Abstract
Background
Severe asthma imposes substantial burden, and many patients remain uncontrolled despite guideline-based therapy. Alpine Altitude Climate Treatment (AACT) improves asthma control and quality of life, yet benefits often attenuate after returning home. eHealth-supported self-management may help sustain AACT gains and prevent post-rehabilitation relapse, though the added value of objective home monitoring devices remains unclear.Methods
In this 12-month pragmatic trial, adults with severe asthma completing AACT in Davos were randomised to eHealth self-management support with or without home monitoring devices measuring airway inflammation, lung function and activity. Randomisation was stratified by baseline fractional exhaled nitric oxide (FeNO; Results
Between 2022-2024, 143 patients were randomised; 130 received the allocated intervention (66 intervention, 64 control), and 105 completed follow-up. Time-to-first severe exacerbation did not differ between groups (median [IQR] intervention: 16.5 [13-23], control: 20 [16-30] weeks; log-rank p=0.93). There was a non-significant trend toward fewer annualised severe exacerbations in the intervention group (aRR 0.68, 95%CI 0.45-1.03; p=0.07). Slower ACQ-6 decline (baseline-6 months) was observed in the intervention group (β -0.50, 95%CI -0.95;-0.05; p=0.03), though this did not persist to 12 months. No effect modification by FeNO strata was observed; no intervention-related serious adverse events occurred.Conclusions
Adding home monitoring devices to eHealth self-management did not prolong time-to-first severe exacerbation or sustain clinical benefits after AACT. More personalised, clinically integrated strategies could support the transition to independent self-management.