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Asthma and Adolescents

Sept. 11, 2003

© 2003 Healthology, Inc.

Taking an asthma inhaler is often the last thing on the mind of a teenager, even one who is coughing or wheezing regularly. Adolescents are often more concerned with their schoolwork and social life than their medication. But it's important that adolescents maintain their asthma therapy, because untreated asthma can severely affect one's ability to lead an active life. Complicating matters, teens are less apt to notice symptoms, which can include daytime sleepiness and poor athletic performance.

Dr. Nancy Ostrum, an associate clinical professor of pediatrics in the division of allergy/immunology at University of California, San Diego, says most teenagers will comply with their treatment regimens if they feel like they are a part of the decision-making process. Below, Dr. Ostrum reviews how best to successfully treat asthma in adolescents.

What is asthma?
Asthma is a condition where the breathing is restricted. We breathe through airways to get the air into our lungs, and it's the airways that are involved with asthma. The airways become inflamed or the airway lining becomes irritated. Secondarily, the airways may become constricted by the muscles that surround them.

This results in difficulty getting a good, deep breath. Other symptoms include wheezing, cough and tightness of the chest.

Is asthma a serious problem or just a nuisance?
Asthma is both a nuisance for people who aren't breathing well and a very serious problem, in that it can cause death. Asthma is a fairly common condition in the United States today, affecting 5 percent to 10 percent of the population. It generally starts sometime in childhood, but it can occur at any time of life. There are approximately 5,000 deaths a year from asthma in the United States. The good news is most of these could be prevented with appropriate identification of the condition and appropriate treatment. So although it's very serious, it's also very manageable.

What symptoms do people experience?
There is a broad range of symptoms that people can experience with asthma, from intermittent tightness or wheezing only when they do heavy exercise, to more serious symptoms and signs of asthma. These can include tightness of the chest, difficulty getting a good deep breath, even disruption of sleep with difficulty breathing at night.

What are some difficulties in dealing with teens with asthma?
The unique part about asthma in adolescence is that adolescents are unique. It's challenging to have adolescent patients recognize their symptoms. They don't want to be different, and they're often less aware of physical symptoms than they are of what they might be doing on the weekend, or that they need to get their homework in on time. We have to be more aware of the more subtle cues such as coughing at night, exercise limitations, or colds or coughs that are lasting longer than normal.

Adolescents often don't tell me their symptoms or haven't even recognized themselves that when they tried to throw a Frisbee with their friend, they couldn't run very fast or very far. Or they might not notice that they're kind of sleepy because they've been coughing an asthma cough for several nights.

So it takes a unique relationship with a patient get to the truth. However, it's not impossible and once that can be achieved, it's very gratifying as a physician, because adolescents are great to work with and when they're healthier, they're active, they're feeling good, and they're very pleased with their quality of life.

The other difficulty with adolescents is they don't like it when adults tell them to do stuff. So trying to get them to do something like take an inhaler twice a day, or take certain pills, is additionally difficult.

Do the characteristics of asthma change during adolescence?
Asthma symptoms can be variable during adolescence, because there are so many great changes in the physiology of the body in general. Some adolescents, however, will have fewer asthma symptoms. Young males in their late adolescence and early adulthood will often notice fewer symptoms. That used to be thought of as growing out of asthma; we now know asthma is not something that goes away, but that the symptoms can lessen over time.

Female adolescents who are going through puberty can have hormonal influences, so they may have more asthma symptoms at different times of the month. Or their asthma may worsen as they go through puberty. Certainly young women can have changes in their asthma due to becoming pregnant, having a pregnancy and delivering a baby, followed by the fatigue of being a new parent.

All of these things are special issues that we need to be aware of and share with our patients, so we're customizing their therapy to best fit with their life.

Are there any special treatment issues in teens?
The treatment of asthma in adolescents is the same for the population in general. Good treatment of symptoms, good treatment of the underlying inflammation and good communication with the patient are key.

Once we've made the diagnosis and defined their pattern of disease, we have to develop a treatment program that is easy enough for them to comply with. However, I usually find a goal that's important to them, not to me. If they can play soccer or play Frisbee with their buddies, or go to the dance and not wheeze or have to sit down because they're not feeling well, then, usually, once they feel better in those ways, they will have a reason to be compliant with their medication.

We do see them more frequently than other patients and remind them about the treatment program, and make sure they're with the program. If we can keep the treatment program simple, once or twice a day—and I negotiate, "Give me six or eight weeks to see how you feel"—when they feel better, they tend to continue their treatment program more compliantly.

What are the dangers of poor medication compliance?
I had a parent tell me the other day, "You can't tell an adolescent to do anything." And I disagreed. I said, "I think when there's a life-threatening condition, we need to find a way to convince them to take their medication," and they understood the gravity of the situation. Then we had a conversation with the adolescent and put it in their hands to control their own disease, to be responsible and be able to prove that they've done it.

Are stories about role models helpful in getting the message to adolescents?
When I speak to adolescents who may be denying their symptoms, or do not want to treat their symptoms, or think that treatment going to limit their life in any way, I talk about the fact that a large percentage of, for example, last year's Olympic swim team has exercise-induced asthma. I do tell patients that I don't expect that they will necessarily be Olympic qualifiers, but that I don't expect their asthma to be an excuse for not living a full, active, fun life.

I saw an adolescent boy the other day who had given up on his soccer club. He'd been an elite soccer player, but he was having symptoms of wheezing and coughing during the play or at the quarter and was being benched more often. We put him on a good course of treatment, and allowed him to be part of the treatment decision-making. After several weeks, he was able to go back and be the best soccer player that he could be. He was playing much more and was really enjoying it again.

His mom was almost tearful when she said, "Now I can go and just watch the game and not worry that my kid's not going to breathe normally." So that was very gratifying.

Do you have any advice for parents of adolescents with regard to helping their adolescents to get through their asthma?
My advice to parents of adolescents is to do the same thing you do to be a good parent of an adolescent in any situation. You keep the lines of communication open, you allow them to own the decision-making about the disease. You involve someone, such as a specialist in asthma, to do the objective medical part and you do the parenting part. That usually works out very well, with the usual adolescent and parent interactions that may make it a little challenging.

© 2003 Healthology, Inc.

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