Page 116 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 7
Abstract
Background: In patients with prednisone-dependent asthma the dose of oral corticosteroids should be adjusted to the lowest possible level to reduce long-term adverse effects. However, the optimal strategy for tapering oral corticosteroids is unknown.
Objective: To investigate whether an internet-based management tool including home monitoring of symptoms, lung function and fraction of exhaled nitric oxide (FeNO) facilitates tapering of oral corticosteroids and leads to reduction of corticosteroid consumption without worsening asthma control (ACQ) or asthma-related quality of life (AQLQ).
Methods: In a 6 months pragmatic, randomised, prospective, multicenter study 95 adults with prednisone-dependent asthma from 6 pulmonary outpatient clinics were allocated to two tapering strategies: according to conventional treatment (n=43) or guided by a novel internet-based monitoring system (internet strategy) (n=52). Primary outcomes were cumulative sparing of prednisone, ACQ and AQLQ. Secondary outcomes were FEV1, exacerbations, hospitalizations and patient’s satisfaction with the tapering strategy.
Results: Cumulative sparing of prednisone was (median (25th-75th percentile) 205 (-221 to 777) mg in the internet strategy group compared with 0 (-497 to 282) mg in the conventional treatment group (p=0.02). Changes in prednisone dose (mixed-effect regression model) from baseline were -4.79 mg/day and +1.59 mg/day, respectively (p<0.001). ACQ, AQLQ, FEV1, exacerbations, hospitalizations and satisfaction with the strategy were not different between groups.
Conclusions: An internet-based management tool including home monitoring of symptoms, lung function and FeNO in severe asthma is superior to conventional treatment in reducing total corticosteroid consumption without compromising asthma control or asthma-related quality of life.
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