Page 21 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

is hardly accessible. These patients will most likely remain dependent on systemic glucocorticoids for many years and develop undesirable adverse effects.
Secondly, the privileged patients who benefit from targeted therapy have usually relied on the chronic use of systemic glucocorticoids and a sudden withdrawal of exogenous steroid use might lead to asthma exacerbations or even a tertiary adrenal insufficiency.
Thirdly, patients with glucocorticoid-dependent asthma are highly complex. They present heterogeneous clinical features resulting from the involvement of diverse cellular and molecular pathways, revealing multiple biological phenotypes [98]. Therefore, these patients require a multidisciplinary evaluation to establish a personalised treatment plan. Sometimes, patients with severe asthma even have to be moved from their home environment and be subjected to long-term admissions in an alpine climate environment to control their symptoms and to reduce the dose of glucocorticoid medication. However, it is not yet clear which patients benefit most from this treatment strategy.
For the reasons here presented, the optimal management of patients with glucocorticoid-dependent severe asthma has still to be further developed. A comprehensive approach should not only include innovative tools for monitoring of asthma symptoms, such as telemanagement, but also include an intensive follow-up of undesirable effects related to the use of glucocorticoids. Furthermore, there should be a personalised plan to tailor the dose of oral glucocorticoids to the individual patient, such that patient’s quality of life is maintained and further damage prevented.
General introduction and aims of the thesis
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