Table Info

Table 1.

Issues and solutions for precision medicine in adolescent patients with asthma

Issue	Potential solutions
Lack of adherence	Understanding the reasons for such, which can include: (1) stigma of illness (2) locus of medication control taken from parent to patient (time of transition) (3) body image (4) social pressures, peer and family, need to give opportunity to discuss issues and not just try to solve them (5) simplify regimen and tie adherence to other activities (6) deal with concerns of dependence on the medication by explaining that inflammation is treated by ICS containing medication, and what one gets dependent on is the reliever (7) create relationship with pharmacy to keep you informed on adherence issues, such as lack of picking up prescriptions and overuse of rescue
Consistency of medical practitioner	May change from pediatric to adult clinician: (1) need to deal directly with the adolescent patient (2) need to empower the patient with education and perspective (3) keep primary care consistent even if a specialist is involved
Rebelliousness and risky behaviors	Consistent messaging about the dangers of inhaled products such as cigarettes, cannabis, and vaping Give them a non-judgmental space to discuss these issues
Pubertal changes	Along with other more obvious changes, asthma also changes, sometimes with poorer control and sometimes for the good (remission), but the same measurements of control are the basics of decision making
Lack of appreciation of how important control is for preventing bad outcomes	Education re control criteria and why it is important to them Technology such as Apps and digital inhalers
Inhaler technique	Digital technology Educators Watch the patient actually use their inhaler
Measuring control	Poor control is underestimated so need education SABA use needs to be watched carefully, do not be free with repeats, keep track and follow accordingly Do spirometry as you may get much poorer lung function than you expect based on the reported symptoms
Trigger avoidance	Evaluate for and discuss allergic triggers Review avoidance and preventative strategies Avoid substance inhalation
Inadequate use of action plan	Use digital technology to incorporate this into their world
Parental concerns	They can be your greatest ally to let you know how things are doing and to reinforce messaging They can also be a threat to your patient relationship by: (1) undermining recommendations (2) minimizing the importance of medication use (3) not providing resources such as financial barriers to access appropriate treatment (4) behaviors at home such as parenteral smoking and substances, finances leading to environmental issues

ICS: inhaled corticosteroids; Apps: applications; SABA: short-acting β₂-agonists

Declarations

Author contributions

AK: Conceptualization, Investigation, Writing—original draft, Writing—review & editing.

Conflicts of interest

Alan Kaplan is a member of advisory board or speaker’s bureau for Astra Zeneca, Boehringer Ingelheim, Covis, GSK, Merck Frosst, Sanofi, Teva, Trudel, Valeo.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

References

Precision medicine [Internet]. [cited 2023 Mar 12]. Available from: https://www.fda.gov/medical-devices/in-vitro-diagnostics/precision-medicine

Most recent national asthma data [Internet]. [cited 2023 Mar 20]. Available from: https://www.cdc.gov/asthma/most_recent_national_asthma_data.htm

Tai A, Tran H, Roberts M, Clarke N, Gibson AM, Vidmar S, et al. Outcomes of childhood asthma to the age of 50 years. J Allergy Clin Immunol. 2014;133:1572–8.e3. [DOI] [PubMed]

Adolescence [Internet]. CC BY-SA; [cited 2023 Mar 12]. Available from: https://en.wikipedia.org/wiki/Adolescence

Trivedi M, Denton E. Asthma in children and adults—what are the differences and what can they tell us about asthma? Front Pediatr. 2019;7:256. [DOI] [PubMed] [PMC]

Price D, Ryan D, Pearce L, Bawden R, Freeman D, Thomas M, et al. The burden of paediatric asthma is higher than health professionals think: results from the Asthma in Real Life (AIR) study. Prim Care Respir J. 2002;11:30–3. [DOI] [PubMed] [PMC]

Scottish Intercollegiate Guidelines Network, British Thoracic Society. British guideline on the management of asthma [Internet]. [cited 2022 Jan 24]. Available form: https://www.sign.ac.uk/media/1773/sign158-updated.pdf

DiMatteo MR, Giordani PJ, Lepper HS, Croghan TW. Patient adherence and medical treatment outcomes: a meta-analysis. Med Care. 2002;40:794–811. [DOI] [PubMed]

Colver A, Rapley T, Parr JR, McConachie H, Dovey-Pearce G, Le Couteur A, et al. Facilitating the transition of young people with long-term conditions through health services from childhood to adulthood: the transition research programme. Southampton (UK): NIHR Journals Library. 2019. [DOI] [PubMed]

10.

Gibson-Scipio W, Gourdin D, Krouse HJ. Asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning to adult health care. J Pediatr Nurs. 2015;30:e53–61. [DOI] [PubMed]

11.

Rhee H, Choi Y, Tumiel-Berhalter L. Transition readiness in middle and older adolescents with asthma and associated factors: a descriptive study. J Asthma. 2023;60:991–9. [DOI] [PubMed] [PMC]

12.

Rhee H, Batek L, Wallace-Farquharson T, Tumiel-Berhalter L. Are mid to late adolescents with asthma ready for transition of care? A qualitative study. Children (Basel). 2022;9:1573. [DOI] [PubMed] [PMC]

13.

Ödling M, Jonsson M, Janson C, Melén E, Bergström A, Kull I. Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma. J Asthma. 2020;57:1119–27. [DOI] [PubMed]

14.

Dubin RE, Kaplan A, Graves L, Ng VK. Acknowledging stigma: its presence in patient care and medical education. Can Fam Physician. 2017;63:906–8. [PubMed] [PMC]

15.

Hamilton J, Daneman D. Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab. 2002;15:115–26. [DOI] [PubMed]

16.

Roberts G, Vazquez-Ortiz M, Knibb R, Khaleva E, Alviani C, Angier E, et al. EAACI guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy. 2020;75:2734–52. [DOI] [PubMed]

17.

Lemanek KL, Kamps J, Chung NB. Empirically supported treatments in pediatric psychology: regimen adherence. J Pediatr Psychol. 2001;26:253–75. [DOI] [PubMed]

18.

Alvin P, Rey C, Frappier JY. Therapeutic compliance in adolescents with chronic disease. Arch Pediatr. 1995;2:874–82. French. [PubMed]

19.

Bender B, Wamboldt FS, O’Connor SL, Rand C, Szefler S, Milgrom H, et al. Measurement of children’s asthma medication adherence by self report, mother report, canister weight, and Doser CT. Ann Allergy Asthma Immunol. 2000;85:416–21. [DOI] [PubMed]

20.

Vrijens B, Dima AL, Van Ganse E, van Boven JF, Eakin MN, Foster JM, et al. What we mean when we talk about adherence in respiratory medicine. J Allergy Clin Immunol Pract. 2016;4:802–12. [DOI] [PubMed]

21.

Burgess S, Sly P, Devadason S. Adherence with preventive medication in childhood asthma. Pulm Med. 2011;2011:973849. [DOI] [PubMed] [PMC]

22.

Kaplan A, Price D. Treatment adherence in adolescents with asthma. J Asthma Allergy. 2020;13:39–49. [DOI] [PubMed] [PMC]

23.

Dal Negro RW, Turco P. Effects of adherence to once-daily treatment on lung function, bronchial hyperreactivity and health outcomes in adolescents with mild-to-moderate asthmoka: a twelve-month survey. Children (Basel). 2022;9:1854. [DOI] [PubMed] [PMC]

24.

Moreland EC, Tovar A, Zuehlke JB, Butler DA, Milaszewski K, Laffel LM. The impact of physiological, therapeutic and psychosocial variables on glycemic control in youth with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2004;17:1533–44. [DOI] [PubMed]

25.

Taddeo D, Egedy M, Frappier JY. Adherence to treatment in adolescents. Paediatr Child Health. 2008;13:19–24. [DOI] [PubMed] [PMC]

26.

Rhee H, Belyea MJ, Brasch J. Family support and asthma outcomes in adolescents: barriers to adherence as a mediator. J Adolesc Health. 2010;47:472–8. [DOI] [PubMed] [PMC]

27.

Bond GG, Aiken LS, Somerville SC. The health belief model and adolescents with insulin-dependent diabetes mellitus. Health Psychol. 1992;11:190–8. [DOI] [PubMed]

28.

Helgeson VS, Reynolds KA, Escobar O, Siminerio L, Becker D. The role of friendship in the lives of male and female adolescents: Does diabetes make a difference? J Adolesc Health. 2007;40:36–43. [DOI] [PubMed]

29.

Naimi DR, Freedman TG, Ginsburg KR, Bogen D, Rand CS, Apter AJ. Adolescents and asthma: Why bother with our meds? J Allergy Clin Immunol. 2009;123:1335–41. [DOI] [PubMed] [PMC]

30.

O’Connor A, Tai A, Carson-Chahhoud K. Isn’t there an app for that? The role of smartphone and tablet applications for asthma education and self-management in adolescents. Children (Basel). 2021;8:786. [DOI] [PubMed] [PMC]

31.

Anderson M, Jiang JJ. Teens, social media and technology 2018 [Internet]. Washington, DC: Pew Research Center; 2023 [cited 2023 May 1]. Available from: https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/

32.

Wartella E, Rideout V, Montague H, Beaudoin-Ryan L, Lauricella A. Teens, health and technology: a national survey. Media Commun. 2016;4:13–23. [DOI]

33.

Perry TT, Marshall A, Berlinski A, Rettiganti M, Brown RH, Randle SM, et al. Smartphone-based vs paper-based asthma action plans for adolescents. Ann Allergy Asthma Immunol. 2017;118:298–303. [DOI] [PubMed]

34.

Local air quality health index [Internet]. [cited 2023 May 1]. Available from: https://weather.gc.ca/airquality/pages/index_e.html

35.

Davis SR, Peters D, Calvo RA, Sawyer SM, Foster JM, Smith L. “Kiss myAsthma”: using a participatory design approach to develop a self-management app with young people with asthma. J Asthma. 2018;55:1018–27. [DOI] [PubMed]

36.

Becklake MR, Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax. 1999;54:1119–38. [DOI] [PubMed] [PMC]

37.

de Benedictis D, Bush A. Asthma in adolescence: Is there any news? Pediatr Pulmonol. 2017;52:129–38. [DOI] [PubMed]

38.

Rietveld S, Everaerd W. Perceptions of asthma by adolescents at home. Chest. 2000;117:434–9. [DOI] [PubMed]

39.

Bijl-Hofland ID, Cloosterman SG, Folgering HT, Akkermans RP, van Schayck CP. Relation of the perception of airway obstruction to the severity of asthma. Thorax. 1999;54:15–9. [DOI] [PubMed] [PMC]

40.

Bacharier LB, Strunk RC, Mauger D, White D, Lemanske RF Jr, Sorkness CA. Classifying asthma severity in children: mismatch between symptoms, medication use, and lung function. Am J Respir Crit Care Med. 2004;170:426–32. [DOI] [PubMed]

41.

Lebecque P, Kiakulanda P, Coates AL. Spirometry in the asthmatic child: is FEF25-75 a more sensitive test than FEV1/FVC? Pediatr Pulmonol. 1993;16:19–22. [DOI] [PubMed]

42.

Valletta EA, Piacentini GL, Del Col G, Boner AL. FEF25-75 as a marker of airway obstruction in asthmatic children during reduced mite exposure at high altitude. J Asthma. 1997;34:127–31. [DOI] [PubMed]

43.

Thomas M, Williams AE. Are outcomes the same with all dry powder inhalers? Int J Clin Pract Suppl. 2005;59:33–5. [DOI] [PubMed]

44.

Dal Negro RW, Turco P, Povero M. Lung function can predict the expected inspiratory airflow rate through dry powder inhalers in asthmatic adolescents. Children (Basel). 2022;9:377. [DOI] [PubMed] [PMC]

45.

Nwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β₂-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. 2020;55:1901872. [DOI] [PubMed] [PMC]

46.

Bloom CI, Cabrera C, Arnetorp S, Coulton K, Nan C, van der Valk RJP, et al. Asthma-related health outcomes associated with short-acting β₂-agonist inhaler use: an observational UK study as part of the SABINA global program. Adv Ther. 2020;37:4190–208. [DOI] [PubMed]

47.

O’Byrne PM, FitzGerald JM, Bateman ED, Barnes PJ, Zhong N, Keen C, et al. Inhaled combined budesonide-formoterol as needed in mild asthma. N Engl J Med. 2018;378:1865–76. [DOI] [PubMed]

48.

Bateman ED, Reddel HK, O’Byrne PM, Barnes PJ, Zhong N, Keen C, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med. 2018;378:1877–87. [DOI] [PubMed]

49.

Rank MA, Wollan P, Li JT, Yawn BP. Trigger recognition and management in poorly controlled asthmatics. Allergy Asthma Proc. 2010;31:99–105. [DOI] [PubMed] [PMC]

50.

Kaplan AG. Cannabis and lung health: Does the bad outweigh the good? Pulm Ther. 2021;7:395–408. [DOI] [PubMed] [PMC]

51.

Rasmussen F, Siersted HC, Lambrechtsen J, Hansen HS, Hansen NC. Impact of airway lability, atopy, and tobacco smoking on the development of asthma-like symptoms in asymptomatic teenagers. Chest. 2000;117:1330–5. [DOI] [PubMed]

52.

Preventing tobacco use among young people. A report of the surgeon general (executive summary). MMWR Recomm Rep. 1994;43:1–10. [PubMed]

53.

Burgess JA, Matheson MC, Gurrin LC, Byrnes GB, Adams KS, Wharton CL, et al. Factors influencing asthma remission: a longitudinal study from childhood to middle age. Thorax. 2011;66:508–13. [DOI] [PubMed]

54.

Creese H, Lai E, Mason K, Schlüter DK, Saglani S, Taylor-Robinson D, et al. Disadvantage in early-life and persistent asthma in adolescents: a UK cohort study. Thorax. 2022;77:854–64. [DOI] [PubMed] [PMC]

55.

Fasola S, Ferrante G, Cilluffo G, Malizia V, Alfano P, Montalbano L, et al. Asthma comorbidities: frequency, risk factors, and associated burden in children and adolescents. Children (Basel). 2022;9:1001. [DOI] [PubMed] [PMC]