Page 166 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Chapter 10
manner is extremely important for the overall well-being of our patients. The results of the studies described in this thesis have several implications that can be applied to ameliorate care for patients with glucocorticoid-dependent severe asthma and can help to achieve the ultimate tapering goal.
Firstly, we have shown that long-term use of systemic steroids is associated with an increased risk of symptoms of depression and anxiety. Unfortunately, many patients might feel uncomfortable to spontaneously report such symptoms to their treating physician. That is why it is important to systematically offer opportunities to discuss psychological alterations [12]. The screening for these morbidities can be performed through validated questionnaires (HADS, NEO- FFI) in the outpatient clinic and additional professional support can be requested if applicable. Diagnosing and treating co-morbidities help to achieve a better control of the asthma and therefore decrease the medication requirements.
Secondly, it is important to acknowledge the role of a multidisciplinary team for the formulation of a comprehensive treatment strategy, taking in account the characteristics and demands of each individual patient. High-altitude climate treatment will most likely lead to improvement in asthma-related quality of life and lung function for all patients. In addition, significant improvements in systemic glucocorticoid intake, body weight and systemic inflammation might be obtained to a variable extend based on the patients’ characteristics before admission.
Thirdly, the internet-based strategy and the prednisone-tapering algorithm are effective and safe for use in the management of patients with glucocorticoid-dependent severe asthma. These tools are readily available for the implementation in other settings. In fact, a recent asthma trial on steroid sparing effect of anti-IL5 [45] has already successfully applied a tapering algorithm based on that of our study.
Finally, we propose to utilize patients’use of internet-based interfaces as a tool to assess the level of adherence to a complex treatment regimen. Non-adherence in patients with chronic diseases is a real problem and has clear consequences for disease control. Patients who are found to have low adherence to internet management could be coached more intensively through the system, which will improve their health.
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