The prevalence of asthma in children and adolescence continues to spiral upward with asthma still
the most common chronic disease of childhood. An increasing morbidity reflects that many
adolescents are not receiving adequate medication related to nonadherence.
This nonadherence is not confined to those with poor insight into their disease. Nonadherence is
endemic in adolescence related to denial of illness, reluctance to seek medical care and to take
medication because of the highly visible symptoms and inhaled medications. This situation had
improved with availability of oral medications such as leukotriene modifiers. Psychosocial and
developmental problems abound such as feelings of omnipotence and peer pressure, which mitigate
against taking medicine, as well as isolation and low self-esteem and depression due to the visibility
of asthma symptoms and medications. Adherence with medications is particularly low if medication is
prescribed more than twice a day, which coupled with poor inhaler technique leads to ineffective
This failure to adhere to medications leads to increase asthma morbidity interfering with the social
and school functions and precipitating increased use of medical care for emergency room visits,
hospitalization and even death. A therapeutic alliance with the adolescent is necessary with an
agreed upon and written action plan with no more than twice-a-day medication and peak flow
monitoring to tailor medication and minimize side affects while optimizing asthma control. The
introduction of oral medications like leukotriene modifiers and dry powder inhalers should simplify
treatment and improve adherence and outcome.
A Special Age Group
The teens are a special group falling in between the catchment area of the internist and the
pediatrician often in the “no man’s land” of health care. They have special needs of related to their
growth and development and suffer from poor adherence with health care because of failure to
recognize evolving asthma and reluctance to seek or accept medical care.
Asthma as a chronic disease afflicts an estimated 5%-10% of American children and adolescents
aged 5-17, affecting a minimum of 4.8 million Americans younger than 18. The prevalence rate for
current asthma in adolescents in a recent study was 12.6% with females having a significantly greater
prevalence rate than males (16.4% vs. 9%). Females also reported more severe symptoms and a
greater number of hospitalizations and emergency room encounters.
The incidence increased 52% in people 5 to 34 years between 1982 and 1991. Longitudinal studies
indicate that asthma improves in adolescence presumably related to physiologic changes including
improving immunity and enlarging airways. However, significant problems remain in 50%. Moreover,
45% of those who were “wheeze-free” at age 14 may have a recurrence of asthma at age 21.
Studies in high school, college and Olympic performers have established a prevalence of
unrecognized exercise induced asthma of 3% to 20%. There was a 33% increase in the prevalence of
disease among individuals aged incidence, in other countries. The estimated cost in association with this disease was $2 billion.
Death Rate Growing
The statistics are sobering. The death rate from asthma in the general population more than doubled
from 1980 to 1993, while the death rate among teenagers aged 12 to 19 years increased more than
four-fold. The predilection for death from asthma in teenagers is largely attributable to a combination
of denial, lack of recognition of asthma symptoms, forgetfulness, belief that medication is ineffective,
inconvenience, cumbersome nature of inhaler technique, fear or side effects and peer disapproval,
inertia and reluctance to pursue medical care.
The intermittent course of asthma with symptoms resolving in 75% of adolescents who wheezed
before age 7 years and the enlargement of airways with age may provide the adolescent with a false
sense of security. These physiologic factors, taken together with the developmental peculiarities of successessay.co.uk
omnipotence, the need for autonomy and peer pressure, conspire to motivate the teen to deny
symptoms, the need for medical evaluation and adherence to therapy. When these factors are
combined with a managed care system that operates on third-party payment and referral, the
adolescent becomes the casualty of poor and erratic care. The symptoms of asthma are
unrecognized by at least 33% of teenagers. A greater awareness of asthma and peer oriented
asthma education adapted to adolescent development and psyche is essential in medical practices
*Adapted from the American Academy of Allergy, Asthma and Immunology