Page 19 - Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

are multifactorial [81;82], efforts must be made to identify possible contributing factors and to propose effective interventions to solve the problem.
Another situation that very often impairs the success of the asthma treatment is the incorrect use of inhaler devices. Shared decision about the best device to be used, teaching the proper technique and reinforcing the instructions at every routine appointment are recognized strategies to improve the correct use [83;84].
Unfortunately, many patients are still dependent on systemic glucocorticoids despite ruling out the above factors. It is currently recommended to add another category of asthma medication or propose a different strategy to control the airway inflammation and reduce the dose of glucocorticoids. Recent studies have shown positive results on the added value of monoclonal antibodies as steroid-sparing drugs [85-87].
4. Monitoring and treatment of adverse events associated with the use of systemic glucocorticoids
As previously described, patients receiving maintenance treatment with systemic glucocorticoids are subjected to a multitude of undesirable adverse effects. There are some recommendations addressing monitoring and prevention of these adverse events, such as routine monitoring of blood pressure, weight and glycaemia. Patients should ingest their glucocorticoid medication as a single dose in the morning to respect the circadian cycle and take H2 blockers or proton pump inhibitors as prophylaxis of peptic ulcer.
With respect to steroid-induced osteoporosis, the patient must be aware of the importance of adequate nutrition and an active lifestyle. International guidelines also recommend routine supplementation of at least 1.000 mg of calcium and 800 IU/day of cholecalciferol [88;89] to reduce the risks of osteoporosis and bone fractures [1;90].
Additionally, patients should have regular appointments with ophthalmologist for control of eye pressure and vision, and where appropriate, be referred to specialists for evaluation of possible psychological morbidities [91].
Also, one should be aware of the possible interaction of glucocorticoids with other drugs and vaccines. Currently, there are more than 700 drugs known
General introduction and aims of the thesis
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