Page 120 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 7
Table 1. Criteria for dose adjustment of oral corticosteroids in the internet-based management group with corresponding dose steps.
Panel A
Δ FeNO > +10 ppb and > 10% Δ FeNO > +10 ppb and ≤ 10% -10 ≤ Δ FeNO ≤ +10ppb
Δ FeNO < -10 ppb
Panel B
Maintenance dose (mg/day)
> 25
20 to 25 10 to 20 < 10
Δ ACQ ≥+0.5
↑ = = ↓
Dose steps (mg/day)
Δ ACQ <+0.5
↓ ↓ ↓ ↓
Increase or decrease 10 mg
Increase or decrease 5 mg
Increase or decrease 2.5 mg
Increase or decrease 2.5 mg every other day
Footnote table 1. In panel A the criteria for dose adjustment of prednisone based on daily FeNO values and weekly ACQ score. In panel B the dose steps for the adjustment of prednisone maintenance dose. Δ ACQ= difference of Asthma Control Questionnaire scores between 2 weeks. Δ FeNO = difference of mean fraction of exhaled nitric oxide between 2 weeks (in parts per billion). ↑ denotes increase of prednisone dose by one step. = denotes no change in prednisone dose. ↓ denotes decrease of prednisone dose by one dose step.
(3) Monitoring support: A study nurse was responsible for coaching the patients, monitoring the data entered at the web page, and facilitating the communication between patients and pulmonologists.
The pulmonologists were not aware of any of the data registered on the study website but were contacted by the study nurse in case of an imminent exacerbation (decrease in morning FEV1 of at least 10% compared to mean FEV1 from the week before). In case of an exacerbation they could overrule the internet dose prescription. The tapering algorithm was then interrupted and immediately restarted at the end of the steroid burst.
Conventional management group
Patients in the conventional management group visited the pulmonology outpatient clinic every month, and had their oral corticosteroids down-titrated according to the prescription by the pulmonologist. Pulmonologists followed the Global Initiative for Asthma (GINA) guidelines for treatment of patients with severe asthma [6] and were instructed to down-titrate the dose of oral corticosteroids whenever possible on clinical grounds.
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