Page 144 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 9
outcomes and therefore save costs related to asthma care. To test our hypothesis, we assessed and evaluated adherence rates and performed a secondary analysis of the data.
Methods
Subjects
The characteristics of the cohort have been described previously [6]; in short, adult patients (18-75 years) were recruited from the outpatient departments of six hospitals in the Netherlands. They were all diagnosed with severe refractory asthma according to American Thoracic Society/European Respiratory Society guideline definitions [21;22] and were all dependent on chronic systemic corticosteroids for at least 3 months before study entry.
Study design
Data from patients who had participated in the internet strategy arm of a 6-months prednisone tapering study [6] were used for a secondary analysis. In this study, patients attended the outpatient pulmonology clinic once a month and were seen by their own pulmonologist for disease control and the study asthma nurse for orientation about study-related procedures. According to the original protocol, patients had daily measurements of the level of asthmatic inflammation in the airways by means of fractional exhaled nitric oxide (FeNO) measurement [25]. Therefore they received a hand-held exhaled nitric oxide- analyzer (Niox Mino®, Aerocrine AB, Solna, Sweden) [26] and were trained to perform home measurements. Patients were asked to fill in the FeNO values and prednisone dose on a daily basis using a designated web application for 6 months. Every week, they received an electronically generated advice on how to adjust their prednisone dose according to pre-programmed algorithm and had remote web communication with a study asthma nurse. Details of the study design and procedures are described elsewhere [6].
Outcome parameters
1. Adherence
Adherence with internet asthma management was defined as the number of values stored in the FeNO -analyzer memory card divided by the number of
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