BACKGROUND: To investigate the effect of asthma rehabilitation at high altitude (3,100 m, HA) compared to low altitude (760 m, LA). METHODS: For this randomized parallel-group trial insufficiently controlled asthmatics (Asthma Control Questionnaire (ACQ) > 0.75) were randomly assigned to 3-week in-hospital rehabilitation comprising education, physical-and breathing-exercises at LA or HA. Co-primary outcomes assessed at 760 m were between group changes in peak expiratory flow (PEF)-variability, and ACQ) from baseline to end-rehabilitation and 3 months thereafter. RESULTS: 50 asthmatics were randomized (median (quartiles) LA ACQ 2.7 (1.7 to 3.2), PEF-variability 19% (14 to 33); HA ACQ 2.0 (1.6 to 3.0), PEF-variability 17% (12 to 32)). The LA-group improved PEF-variability by median (95%CI) -7% (-14 to 0, p = 0.033), ACQ -1.4 (-2.2 to -0.9, p < 0.001), and after 3 months by -3% (-18 to 2, p = 0.103) and -0.9 (-1.3 to -0.3, p = 0.002). The HA-group improved PEF-variability by -10% (-21 to -3, p = 0.004), ACQ -1.1(-1.3 to -0.7, p < 0.001), and after 3 months by -9% (-10 to -3, p = 0.003) and -0.2 (-0.9 to 0.4, p = 0.177). The additive effect of HA versus LA directly after the rehabilitation on PEF-variability was -6% (-14 to 2), on ACQ 0.3 (-0.4 to 1.1) and after 3 months -5% (-14 to 5) respectively 0.4 (-0.4 to 1.1), all p = NS. CONCLUSION: Asthma rehabilitation is highly effective in improving asthma control in terms of PEF-variability and symptoms, both at LA and HA similarly. TRIAL REGISTRATION: ClinicalTrials.gov NCT02741583, Registered April 18, 2016.

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