Page 164 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 10
disease when they are admitted to a specialized center [24-26]. The Dutch Asthma Centre in Davos, Switzerland, is located in a low-trigger environment at 1600 meters above sea level and has a successful history in improving patients’ outcomes irrespective of their atopic status [27]. The study described in chapter 4 increases our knowledge by revealing that specific characteristics from patients with severe asthma can predict a more or less beneficial outcome of high altitude climate therapy. These findings are in line with the innovative concept of personalized therapy, which implies that the treatment goals should be tailored to the characteristics of each individual patient [28;29].
Another innovative proposal to improve the management of patients with complex diseases is the application of internet technology to the health system [30;31]. Telemanagement has been subject of many health care programs worldwide [32;33] and it has been shown to be feasible and effective for a number of chronic diseases [34-36]. Nevertheless, studies exploring the utilization of web interfaces in the management of patients with severe glucocorticoid-depend asthma were lacking.
In addition, although there is enough concern about the consequences of prolonged use of oral steroids in patients with asthma [7-9;12-15;21] there is insufficient information available on how to taper the medication safely.
The results described in chapters 7 and 9 from this thesis clearly help to solve these problems. While previous studies on steroid-sparing drugs had not shown a safe [37] or substantial effect on the reduction of the cumulative dose of glucocorticoids [38;39], we demonstrated in our study that adjusting the dose of the medication using the algorithm of our study website is a feasible and efficient way to succeed. In fact, 10 out of the 51 patients who were allocated to the internet strategy group managed to taper their dose of prednisolone to 0 mg/day, which is an impressive accomplishment for glucocorticoid-dependent patients.
Also in chapter 9 we emphasise the advantages of adopting a telemanagement strategy to guide treatment decisions for patients with severe asthma, since we showed for the first time that good adherence to an internet-based management strategy is associated with better clinical outcomes and lower health care use. This implies that patients with this severe disease are ready for
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