{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T06:05:32Z","timestamp":1784786732479,"version":"3.55.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite optimized pharmacological therapy, a significant subset of severe asthma patients remains poorly controlled. Lack of control is often driven by complex, non-inflammatory \u201ctreatable traits\u201d that require a multidimensional management strategy beyond traditional airway targeting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize clinical, functional, and inflammatory profile of severe asthma patients at the time of prescribing biologic therapy and identify potential candidates to ARM (Assessment-Rehabilitate-Maintenance) pulmonary rehabilitation (PR) program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study analyzed 195 consecutive adults meeting GINA criteria for severe asthma admitted to our outpatient clinic between January 1, 2015, and December 31, 2025. ARM-program candidacy was predefined by the coexistence of: FEV1 &amp;lt; 80% predicted, mMRC \u2265 2, ACT &amp;lt; 20, and \u22652 annual exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age of the cohort was 55 years and 60% of patients were female. A substantial disease burden was detected (median ACT: 16; annual exacerbations: 3). Females showed significantly higher maintenance oral corticosteroid (OCS) dependence (35.9% vs. 21.8%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.036) and increased risk of air trapping (RV\/TLC: 42.0% vs. 38.5%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.035). 47 patients (24%) met ARM candidacy criteria, showing higher OCS use (42.6% vs. 26.4%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.035), and a four-fold higher prevalence of anxiety\/depression (12.8% vs. 3.4%;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.015) compared with non-candidates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>At the time of biologic prescription, a significant proportion of severe asthma patients present a multidimensional burden, including dyspnea, frequent exacerbations, and psychological comorbidities and are potential candidates to ARM PR program. Prospective studies are needed to validate patient selection criteria and support whether pulmonary rehabilitation\u2014may improve clinical and functional outcomes in target subgroup.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1853986","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:37:49Z","timestamp":1784785069000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A Multidimensional approach to Severe Asthma Management: the need for Pulmonary Rehabilitation among candidates for Biologic Therapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Michela","family":"Pozza","sequence":"first","affiliation":[{"name":"Respiratory Pathophysiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova","place":["Padova, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella","family":"Guarnieri","sequence":"additional","affiliation":[{"name":"Respiratory Pathophysiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova","place":["Padova, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Vianello","sequence":"additional","affiliation":[{"name":"Respiratory Pathophysiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health University of Padova","place":["Padova, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","unstructured":"Global\n              Initiative for Asthma\n            \n          \n          Global Strategy for Asthma Management and Prevention\n          \n          2024"},{"key":"B2","doi-asserted-by":"publisher","first-page":"240088","DOI":"10.1183\/16000617.0088-2024","article-title":"Biologics in severe asthma: a state-of-the-art review","volume":"34","author":"Gyawali","year":"2025","journal-title":"Eur Respir Rev Gennaio."},{"key":"B3","doi-asserted-by":"publisher","first-page":"457","DOI":"10.2147\/JAA.S260604","article-title":"Uncontrolled asthma: unmet needs in the management of patients","volume":"14","author":"Caminati","year":"2021","journal-title":"JAA Maggio."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1164\/rccm.201309-1634ST","article-title":"An official american thoracic society\/European respiratory society statement: key concepts and advances in pulmonary rehabilitation","volume":"188","author":"Spruit","year":"2013","journal-title":"Am J Respir Crit Care Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1709710","DOI":"10.3389\/fmed.2025.1709710","article-title":"The role of pulmonary rehabilitation in severe asthma: a comprehensive review","volume":"12","author":"Guarnieri","year":"2025","journal-title":"Front Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1761011","DOI":"10.3389\/fmed.2026.1761011","article-title":"Designing an effective pulmonary rehabilitation program for severe asthma","volume":"13","author":"Guarnieri","year":"2026","journal-title":"Front Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1701655","DOI":"10.1183\/13993003.01655-2017","article-title":"Precision medicine in airway diseases: moving to clinical practice","volume":"50","author":"Agust\u00ed","year":"2017","journal-title":"Eur Respir J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"219","DOI":"10.4168\/aair.2021.13.2.219","article-title":"Sex differences in severe asthma: results from severe asthma network in Italy-SANI","volume":"13","author":"Senna","year":"2021","journal-title":"Allergy Asthma Immunol Res."},{"key":"B9","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1186\/s12955-020-01505-x","article-title":"Association between patient-reported outcomes and exercise test outcomes in patients with COPD before and after pulmonary rehabilitation","volume":"18","author":"Meys","year":"2020","journal-title":"Health Qual Life Outcomes."},{"key":"B10","doi-asserted-by":"publisher","first-page":"108421","DOI":"10.1016\/j.rmed.2025.108421","article-title":"Treatable Traits. 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Insights from the German Asthma Net","volume":"11","author":"Jarosch","year":"2025","journal-title":"ERJ Open Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1080\/02770903.2023.2188565","article-title":"A hierarchical cluster analysis of the psycological impact of the COVID-19 pandemic on Italian severe asthma patients","volume":"60","author":"Guarnieri","year":"2023","journal-title":"J Asthma."},{"key":"B13","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/s12890-022-02152-2","article-title":"A pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult-to-control asthma and elevated body mass index","volume":"22","author":"Ricketts","year":"2022","journal-title":"BMC Pulm Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1164\/rccm.201510-1966ST","article-title":"An official American thoracic society\/European respiratory society policy statement: enhancing implementation, use, and delivery of pulmonary rehabilitation","volume":"192","author":"Rochester","year":"2015","journal-title":"Am J Respir Crit Care Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.1136\/thoraxjnl-2019-213223","article-title":"Economic burden of multimorbidity in patients with severe asthma: a 20-year population-based study","volume":"74","author":"Chen","year":"2019","journal-title":"Thorax."},{"key":"B16","doi-asserted-by":"publisher","first-page":"97","DOI":"10.18176\/jiaci.0871","article-title":"Prevalence, T2 biomarkers, and cost of severe asthma in the era of biologics: the BRAVO-1 study","volume":"34","author":"Domingo","year":"2024","journal-title":"J Investig Allergol Clin Immunol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1007\/s10198-024-01736-5","article-title":"The economic burden of asthma in Italy: evaluating the potential impact of different treatments in adult patients with severe eosinophilic asthma","volume":"26","author":"Scortichini","year":"2024","journal-title":"Eur J Health Econ."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1016\/j.jval.2021.01.017","article-title":"Cost-effectiveness of pulmonary rehabilitation in patients with bronchial asthma: an analysis of the EPRA randomized controlled trial","volume":"24","author":"B\u00f6ckmann","year":"2021","journal-title":"Value Health."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1853986\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:37:51Z","timestamp":1784785071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1853986\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":18,"alternative-id":["10.3389\/fmed.2026.1853986"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1853986","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1853986"}}