The Adolescent With Asthma: Fostering Adherence to Optimize Therapy

Children with chronic diseases requiring daily therapy are uniquely burdened by their condition(s) and are at significant risk of morbidity from nonadherence to therapeutic regimens. Children usually rely on parents or caregivers for daily management of their disease. However, in adolescence, there is a necessary transition from parental management to self‐management. Conceptualizing this transition requires understanding the complex changes involved, which can be broadly categorized into physical, social, emotional, cognitive, and moral ( Table 1 ), one or more of which frequently contribute to poor adherence to therapeutic regimens. 1 Failure on the part of the practitioner to recognize these issues and effectively aid the adolescent in the transition to self‐management will lead to poor adherence to the medication regimen, potentially resulting in increased disease morbidity. This is particularly true for asthma, one of the most common chronic diseases in adolescents. It should also be recognized that adolescence represents a period of inherent risk, given the alterations in drug disposition and dosing requirements in the context of somatic growth and potential hormonal influences. This inherent risk is further increased by poor adherence to therapeutic regimens by adolescents. If adequately addressed, this is a significantly modifiable risk factor. The therapeutic management of the adolescent with asthma presents a particular challenge to physicians and to the doctor–patient relationship as the patient transitions from dependency on parents or caregivers to independent care. The discussions in this article highlight the unique aspects of adolescence that must be addressed to achieve and improve adherence to therapeutic regimens in this age group. Clinical Pharmacology & Therapeutics (2008); 84 , 6, 749–753 doi: 10.1038/clpt.2008.189