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Original article
Internet-based tapering of oral corticosteroids in severe asthma: a pragmatic randomised controlled trial
  1. Simone Hashimoto1,
  2. Anneke Ten Brinke2,
  3. Albert C Roldaan3,
  4. Ilonka H van Veen4,
  5. Gertrude M Möller5,
  6. Jacob K Sont6,
  7. Els J M Weersink1,
  8. Jaring S van der Zee1,
  9. Gert-Jan Braunstahl7,
  10. Aeilko H Zwinderman8,
  11. Peter J Sterk1,
  12. Elisabeth H Bel1
  1. 1Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Pulmonology, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
  3. 3Department of Pulmonology, Haga Ziekenhuis, Den Haag, The Netherlands
  4. 4Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands
  5. 5Department of Pulmonology, Leiden University Medical Centre, Leiden, The Netherlands
  6. 6Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
  7. 7Department of Pulmonary Medicine, St Franciscus Gasthuis, Rotterdam, The Netherlands
  8. 8Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, The Netherlands
  1. Correspondence to Simone Hashimoto, Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, F5-260, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands; s.hashimoto{at}amc.nl

Abstract

Background In patients with prednisone-dependent asthma the dose of oral corticosteroids should be adjusted to the lowest possible level to reduce long-term adverse effects. However, the optimal strategy for tapering oral corticosteroids is unknown.

Objective To investigate whether an internet-based management tool including home monitoring of symptoms, lung function and fraction of exhaled nitric oxide (FENO) facilitates tapering of oral corticosteroids and leads to reduction of corticosteroid consumption without worsening asthma control or asthma-related quality of life.

Methods In a 6-month pragmatic randomised prospective multicentre study, 95 adults with prednisone-dependent asthma from six pulmonary outpatient clinics were allocated to two tapering strategies: according to conventional treatment (n=43) or guided by a novel internet-based monitoring system (internet strategy) (n=52). Primary outcomes were cumulative sparing of prednisone, asthma control and asthma-related quality of life. Secondary outcomes were forced expiratory volume in 1 s (FEV1), exacerbations, hospitalisations and patient's satisfaction with the tapering strategy.

Results Median cumulative sparing of prednisone was 205 (25–75th percentile −221 to 777) mg in the internet strategy group compared with 0 (−497 to 282) mg in the conventional treatment group (p=0.02). Changes in prednisone dose (mixed effect regression model) from baseline were −4.79 mg/day and +1.59 mg/day, respectively (p<0.001). Asthma control, asthma-related quality of life, FEV1, exacerbations, hospitalisations and satisfaction with the strategy were not different between groups.

Conclusions An internet-based management tool including home monitoring of symptoms, lung function and FENO in severe asthma is superior to conventional treatment in reducing total corticosteroid consumption without compromising asthma control or asthma-related quality of life.

Clinical trial registration number Clinical trial registered with http://www.trialregister.nl (Netherlands Trial Register number 1146).

  • Severe asthma
  • oral corticosteroids
  • monitoring
  • internet
  • self-management
  • asthma
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Footnotes

  • Funding This study was funded by The Netherlands Organization for Health Research and Development (ZonMw). Equipment for the analysis of nitric oxide was provided by Aerocrine-AB in April 2007. The funding sources had no role in the study design, data collection, analysis or interpretation, or in the decision to submit this article for publication.

  • Competing interests None.

  • Patient consent All patients provided written informed consent.

  • Ethics approval The study was approved by the ethics committee of all participating institutions (Academic Medical Centre, University of Amsterdam, Amsterdam; Medical Center Leeuwarden, Leeuwarden; HagaZiekenhuis, Den Haag; Medisch Spectrum Twente, Enschede; Leiden University Medical Center, Leiden; St Franciscus Gasthuis, Rotterdam, The Netherlands).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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