Page 162 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 10
Figure 1: Schematic representation of telemanagement in asthma
Legend to figure 1: This figure represents key components of a telemanagement approach in asthma, a continuous process that is jointly shaped by the patient and professional. PHR stands for “personal health record”, EMR stands for “electronic medical record” (courtesy from van Gaalen et al, chapter 6 from this thesis)
Chapter 7 describes an internet-based management study designed to decrease oral steroids to the lowest effective dose in patients with glucocorticoid-dependent asthma. Participant patients were randomized to a tapering strategy according to conventional treatment (n=43) or to an internet-based strategy (n=51), which included daily home monitoring of asthma symptoms, lung function and fraction of exhaled nitric oxide. Patients who followed the internet-based strategy had a cumulative sparing dose of prednisone of (median (25-75%)) 205 (-221 to 777) mg compared with 0 (-497 to 282) mg in the group with conventional treatment. Therefore, the internet- based strategy proved to be superior to conventional treatment in reducing total corticosteroid consumption without compromising asthma control or asthma-related quality of life.
In chapter 8 we provide a short counter argumentation on the comment [17] that specific conditions could potentially have influenced the results from the internet-based tapering study described in chapter 7. We conclude that, despite a potential change in patient’s adherence to the medication resulting
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