Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper

Karin B. Fieten, Marieke T. Drijver-Messelink, Annalisa Cogo, Denis Charpin, Milena Sokolowska, Ioana Agache, Luís Manuel Taborda-Barata, Ibon Eguiluz-Gracia, Gerrit J. Braunstahl, Sven F. Seys, Maarten van den Berge, Konrad E. Bloch, Silvia Ulrich, Carlos Cardoso-Vigueros, Jasper H. Kappen, Anneke ten Brinke, Markus Koch, Claudia Traidl-Hoffmann, Pedro da Mata, David J. PrinsSuzanne G.M.A. Pasmans, Sarah Bendien, Maia Rukhadze, Mohamed H. Shamji, Mariana Couto, Hanneke Oude Elberink, Diego G. Peroni, Giorgio Piacentini, Els J.M. Weersink, Matteo Bonini, Lucia H.M. Rijssenbeek-Nouwens, Cezmi A. Akdis

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro-immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.

Original languageEnglish
Pages (from-to)1991-2024
Number of pages34
JournalAllergy: European Journal of Allergy and Clinical Immunology
Issue number7
StatePublished - Jul 2022
Externally publishedYes


  • altitude
  • asthma
  • climate
  • environment
  • pulmonary rehabilitation


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