Open Access
Feature Article

Asthma in adolescents: often overlooked, not to be forgotten

VIKRAM PALIT, Geshani Jayasuriya, SUSAN TOWNS
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© CORDELIA MOLLOY/SPL MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© CORDELIA MOLLOY/SPL MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY

Abstract

The management of adolescents and young people with asthma can be challenging and requires clinicians to consider life stage, development and psychosocial factors to ensure treatment is both appropriate and effective.

Key Points

  • Confirm the diagnosis of asthma with objective tests and monitor regularly to avoid over- or undertreatment.
  • Review the young person alone for at least part of your consultation and provide reassurance regarding confidentiality.
  • Develop, discuss and update an asthma action plan at every visit.
  • Red flags for patients at high-risk of asthma include poor asthma control, nonadherence, under-recognition of symptoms, psychosocial stressors, risk-taking behaviours and communication barriers.
  • Embrace digital health technologies in your clinical practice as they have been shown to improve adherence and symptom control.

Adolescents with asthma present a unique set of challenges for the discerning clinician due to their developmental stage, physiological changes and the emergence of psychosocial factors that can impact management. Adolescents may modify their behaviours due to poor asthma control or under-recognise their symptoms leading to poor adherence to treatment. Nonadherence to asthma medications is a well-known problem in the adolescent age group, further complicated by risk-taking behaviours such as smoking, vaping and other substance use, which can lead to unexpected exacerbations and complications.

Parents are often surprised when their teenage child has an asthma episode, having been told they would outgrow their childhood asthma. Although some children with asthma do seem to recover, adolescents with childhood asthma should continue to be actively screened for symptoms of wheeze, chest tightness and shortness of breath. Recent data from the Australian Institute of Health and Welfare National Health Survey 2017–18, shows that the prevalence of asthma in young people aged 15 to 24 years is about 10% in both sexes, similar to the 0 to 14-year-old age group (12% boys and 8% girls, respectively).1 Puberty does not predict remission of asthma and almost two-thirds of children with chronic asthma have persistent symptoms throughout puberty.2 Additionally, it is relatively common for asthma to first present during adolescence and this occurs more commonly in girls than boys.3

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GPs play a key role in the assessment and management of adolescents and young people with asthma. Most primary care providers are well versed in the use of National Asthma Action Plans (AAPs) such as those available via the National Asthma Council Australia.4 Written and digital AAPs are one of most effective clinical interventions we have and should be revisited at every consultation. Regularly updated AAPs have been shown to:

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  • improve adherence
  • reduce school absenteeism
  • reduce GP presentations
  • reduce visits to the emergency department and hospital inpatient admissions.

As GPs rightly continue to provide the bulk of care for adolescents with asthma, it is important to consider the following during clinic visits:

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  • identify adolescents who are vulnerable or at high risk (Box 1)
  • address poor adherence and comorbid psychosocial issues
  • promote ongoing self-management and emerging independence
  • refer patients early for further assessment when the diagnosis is uncertain, there is treatment failure or red flags emerge (Box 1).

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© CORDELIA MOLLOY/SPL MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© CORDELIA MOLLOY/SPL MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
Dr Palit is a Fellow in Paediatric Respiratory Medicine and Adolescent Health at the Sydney Children’s Hospital Network, Sydney; and a Senior Lecturer in Health Services Management, School of Public Health and Community Medicine, UNSW Sydney, Sydney. Dr Jayasuriya is a Consultant Paediatrician in the Department of Respiratory Medicine and an Honorary Consultant in the Department of Adolescent Medicine, The Children’s Hospital at Westmead, Sydney; and a Clinical Lecturer in the Discipline of Paediatrics and Child Health, Faculty of Medicine, The University of Sydney, Sydney. Associate Professor Towns is Head of Adolescent Medicine for The Sydney Children’s Hospitals Network; a Consultant Paediatrician in the Department of Respiratory Medicine, The Children’s Hospital at Westmead, Sydney; and Clinical Associate Professor in the Discipline of Paediatrics and Child Health, Faculty of Medicine, The University of Sydney, Sydney, NSW.