Pulmonary rehabilitation combining education and exercise training in adults with asthma: a systematic review and meta-analysis of clinical outcomes and program duration effects.

BACKGROUND: Pulmonary rehabilitation (PR) has been widely studied and established as an effective intervention in several chronic pulmonary diseases. Nevertheless, evidence in adults with asthma remains inconclusive. OBJECTIVE: . To assess the efficacy of PR, including at least education and exercise training (ET), in adults with asthma. METHODS: . This systematic review followed PRISMA guidelines. Four databases were searched from inception to November 2025. We included randomized clinical trials in adults with asthma who underwent a PR intervention compared to other interventions (including PR within education and ET components), usual care, or no intervention. Primary outcomes were asthma control, lung function, exercise capacity, and airway inflammation. Certainty of evidence and risk of bias were assessed. RESULTS: . Sixteen studies were included, and thirteen in at least one meta-analysis. Most studies enrolled moderate-to-severe asthma. Meta-analysis results showed significant differences in favor of PR in asthma control, exercise capacity, quality of life, anxiety, and depression compared to control group (CG). PR showed significant differences at short-term follow-up in asthma control and quality of life. No significant differences were observed for lung function, airway inflammation, physical activity levels, and body composition. Most studies had a high risk of bias, and the certainty of evidence was very low for some outcomes. CONCLUSIONS: . PR improved asthma control, exercise capacity, quality of life, anxiety, and depression in adults with asthma compared to CG. Nevertheless, these findings should be interpreted cautiously because of the high risk of bias, low certainty of evidence for some outcomes, and uncertainty in sensitivity analyses.