Page 167 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

In the introduction of this thesis we presented the case of Mr. B, a man with very severe glucocorticoid-dependent asthma and undesirable side effects related to the prolonged use of the medication. Mr. B was referred to a specialized asthma centre and had the opportunity to down-titrate the prednisolone in a safe way with the combination of internet based management and multidisciplinary assessment. The results from the studies described in this thesis may benefit other patients like Mr. B, who are severely hampered in daily life by the combination of asthma symptoms and side effects of glucocorticoid medication. The newly released pocket guide for the management of severe asthma [46] emphasizes the reduction of systemic glucocorticoids consumption as a high priority. The authors of this guide recommend internet- based monitoring of patients as an effective tool to achieve this goal; the lessons learned from our studies pave the way for this important worldwide assignment.
Future perspectives
The development of new drugs for the targeted treatment of severe asthma has already changed the situation of some patients in prosperous countries. It is expected that within a few decades patients with glucocorticoid-dependent asthma may be an exception. However, there is a long way to go until these very expensive therapies become available worldwide. Meanwhile, we must try to offer the most comprehensive and accessible treatment to our patients.
The use of technologies such as web-interfaces and Internet applications to facilitate our routine is already a reality. Implementing these tools in the health system will optimize the management of patients, allowing real-time long- distance support and improvement of the communication between patients and health providers.
Furthermore, internet-based platforms can also be combined to already existent strategies for the management of patients with severe asthma, such as high-altitude climate treatment. This combination could, for example, allow a shorter stay in the asthma center facility without impeding close monitoring and support. Further studies should be performed to evaluate the cost- effectiveness of such initiatives and eventual implementation in the standard health care of patients with severe asthma.
Summary and general discussion
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