Comprehensive treatment of patients with glucocorticoid-dependent severe asthma

Patients with glucocorticoid-dependent severe asthma are particularly vulnerable because of the complex interaction between disease activity and adverse-effects associated with the chronic use of systemic steroids. Reducing (and ultimately discontinuing) the use of systemic steroids in a safe manner is extremely important for the overall well-being of our patients.
The purpose of this thesis was to investigate distinct features related to patients with glucocorticoid-dependent severe asthma and propose solutions for the outstanding problems.
The results our studies can be applied to ameliorate the care for patients with severe asthma and help to achieve the ultimate steroid-tapering goal.
In summary, we demonstrated the benefits of high-altitude climate treatment and a multidisciplinary team for the improvement of patients’ outcomes such as asthma-related quality of life and lung function. Secondly, our results show that patients with glucocorticoid-dependent asthma present more symptoms of anxiety and depression, suggesting that diagnosing these co-morbidities may help to achieve a better control of the asthma and therefore decrease the medication requirements. Finally, we demonstrate that an internet-based strategy to taper down the dose of prednisone is effective and safe for use in the management of patients with glucocorticoid-dependent severe asthma.
The implementation of web-interfaces and internet applications 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.