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Asthma and Adolescents
Hard time thinking about the future Adolescents can have a hard time thinking about the future. They want to be off of their meds as soon as possible, and don't realize that the controller meds— which they do have to take every day— help prevent them from getting sick down the road. They don't always understand the chronic nature of asthma. I've found it helps to get them to start thinking about their asthma as a chronic illness, like diabetes, where they'll have well days and sick days, and they need to take medicine on their well days so that they have fewer sick days.Elizabeth R. Woods, MD, MPH, Associate Chief, Division of Adolescent/Young Adult Medicine, Director, Children's Hospital Boston Community Asthma Initiative It's a tough patient population It's a tough patient population because of their age and their compliance with asthma.When adolescents are feeling great, they don't really think about taking their controller medications for their asthma, and they end up getting really sick. It's hard for them to understand that the controller meds are really the key to keeping their asthma under control. Erin Towler, RN, BSN, Staff Nurse, Adolescent Medicine Don't think about asthma on a day-to-day basis We ask new patients in our adolescent clinic, “Do you have any past medical issues?” and often they say no. I usually follow up with “Do you have any problems, like asthma?” and then they'll be like, “Oh yeah! I have asthma!” So I don't think that adolescents necessarily think about asthma on a day-to-day basis when they're feeling well.Erin Towler, RN, BSN, Staff Nurse, Adolescent Medicine I quiz them before they leave their appointments Something that I do that is helpful when I work with adolescents is after I explain everything to them and give them their written plans, I quiz them before I let them leave. I ask “When are you supposed to take this?” or “How many puffs do you need to take of that?” and asking them those kinds of things at the end of my teaching spiel and hearing their responses is how I know if they get it or not. If they don't, then I know we need to go over it again until they do.Erin Towler, RN, BSN, Staff Nurse, Adolescent Medicine I think compliance is an issue for anyone who treats adolescents in any kind of medical situation. You have to creatively deal with it on an individual basis, depending on what that adolescent is willing to tolerate or not tolerate. You can come up with great Asthma Action Plans* and say, “If you take this and this and this and prevent these triggers you're not going to get asthma,” but it's not going to work for a lot of adolescents— so you have to factor in what are they really going to do. I don't have a magical answer to how to get adolescents to be compliant with their medicines other than sitting and talking to them and trying to be creative about what they're willing to do and what they're not willing to do.Hans Oettgen, MD, PhD, Associate Chief, Division of Immunology, Children's Hospital Boston *To view examples of Asthma Action Plans, click here or visit the Clinician Contributions main page. Adherence is a problem with adolescents Adherence is a problem with adolescents, whether it be taking their medicines or coming in for follow-up appointments. We try to have them return for a recheck in a month after a first appointment, but often they don't come back and don't continue their medicines. They just take the meds they need to get over an attack, and then they and stop. They never get to the point where they are taking their medicines regularly so that they manage their asthma most effectively. When kids do come back for a follow-up, they are amazed that they feel so much better and that they're not coughing all night. They can do their sports and be active. But it takes a while to get them to that point.Elizabeth R. Woods, MD, MPH, Associate Chief, Division of Adolescent/Young Adult Medicine, Director, Children's Hospital Boston Community Asthma Initiative I like working with adolescents. They're fun, they're adjustable, and they talk to you about what is on their minds.Elizabeth R. Woods, MD, MPH, Associate Chief, Division of Adolescent/Young Adult Medicine, Director, Children's Hospital Boston Community Asthma Initiative Getting their families involved It helps to involve families of adolescents. That might mean seeing parents at the end if the visit with the young person to go over the medications, the reasons for the medications, and the length of time that they need to be on medications. If the parents do not come to the appointment, calling them on the phone when the adolescent is in the office can be helpful. Sometimes adolescents don't follow through on taking their medicines until you can connect with the families, so the more you can help the family to understand what the adolescent needs to do to manage his or her asthma, the better.Elizabeth R. Woods, MD, MPH, Associate Chief, Division of Adolescent/Young Adult Medicine, Director, Children's Hospital Boston Community Asthma Initiative I would love to get coaches more involved in reinforcing the need for kids to take their asthma medications, especially adolescents, since sometimes the coach can be very influential.Susan Sommer, RNC, NP, Nurse Case Manager, Community Asthma Initiative I try to put things in terms that work for them Well, compliance is a big issue when working with adolescents. I try to put things in terms that work for them, so I am always reminding them that if they take their medication (and complete the full treatment plan) they will feel better. The Asthma Action Plan* is a great tool to have on the refrigerator as a daily reminder of their regimen of medications and also to give a copy to the school nurse because it is a signed Dr.'s order.Peg Walsh, RN, Staff Nurse ll, Adolescent Medicine *To view examples of Asthma Action Plans, click here or visit the Clinician Contributions main page.
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Hospital Boston Department of Psychiatry. All Rights Reserved. The information on this website should not be taken as medical advice, which can only be given to you by your personal health care professional. Updated: June 5, 2007 |
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