Internet monitoring benefits patients with severe asthma
MedWire News: An internet monitoring strategy helps patients with severe asthma reduce their overall use of oral corticosteroids, results from a Dutch study show.
"Some patients with severe asthma require frequent bursts or even daily use of oral corticosteroids despite treatment with high dose of inhaled asthma medication,” explained Simone Hashimoto, from the University of Amsterdam.
“This can lead to serious long-term adverse effects such as diabetes, blood hypertension, depression, and osteoporosis, that may critically affect patients’ quality of life and have considerable public health implications.”
She added: “Since adverse effects are dose and time dependent, corticosteroids should always be used in the lowest possible dose.”
To investigate the effectiveness of an internet monitoring strategy for reducing corticosteroid use without worsening asthma control or asthma-related quality of life, Hashimoto and team studied 89 patients, aged an average of 50 years, with prednisone-dependent asthma.
The patients were randomly assigned to receive a tapering strategy involving usual care (n=38) or an internet-supported tapering strategy (n=51), in which patients recorded daily fractional exhaled nitric oxide (FeNO) level, FEV1 values, and symptoms, and received weekly instructions about the dose of oral corticosteroids they should use.
Over the 6-month study period, the cumulative spared dose of prednisone was significantly higher among patients in the internet group, at a median of 205 mg, than in the usual care group, at a median of 0 mg.
Furthermore, mean oral corticosteroid dose decreased from 13.9 to 9.51 mg/day in the internet group compared with an increase of 11.5 to 12.7 mg/day in the usual care group.
There were no significant differences in asthma-related quality of life, FEV1, or exacerbation frequency between the two groups over the study period.
Speaking at the American Thoracic Society International Conference in New Orleans, Louisiana, USA, Hashimoto concluded: “Our study shows that a novel internet-supported strategy including daily measurements of an objective marker of airway inflammation, FeNO, and supervision by an asthma nurse allows frequent adjustments of prednisone dose, and leads to significant reduction of total corticosteroid consumption over a 6-month study period, as compared with patients receiving usual care.
“This was not accompanied by deterioration of asthma control or asthma-related quality of life.”
She added that further research is needed to “to evaluate whether this strategy should be incorporated in guidelines for management of patients with severe asthma.”
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By Mark Cowen