
Exercise Is a Key Component of ICS Dosage Reduction
At 6 months, more people in the exercise group had decreased their ICS dose by 25% or more than those in the control group (63.1% vs. 50%). When comparing the exercise group with the control group at baseline, the mean change in daily ICS dosage favoring exercise was statistically significant, equating to a 24% decrease in ICS dosage (234 µg/969 µg) for those in the exercise group.
The Positive Effects of a Long-Acting β2-Agonist on Quality of Life
Long-acting β2-agonist (LABA) use decreased by −0.02 units in the exercise group and increased by 0.24 units in the control group, yielding a treatment effect in favor of the exercise group. Concurrently, those in the exercise group reported fewer symptoms and a higher quality of life than those in the control group.
Exercise-Induced Alterations in Asthmatic Patients
The exercise group lost significantly more weight and fat percentage and improved their cardiorespiratory fitness compared to the control group. An ICS step-down regimen is often associated with an increased risk of exacerbations, which is of major therapeutic consequence. But there were no discernible variations in exacerbation rates across the groups. In addition, there were no variations in markers of type 2 inflammation across the groups, even though decreasing ICS use often results in a rise in these markers.
Despite using less medication, those in the exercise group reported improved overall control of their asthma symptoms and quality of life.
Pitzner-Fabricius, A., Dall, C. H., Henriksen, M., Hansen, E. S. H., Toennesen, L. L., Hostrup, M., & Backer, V. (2023). Effect of High-Intensity Interval Training on Inhaled Corticosteroid Dose in Asthma Patients: A Randomized Controlled Trial. The journal of allergy and clinical immunology. In practice, 11(7), 2133–2143.e8. https://doi.org/10.1016/j.jaip.2023.04.013