Page 143 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Introduction
E-health was introduced as a promising tool to improve health care in patients with chronic diseases [1] and has been subject of main health care programs worldwide [2;3]. In the last years a number of internet applications have been developed and successfully applied to patients with chronic diseases such as diabetes [4], cardiovascular diseases [5] and asthma [6;7].
Feasibility of e-health and telemanagement has been widely demonstrated [8- 11] but there are still controversies about efficacy [12;13] and cost-effectiveness [14-16]. One possible explanation could be the level of patient’s adherence to the telemanagement strategy, in other words, the degree to which the user followed the internet program as it was designed [17]. Currently, little is known about the influence of adherence to e-program on outcomes. In conventional management of diseases and pharmaceutical trials, adherence to treatment is considered highly influential. In e-therapy, adherence may be just as important to be taken in consideration [8;17].
Asthma is a complex and heterogeneous inflammatory disease affecting the airways of nearly 334 million people worldwide [18]. In most cases, asthma can be effectively controlled with the regular use of inhaled therapy (inhaled corticosteroids and long-acting β2 agonists) [19-21] but some patients with severe refractory asthma also require daily usage of oral corticosteroids which implies in a large list of serious adverse effects such as obesity, diabetes and osteoporosis [21-23]. These patients experience considerable morbidity and mortality and consume a disproportionally large amount of health care resources related to emergency room visits, hospitalizations and days out of work [24].
In a previous randomized controlled study [6] we applied internet management to patients with severe asthma aiming to decrease the total consumption of oral corticosteroids. We demonstrated that the internet application is a safe and efficient tool to adjust the dose of oral corticosteroids as compared to conventional treatment [6].
In the present study we hypothesized that higher adherence to the internet based asthma management would be associated with better health care
Adherence to telemanagement
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