Asthma in Adolescents: Ask Direct Questions
Clinicians who work with adolescents who have asthma report numerous adherence barriers.
In almost every chronic disease that begins in childhood, clinicians report management difficulties when children enter adolescence. During this period of tumultuous transition, adolescent patients desire autonomy, and develop their own preferences. Other factors also influence their adherence to asthma, and clinicians who work with adolescents who have asthma report numerous adherence barriers.
Researchers from the University of North Carolina at Chapel Hill, in an effort to understand the relationship between the problems youth report, and their ultimate adherence, have conducted and published a study in the Annals of Pharmacotherapy, describing their findings. The study, in addition to including adolescent patients, also included caregivers.
Adolescent patients experience difficulties in a number of different areas. They may have problems with the following:
- using asthma medications
- developing and maintaining asthma management self-efficacy
- structuring reasonable outcome expectations
- adhering to asthma controller medications
These researchers recruited 359 adolescents with persistent asthma and their caregivers from 4 pediatric practices. They interviewed the adolescents after they had been seen by their primary care providers, and meanwhile, caregivers completed questionnaires.
Most of the study participants (319) were prescribed controller medications. Youth reported lower average adherence rates (60%) then caregivers did (69%). For the adolescents, two factors seem to have the greatest influence on adherence: difficulty using the inhaler, and difficulty remembering reduced adherence rates significantly. Among caregivers, their own difficulty remembering to remind, and supervise their charges was also a significant factor in nonadherence.
Adolescents, and caregivers who had higher outcome expectations tended to report higher levels of adherence. That is, if they believed the medication would work, and prevent exacerbations, they used the medication. This finding led the researchers to suggest that pharmacists consider administering a 5-item asthma outcome expectations scale. The results of such an inquiry could indicate whether youth and their caregivers believe that adherence leads to better outcomes, and suggests an area where better counseling is needed.
Overall, the researchers suggest that pharmacists should ask adolescents, and caregivers to describe their specific problems with asthma medications, their asthma management approaches, and outcome expectations. If pharmacists identify problems, they can target counseling specifically to those difficulties.
Sleath B, Gratie D, Carpenter D, et al. Reported problems and adherence in using asthma medications among adolescents and their caregivers. Ann Pharmacother. 2018 Mar 1:1060028018766603. doi: 10.1177/1060028018766603. [Epub ahead of print]