"We know that in patients with prednisone-dependent asthma it is important to adjust the daily dose of oral corticosteroids to the lowest possible level in order to reduce long-term side effects," said Simone Hashimoto, M.D., research fellow from the department of respiratory medicine of the University of Amsterdam.
"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 six months study period, as compared with patients receiving usual care. This was not accompanied by deterioration of asthma control or asthma-related quality of life."
The findings were presented at the ATS 2010 International Conference in New Orleans.
People with chronic health conditions, such as severe asthma, require continuous medical supervision, which can often be a logistical challenge, not only for overburdened healthcare systems, but for patients themselves, who may not have the time or flexibility to keep frequent appointments. "Internet monitoring allows centralized continuous long-distance support of patients, which can improve the quality of care, reduce the hazards associated with oral corticosteroids tapering, and can prevent drug-induced morbidity and mortality," explained Dr. Hashimoto.
While it was known that in patients with milder asthma, such programs had shown success, patients with severe asthma had yet been studied.
"Some patients with severe asthma require frequent bursts or even daily use of oral corticosteroids despite treatment with high dose of inhaled asthma medication. This leads 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," explained Dr. Hashimoto. "Since adverse effects are dose and time dependent, corticosteroids should always be used in the lowest possible dose. In current practice, oral corticosteroid dose adjustments are made periodically by the patient's physician, based on subjective symptoms and signs, and not by objective parameters."
Dr. Hashimoto and colleagues designed a prospective, randomized, parallel, multicenter study with 89 patients with severe asthma study to test the hypothesis that a new internet-based strategy including daily home monitoring of symptoms, lung function, FENO, and regular feedback by an internet asthma nurse, would lead to a significant reduction of corticosteroid consumption without worsening of asthma control or asthma-related quality of life. In total, 89 patients were randomized to two tapering strategies: usual care, or internet-supported with daily monitoring of FENO, FEV1 and symptoms.
For those assigned to the internet-supported strategy, each patient had a password used to log in to a secure site where they recorded daily symptoms, lung function values, FENO value and dose of medicine that they took in the day. The values were controlled every day by a specialized asthma nurse and once a week patients received instructions about the dose of oral corticosteroids they should use. The process took about 5 minutes per day for the patient, and was well accepted. Patients could also contact the asthma nurse via the website or email in the event of questions or problems.
The researchers found that among patients assigned to the internet-supported strategy, cumulative 6-month dosing of OCS was significantly lower. "Of course, we hoped to find a positive result, because internet based self-management and management guidance by FENO has already been proven to be successful in adolescents with milder forms of asthma," said Dr. Hashimoto. "However, we were surprised that also in patients with severe prednisone-dependent asthma this strategy proved to be successful. These patients have years of continuous use of oral corticosteroids and a long history of attempts to taper their maintenance prednisone dose without success. This strategy gives them new hope that they can safely reduce the deleterious long-term side effects of prednisone."
"Our findings suggest that this novel internet-based strategy can and should be applied in all patients with severe prednisone dependent asthma to reduce total corticosteroid consumption. Internet technologies as well as biomarker driven therapies will become more and more common in future health care," Dr. Hashimoto concluded. "In the future, we will do more studies on a larger scale, to evaluate whether this strategy should be incorporated in guidelines for management of patients with severe asthma."
"Monitoring Exhaled Nitric Oxide (FENO) to Tailor the Lowest Effective Dose of Oral Corticosteroids in Sever Asthma (MONOSA- Study)" (Session B92, Monday, May 17, 1:30- 4:00 p.m., CC-Room 228-230 (Second Level), Morial Convention Center; Abstract 492)
Keely Savoie | EurekAlert!
Laser activated gold pyramids could deliver drugs, DNA into cells without harm
24.03.2017 | Harvard John A. Paulson School of Engineering and Applied Sciences
What does congenital Zika syndrome look like?
24.03.2017 | University of California - San Diego
Astronomers from Bonn and Tautenburg in Thuringia (Germany) used the 100-m radio telescope at Effelsberg to observe several galaxy clusters. At the edges of these large accumulations of dark matter, stellar systems (galaxies), hot gas, and charged particles, they found magnetic fields that are exceptionally ordered over distances of many million light years. This makes them the most extended magnetic fields in the universe known so far.
The results will be published on March 22 in the journal „Astronomy & Astrophysics“.
Galaxy clusters are the largest gravitationally bound structures in the universe. With a typical extent of about 10 million light years, i.e. 100 times the...
Researchers at the Goethe University Frankfurt, together with partners from the University of Tübingen in Germany and Queen Mary University as well as Francis Crick Institute from London (UK) have developed a novel technology to decipher the secret ubiquitin code.
Ubiquitin is a small protein that can be linked to other cellular proteins, thereby controlling and modulating their functions. The attachment occurs in many...
In the eternal search for next generation high-efficiency solar cells and LEDs, scientists at Los Alamos National Laboratory and their partners are creating...
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are less stable. Now researchers at the Technical University of Munich (TUM) have, for the first time ever, produced a composite material combining silicon nanosheets and a polymer that is both UV-resistant and easy to process. This brings the scientists a significant step closer to industrial applications like flexible displays and photosensors.
Silicon nanosheets are thin, two-dimensional layers with exceptional optoelectronic properties very similar to those of graphene. Albeit, the nanosheets are...
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to simulate these confined natural conditions in artificial vesicles for the first time. As reported in the academic journal Small, the results are offering better insight into the development of nanoreactors and artificial organelles.
Enzymes behave differently in a test tube compared with the molecular scrum of a living cell. Chemists from the University of Basel have now been able to...
20.03.2017 | Event News
14.03.2017 | Event News
07.03.2017 | Event News
24.03.2017 | Materials Sciences
24.03.2017 | Physics and Astronomy
24.03.2017 | Physics and Astronomy