Asthma Management Handbook

Supporting adolescents and young adults to self-manage their asthma

Recommendations

Make sure young people understand that they need to carry a reliever inhaler with them at all times, so they can use it immediately if they experience asthma symptoms.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Ensure every patient has a written asthma action plan appropriate to their age and self-management capability.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Encourage self-management and provide support and education appropriate to the individual’s stage of psychosocial development. Repeat the key information at each visit.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Offer self-management support that is appropriate to the person’s preferences (e.g. text message reminders about appointments, online information, electronic written asthma action plan) and direct them to appropriate resources and programs (e.g. peer-led asthma education, if available).

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Asthma self-management for adolescents

Children’s knowledge of asthma improves during adolescence.1 However, the latest available data show that less than one in five (18%) Australian adolescents has a written asthma action plan, and only 28% have discussed their asthma management plan with their GP within the previous 12 months.2

During adolescence, young people get their asthma knowledge mainly from parents.1 Adolescents whose parents were born overseas in countries with a lower asthma prevalence may have less knowledge of asthma. Chronic disease carries stigma in some communities, particularly Asian cultures. Children and adolescents from culturally and linguistically diverse communities may be expected to self-manage at a younger age and with less monitoring by parents, and so may need more support and education.

Specialised asthma nurses and asthma and respiratory educators are an invaluable resource for instruction, training and providing support for adolescents with asthma and their families.

Self-management programs

Asthma self-management education programs designed for adolescents can improve asthma-related quality of life,3456 improve asthma knowledge,347 improve ability to use a spacer correctly,3 improve adolescents’ confidence or belief in their ability (self-efficacy) to manage their asthma,36 increase behaviour to prevent asthma symptoms,6 increase use of preventer medicines,6 increase use of written asthma action plans,6 reduce symptoms36 reduce limitation of activity due to asthma,6 reduce school absences due to asthma,36 and reduce rates of acute care visits, emergency department visits, and hospitalisations.6

However, there is not enough evidence to determine which types of self-management programs for adolescents are most effective or the most important components of programs. (Few RCTs directly compared different programs.)

Most of the asthma programs designed for adolescents have been run in schools.

Peer-led asthma programs

Several studies have shown that adolescents can be trained to teach their peers about asthma self-management and motivate them to avoid smoking.458 Asthma self-management programs for adolescents that use peer leaders can:

  • significantly influence self-management behaviour, compared with adult-led programs8
  • achieve clinically important improvements in health-related quality of life,45 increase adolescents’ belief in their ability (self-efficacy) to resist smoking,4 and increase asthma self-management knowledge4 (compared with adolescents at schools not involved in this type of program4 or with baseline5)
  • may be particularly beneficial for boys from low socioeconomic status background.5

The Triple A (Adolescent Asthma Action) program is a school-based peer-led adolescent asthma self-management education program developed in Australia.9

Use of technology to support self-care

Providing asthma education messages through technologies that adolescents use every day (e.g. internet, phones, interactive video)101112 may be an effective way to deliver asthma health messages, compared with traditional media or with strategies that are not tailored for adolescents.

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Resources for health professionals working with adolescents
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Transition to adult asthma care

The late teens and early twenties can be a dangerous period for young people with asthma because GPs and parents often assume that the parent’s good management of their child’s asthma will automatically continue as the child grows up. Good self-management cannot be assumed, and health professionals need to carefully check the patient’s understanding of their asthma and its treatment.

Equipping and supporting an adolescent with a chronic disease to take over self-management of their condition as they grow up and make a smooth transition to adult health services requires planning. Some experts consider this in three phases:

  • early stage (12–14 years) – the adolescent begins to participate in his or her own care
  • middle stage (15–16 years) – the adolescent gains skills and information to take over self-care
  • late stage (17–18 years) – the young person moves into the adult system.
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References

  1. Barton C, Abramson M, Aroni R, et al. What determines knowledge of asthma among young people and their families?. J Asthma. 2002; 39: 701-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12507190
  2. Australian Institute of Health and Welfare. Young Australians: their health and wellbeing. Australian Institute of Health and Welfare, Canberra, 2011. Available from: http://www.aihw.gov.au/publication-detail/?id=10737419261
  3. Velsor-Friedrich B, Militello LK, Richards MH, et al. Effects of coping-skills training in low-income urban African-American adolescents with asthma. J Asthma. 2012; 49: 372-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22352813
  4. Al-sheyab N, Gallagher R, Crisp J, Shah S. Peer-led education for adolescents with asthma in Jordan: a cluster-randomized controlled trial. Pediatrics. 2012; 129: e106-12. Available from: http://pediatrics.aappublications.org/content/129/1/e106.long
  5. Rhee H, Belyea MJ, Hunt JF, Brasch J. Effects of a peer-led asthma self-management program for adolescents. Arch Pediatr Adolesc Med. 2011; 165: 513-9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252732/
  6. Bruzzese JM, Sheares BJ, Vincent EJ, et al. Effects of a school-based intervention for urban adolescents with asthma. A controlled trial. Am J Respir Crit Care Med. 2011; 183: 998-1006. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086747/
  7. Mosnaim GS, Li H, Damitz M, et al. Evaluation of the Fight Asthma Now (FAN) program to improve asthma knowledge in urban youth and teenagers. Ann Allergy Asthma Immunol. 2011; 107: 310-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21962090
  8. Rhee H, Pesis-Katz I, Xing J. Cost benefits of a peer-led asthma self-management program for adolescents. J Asthma. 2012; 49: 606-13. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434702/
  9. Shah S, Roydhouse JK, Sawyer SM. Medical students go back to school--the Triple A journey. Aust Fam Physician. 2008; 37: 952-4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19037472
  10. Joseph CL, Peterson E, Havstad S, et al. A web-based, tailored asthma management program for urban African-American high school students. Am J Respir Crit Care Med. 2007; 175: 888-95. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1899296/
  11. Mosnaim GS, Cohen MS, Rhoads CH, et al. Use of MP3 players to increase asthma knowledge in inner-city African-American adolescents. Int J Behav Med. 2008; 15: 341-6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19005935
  12. Bynum A, Hopkins D, Thomas A, et al. The effect of telepharmacy counseling on metered-dose inhaler technique among adolescents with asthma in rural Arkansas. Telemed J E Health. 2001; 7: 207-17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11564356