Page 160 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 10
Conclusions of the studies
Treatment of severe asthma
In chapter 2 we reviewed the available literature on management of severe refractory asthma in adults and proposed options to guide the therapy according to patients with specific asthma phenotypes (early onset severe allergic asthma, late onset non-atopic eosinophilic asthma, late onset non- eosinophilic asthma with obesity). Furthermore, we also emphasized the need of a comprehensive evaluation of these complex patients by a multidisciplinary team allowing the establishment, re-evaluation and maintenance of the personalized asthma management.
In chapter 3 we explored the association between the severity of asthma and relevant psychological co-morbidities and personality traits. For this purpose we applied screening questionnaires (Hospital Anxiety and Depression Scale (HADS) and NEO-Five Inventory (NEO-FFI)) to patients with mild-moderate asthma, severe asthma and severe glucocorticoid-dependent asthma. We identified significantly more anxiety and depression symptoms in patients with glucocorticoid-dependent severe asthma as compared to patients with non- glucocorticoid dependent severe-asthma or mild-moderate asthma. These findings highlight the relevance of systematic screening of psychological conditions, which can be an undesirable consequence from the chronic use of systemic steroids and lead to considerable impairment of the asthma control. Psychological distress in patients with severe asthma should not be underestimated and these patients deserve to be referred to specialists for further evaluation and possible treatment.
In chapter 4 we introduced the concept of personalized medicine applied to the treatment of patients with severe asthma at a high-altitude climate. In this study we investigated whether particular characteristics of patients with severe asthma referred to the Dutch Asthma Centre in Davos could predict a specific outcome after 12 weeks of treatment. The five clinically relevant outcomes considered were: change in oral glucocorticoid dose, change in asthma related quality of life (AQLQ), change in lung function (FEV1), change in blood eosinophils and change in body mass index (BMI). We demonstrated that the beneficial effect of alpine climate therapy in adults with severe asthma can be
158