Page 127 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Table 4. Contribution of FeNO and ACQ to algorithm decisions
Internet-based tapering of OCS in severe asthma
Monitoring adverse events
Three patients had newly diagnosed severe adverse effects: diabetes (2 patients), glaucoma (1 patient).
The internet algorithm
The compliance with measuring FEV1, FeNO, ACQ and entering the data into the website was very high (88.8% in the conventional treatment group, 89.6% in the internet strategy group and 89.3% in the complete group).The computer algorithm was overruled by the pulmonologist in 37 of a total of 1023 decisions. The main reasons for these were to slow down the pace of steroid tapering (65%), to treat an exacerbation (9.7%) or to increase the oral corticosteroid dose based on clinical grounds (9%). In 8 occasions patients themselves decided not to follow the computer advice for a variety of reasons. ACQ and FeNO contributed to the decisions of the computer algorithm in 859 (84%) and 164 (16%) cases, respectively (Table 4). There was no difference in total sparing dose of oral corticosteroids between patients who had or had not FeNO-related decisions by the algorithm (482.7 ±1223 mg versus 462.12 ±455 mg, p= 0.83).
Δ FeNO > +10 ppb and > 10% Δ FeNO > +10 ppb and ≤ 10% -10 ≤ Δ FeNO ≤ +10 ppb
Δ FeNO < -10 ppb
Δ ACQ ≥+0.5
OCS ↑
36 (3.5%)*
No change in OCS 1 (0.1%)*
No change in OCS 105 (10.3%)*
OCS ↓
22 (2.2%)*
Δ ACQ <+0.5
OCS ↓
128 (12.5%)*
OCS ↓
3 (0.3%)*
OCS ↓
621 (60.7%)*
OCS ↓
107 (10.5%)*
Footnote table 4. * Number of observed decisions (and their relative percentage to the total number of interventions) corresponding to the different algorithm possibilities in the internet management group . Δ ACQ= difference of Asthma Control Questionnaire scores between 2 weeks. Δ FeNO = difference of mean fraction of exhaled nitric oxide (in parts per billion) between 2 weeks. ↑ OCS denotes increase of prednisone dose by one step. ↓ OCS denotes decrease of prednisone dose by one dose step.
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