The treatment of
asthma largely depends on guideline-based pharmacologic
therapies. However, nonpharmacologic
therapies for
asthma such as pulmonary rehabilitation, focused breathing techniques, and
bronchial thermoplasty have an important, yet underappreciated, role. Structured pulmonary rehabilitation programs can reduce
dyspnea and increase cardiopulmonary fitness. The educational component of these programs can ensure that
therapies are being used appropriately, increase compliance, and decrease health care utilization. Studies have demonstrated a reduction in inflammatory mediators in patients with
asthma who are engaged in an exercise program. Focused breathing techniques are commonly used by patients with
asthma, yet benefit has not been clearly shown in randomized controlled trials. For the patients with severe
asthma who are unresponsive to maximum medical
therapy and have evidence of
airway remodeling,
bronchial thermoplasty has demonstrated long-term improvement in quality of life and reduction in severe exacerbations and health care utilization. Recent airway biopsy studies have demonstrated
bronchial thermoplasty's disease-modifying effect on smooth muscle, inflammatory mediators, and bronchial nerve endings. These nonpharmacologic
therapies are complementary to current guideline-based treatment, including the use of
biologic modifiers, for severe
asthma.