Omalizumab treatment and exercise capacity in severe asthmatics – Results from a pilot study

Schäper, Christoph; Gläser, Sven; Felix, Stephan B.; Gogolka, Annette; Koch, Beate; Krüll, Matthias; Ewert, Ralf; Noga, Oliver

doi:10.1016/j.rmed.2010.07.023

« Previous Next »Respiratory Medicine
Volume 105, Issue 1 , Pages 3-7, January 2011

Omalizumab treatment and exercise capacity in severe asthmatics – Results from a pilot study

Christoph Schäper
- Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Friedrich-Loeffler-Str. 23, D-17475 Greifswald, Germany
- Corresponding author.
- CS and SG contributed equally to this work.
Sven Gläser
- Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Friedrich-Loeffler-Str. 23, D-17475 Greifswald, Germany
- Tel.: +49 38348622401; fax: +49 38348622422.
- CS and SG contributed equally to this work.
Stephan B. Felix
- Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Friedrich-Loeffler-Str. 23, D-17475 Greifswald, Germany
Annette Gogolka
- Institute for Allergy and Asthma Research Berlin, Tempelhofer Damm 176, D-10299 Berlin, Germany
Beate Koch
- Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Friedrich-Loeffler-Str. 23, D-17475 Greifswald, Germany
Matthias Krüll
- Institute for Allergy and Asthma Research Berlin, Tempelhofer Damm 176, D-10299 Berlin, Germany
- Department of Pneumology and Infectious Diseases, Charité, University Medicine Berlin, Germany
Ralf Ewert
- Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, Friedrich-Loeffler-Str. 23, D-17475 Greifswald, Germany
Oliver Noga
- Institute for Allergy and Asthma Research Berlin, Tempelhofer Damm 176, D-10299 Berlin, Germany
- Department of Pneumology and Infectious Diseases, Charité, University Medicine Berlin, Germany

Received 17 June 2010; accepted 28 July 2010. published online 27 August 2010.

Summary

Background

In patients with moderate to severe allergic asthma, clinical effectiveness of omalizumab, an approved anti-IgE-reacting substance, is usually assessed by pulmonary function testing (PFT), symptom scores and physicians judgement.

Aims

We postulate that cardiopulmonary exercise testing (CPET) may provide an additional option to verify symptomatic changes in patients with allergic asthma.

Methods

Ten consecutive patients with allergic asthma were treated with omalizumab. Prior to and after 16 weeks of treatment all patients underwent PFT and symptom-limited CPET. Results were compared to 10 asthmatic controls without omalizumab medication. Symptoms were assessed according to investigators judgement (IGETE).

Results

All 20 patients showed a significantly impaired exercise capacity at baseline [peak oxygen uptake (VO₂) 71 ± 16% predicted]. In patients with omalizumab, peakVO₂ increased from 13.8 (8.4–21.4) to 16.8 (11.2–23.9) ml/kg/min (p < 0.05), VO₂ at anaerobic threshold increased by 22% [9.8 (3.3–15.2) to 12.3 (6.7–14.4) ml/kg/min (p < 0.05)]. There was no improvement in the controls. The increase in VO₂ was significantly correlated to the improvement in symptoms. All patients revealed dynamic hyperinflation under exercise with a decreasing extent with omalizumab treatment.

Conclusion

This study suggests that CPET may provide additional and useful tools to assess and verify the individual clinical response to omalizumab treatment. An improvement in exercise capacity can reliably mirror changes in quality of life and IGETE. Patients with omalizumab experience significant improvements in their initially impaired exercise capacity. CPET can be safely accomplished in patients with severe asthma.

Keywords: Exercise, Ventilation, Asthma, Omalizumab, Oxygen uptake