Page 163 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

from the participation in the study (Hawthorne effect), it did not compromise the outcomes.
Finally, in chapter 9 we explored in more detail the added value of telemanagement in the treatment of patients with severe glucocorticoid- dependent asthma. We also introduced the concept of adherence to the internet-based strategy and the association with health-related costs. Adherence rates were positively associated with the spared dose of prednisone over 6 months (r=0.51, p-value=0.001) and inversely associated with costs related to consultations with health care providers as well as overall costs related to health consumption (b=-0.039, p-value = 0.03). We concluded that the level of adherence is an important modifier of the benefits of internet based monitoring systems in patients with severe asthma. Better adherence to the internet system in these patients was associated with better health outcome and with lower medical costs.
General discussion
The management of patients with severe-refractory asthma is complicated [18- 20]. The long-term use of systemic glucocorticoids increases the complexity of the treatment, mainly because of the accompanying adverse effects and comorbidities [8-10;13;21].
The association of psychiatric disorders with severe asthma has been described previously [22;23] but to what extent the chronic use of systemic glucocorticoids increases the risks for these morbidities was not yet known. In the study described in chapter 3 we found that patients with glucocorticoid-dependent severe asthma had a higher prevalence of clinically significant symptoms of depression and anxiety compared with patients with severe asthma who were non-glucocorticoid dependent. This suggests that, in addition to the severity of asthma, the consumption of systemic glucocorticoids contributes substantially to the risks for psychiatric disorders in these patients.
Sometimes, the management of patients with severe asthma becomes so difficult that patients can only achieve a better control and stability of their
Summary and general discussion
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