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Summary of the management of asthma in adolescents (from the British guideline on the management of asthma)

  • Adolescents are defined by the World Health Organisation (WHO) as young people between the ages 10 and 19 years of age.
  • Key elements of working effectively with adolescents in the transition to adulthood include:
    • seeing them on their own, separate from their parents/carers, for part of the consultation, and
    • discussing confidentiality and its limitations

Prevalence of asthma in adolescents

  • Asthma is common in adolescents but is frequently
    undiagnosed because of under-reporting of symptoms
  • Clinicians seeing adolescents with any cardiorespiratory symptoms should consider asking about symptoms of asthma

Diagnosis and assessment

  • Symptoms and signs of asthma in adolescents are no different from those of other age groups
  • Exercise-related wheezing and breathlessness are common asthma symptoms in adolescents but only a minority show objective evidence of exercise-induced bronchospasm. Other causes such as hyperventilation or poor fitness can usually be diagnosed and managed by careful clinical assessment
Questionnaires
  • The asthma control questionnaire (ACQ) and the asthma control test (ACT) have been validated in adolescents with asthma
Quality of life measures
  • QoL scales (such as AQLQ12+) can be used
Lung function
  • Tests of airflow obstruction and airway responsiveness may provide support for a diagnosis of asthma but most adolescents with asthma will have normal lung function
Bronchial hyper-reactivity
  • A negative response to an exercise test is helpful in excluding asthma in children with exercise related breathlessness
Anxiety and depressive disorders
  • Major depression, panic attacks, and anxiety disorder are commoner in adolescents with asthma and make asthma symptoms more prominent
  • Brief screening questionnaires for anxiety and depression may help identify those with significant anxiety and depression

Non-pharmacological management

  • Adolescents with asthma (and their parents and carers) should be encouraged to avoid exposure to environmental tobacco smoke and should be informed about the risks and urged not to start smoking
  • Adolescents with asthma should be asked if they smoke personally. If they do and wish to stop, they should be offered advice on how to stop and encouraged to use local NHS smoking cessation services
  • Healthcare professionals should be aware that CAM use is common in adolescents and should ask about its use

Pharmacological management

  • Specific evidence about the pharmacological management of adolescents with asthma is limited and is usually extrapolated from paediatric and adult studies
  • Specific evidence about inhaler device use and choice in adolescents is also limited

Inhaler devices

  • Adolescent preference for inhaler device should be taken into consideration as a factor in improving adherence to treatment
  • As well as checking inhaler technique it is important to enquire about factors that may affect inhaler device use in real life settings, such as school
  • Consider prescribing a more portable device (as an alternative to a pMDI with spacer) for delivering bronchodilators when away from home

Long-term outlook and entry into the work place

  • Young adults with asthma have a low awareness of occupations that might worsen asthma (e.g, exposure to dusts, fumes, spray, exertion and temperature changes)
  • Clinicians should discuss future career choices with adolescents with asthma and highlight occupations that might increase susceptibility to work related asthma symptoms

Organisation and delivery of care

  • School based clinics may be considered for adolescents with asthma to improve attendance
  • Peer-led interventions for adolescents in the school setting should be considered
  • Integration of school based clinics with primary care services is essential

Transition to adult based health care

  • Transition to adult services is important for all adolescents with asthma, irrespective of the asthma severity. Transition should be seen as a process and not just the event of transfer to adult services. It should begin early, be planned, involve the young person, and be both age and developmentally appropriate

Patient education and self management

  • Effective transition care involves preparing adolescents with asthma to take independent responsibility for their own asthma management. Clinicians need to educate and empower adolescents to manage as much of their asthma care as they are capable of doing while supporting parents gradually to hand over responsibility for management to their child
  • Adherence
    • when asked, adolescents with asthma admit their adherence with asthma treatment and with asthma trigger avoidance is often poor.
    • strategies to improve adherence emphasise the importance of focusing on the individual and their lifestyle and using individualised asthma planning and personal goal setting

full guidelines available from...
www.sign.ac.uk/guidelines/fulltext/153/index.html

British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma. September 2016.
Reproduced with kind permission from SIGN.

First included: November 2016.