Page 119 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Internet-based tapering of OCS in severe asthma
Internet group
The Internet-based management tool comprised of (1) an electronic diary, (2) a treatment decision support for the patients and (3) a monitoring support by a study nurse.
(1) Electronic diary: Patients recorded symptoms, registered their dose of oral corticosteroids, lung function (hand-held spirometer Piko-1; Ferraris Respiratory, Hertford, UK) and exhaled nitric oxide (FeNO: hand-held NO-analyzer Niox Mino®, Aerocrine AB, Solna, Sweden) before medicine intake on a daily base [23]. Asthma control questionnaires (ACQ) [24] were completed weekly, whilst asthma related quality of life questionnaires (AQLQ) [25] were completed at baseline and every 3 months thereafter. Patients registered their data via a validated asthma monitoring service using an internet application or SMS messages [16]. They also registered every event related to asthma, such as antibiotics intake, emergency room visits or deterioration of symptoms. At the end of the study patients rated their global satisfaction with the tapering strategy on a 7-point scale ranging from “absolutely not satisfied” to “completely satisfied”.
(2)Treatment decision support: Patients had daily information about their asthma graphically on the webpage and received weekly instructions via the web page for step-wise corticosteroid dose adjustments according to a built-in algorithm (Table 1). The decision rule of this algorithm was based on week-to-week changes in mean levels of FeNO and ACQ as follows: if asthma remained controlled (change in ACQ <+0.5) the algorithm recommended down-titration by one dose step. If asthma control deteriorated, the algorithm recommended up-titration of the corticosteroid dose only in case of concomitant increase in FeNO >10 ppb. This was to avoid an increase in the dose of oral corticosteroids for other reasons than a flare-up of asthmatic airway inflammation [11]. Steroid dose was decreased in case of ACQ > 0.5 but FENO decreased by more than 10 ppb. In all other instances the algorithm recommended to keep the dose of corticosteroids unchanged.
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