Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma

Barriers and facilitators to transition from pediatric to adult healthcare for immigrant youth with chronic health conditions

PURPOSE

The objective of this study was to investigate the experience of first- and second- generation immigrant youth living with chronic health conditions in Canada, their parents or caregivers, and healthcare and service providers who care for immigrant youth, regarding the transition from pediatric to adult healthcare.

DESIGN AND METHODS

We conducted semi-structured individual interviews and focus groups. Youth were 1st or 2nd generation immigrants, aged 16-25, with pediatric-onset chronic health conditions. Parents or caregivers had raised youth children as described. Providers delivered healthcare or other services to immigrant populations. Thematic analysis was conducted of all transcripts.

RESULTS

Twenty youth, 14 parents/caregivers and five service providers participated. Most participants described healthcare transition as very difficult to navigate. Two major themes emerged across participant narratives: 1. Barriers to transition: lack of family experience in Canada, language, discrimination, financial strain, stigma, and long wait times. Some of these barriers are specific to newcomer families, but others are generalizable to the Canadian population. 2. Facilitators of transition: youth independence, youth acting as cultural bridges within their families, and cross-sector support between healthcare, education, social work and settlement services.

CONCLUSIONS

Immigrant youth and their families face a broad range of barriers to healthcare transition. The collaborative nature of cross-sector support effectively addressed some of the barriers faced by newcomer families.

PRACTICE IMPLICATIONS

Clinicians should provide immigrant youth and their families with accessible information about the health condition and how to navigate the adult healthcare system prior to transition, particularly when language barriers exist.

Children and young people's self-reported experiences of asthma and self-management nursing strategies: An integrative review

AIM

To explore children and young people's (CYP) (5-24 years of age) self-reported experiences of asthma self-management strategies (ASMS) with nursing involvement across various settings.

BACKGROUND

Childhood asthma is an increasingly significant health issue, highlighting the importance of acquiring self-management skills to optimise future health outcomes. Registered nurses play a pivotal role in delivering appropriate, personalized self-management support.

METHODS

This integrative review searched four electronic databases: Cumulated Index to Nursing and Allied Health Literature via Elton B. Stephens Company, Medical Literature Analysis and Retrieval System Online (MEDLINE), Object, View and Interactive Design (OVID), and PubMed, that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flowchart. Included studies were critically appraised using the Joanna Briggs Institute critical appraisal tools. Braun and Clarks thematic analysis was used to generate themes, and sub-themes.

FINDINGS

Fifteen studies were included for review. Thematic analysis generated three themes being healthy literacy; health and wellbeing; and tools and working together.

CONCLUSIONS

Asthma continues to have negative physical, psychological, and social implications among CYP. CYP are both willing and capable of engaging in ASMS and learning self-management skills, however, continue to have unmet self-management needs.

IMPLICATIONS TO PRACTICE

Strategies must bolster health literacy, improve physical and psychological health, and harness interactive, youth-centric, and informative tools to facilitate communication and decrease the burden of self-management. Applications pose a promising avenue for self-management support. This age group remains under-explored and future research should enable meaningful engagement with CYP to better understand their perspectives and improve strategy success.

The effect of mobile game training designed for asthmatic children on asthma management and quality of life

PURPOSE

This study aimed to examine the effect of mobile game training designed for children with asthma on inhaler use skills, asthma symptoms and treatment needs, and quality of life.

DESIGN AND METHODS

This randomized controlled study was conducted between April and October 2023 at "Pediatric Asthma and Allergy Clinic" in Turkey. The sample of the study consists of a total of 74 children diagnosed with asthma, including the Mobile game (n: 37) and the Control group (n: 37). In the study, a mobile game was developed for children with asthma between the ages of 8-12. In collecting research data; Child and Parent Information Form, Inhaler Use Skill Evaluation Form, Asthma Symptom and Treatment Need Scoring (Asthma Symptom Score [ASS], Rhinitis Symptom Score [RSS] and Total Symptom Score [TSS]), DISABKIDS Asthma Scale were used.

RESULTS

There was no significant difference between the groups in terms of the demographic status of the children (p > 0.05). It was determined that the average inhaler use skill score and DISABKIDS asthma scale Child/Parent score average of the children in the mobile game group were higher than the control group (p < 0.05). When the children's final follow-up ASS, RSS and TSS total scores were examined; It was determined that there was a statistically significant difference between the children in the mobile game and control groups (p < 0.05).

CONCLUSIONS

As a result of this study, it was determined that mobile game training designed for children is an effective method in increasing children's ability to use inhaler medications, reducing asthma symptoms and treatment needs, and improving quality of life.

PRACTICE IMPLICATION

Nurses can improve children's quality of life by using mobile game training programs that attract children's attention.

Telehealth interventions for transition to self-management in adolescents with allergic conditions: A systematic review

Telehealth is an emerging approach that uses technology to provide healthcare remotely. Recent publications have outlined the importance of supporting the transition to self-management of adolescents with allergic conditions. However, no synthesis of the evidence base on the use and impact of telehealth interventions for this purpose has been conducted to date. This review achieves these aims, in addition to exploring the language use surrounding these interventions, and their implementation. Four databases were searched systematically. References were independently screened by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. Eighteen articles were included, reporting on 15 telehealth interventions. A total of 86% targeted adolescents with asthma. Mobile applications were the most common telehealth modality used, followed by video-conferencing, web-based, virtual reality and artificial intelligence. Five intervention content categories were identified; educational, monitoring, behavioural, psychosocial and healthcare navigational. Peer and/or healthcare professional interaction, gamification and tailoring may increase engagement. The studies showed positive effects of the interventions or no difference from active controls, in self-management outcomes such as knowledge, health outcomes such as quality-of-life, and economic outcomes such as healthcare utilization. The most common implementation outcomes reported were acceptability, appropriateness, feasibility and fidelity.

Breathing across ages: a systematic review on challenges and components of transitional care for young people with asthma

Introduction

Asthma is a chronic condition that affects millions of adolescents and young adults (AYA) worldwide. The transition from pediatric to adult care presents unique challenges for this population, affecting their self-management, quality of life and overall health outcomes. This systematic review aims to consolidate the available evidence on challenges encountered by AYA with asthma during the transition period from child to AYA and on the key elements of transitional care for AYAs with asthma including the outcomes achieved, ultimately enhancing outcomes.

Methodology

A systematic literature search was performed in PubMed, Embase, Medline, Scopus, and Web of Science from their inception to October 2, 2023, to provide an overview of currently available literature. Primary quantitative and qualitative studies, published in peer-reviewed journals that focused on AYA with a confirmed diagnosis of asthma were considered if they focused on challenges encountered by AYA with asthma during the transition process and/or components of transitional care and their outcomes assessed.

Results

A total of 855 studies were initially identified and 6 articles were included in this systematic literature review. Several challenges experienced by AYA with asthma were identified including maintaining medication adherence, the need to take responsibility and being involved, understanding their condition and its severity, feeling left out of the care system, and experiencing a lack of engagement. The identified transitional care components included a standardized form for medical data transmission, a joint consultation and to offer several longer consultations.

Conclusion

Several international guidelines for asthma care recommend implementing transition programs in the care for AYA with asthma. Such transition programs should include a comprehensive and individualized approach addressing several challenges faced, to ensure optimal outcomes post-transition. However, to date, data on effective components of transitional care facilitating good outcomes were found to be limited. This systematic review underscores the need for larger studies evaluating the effect of the components of transition programs.

Parents' Experiences and Perceptions of Healthcare Transition in Adolescents with Asthma: A Qualitative Study

Adolescence marks a significant transition from pediatric to adult healthcare, and parents play critical roles in supporting their adolescents with chronic conditions through this process. However, little is known about parents' experiences, perceptions, and needs during this healthcare transition. This qualitative study explores the experiences and perceptions of parents regarding the care transition of their 16-17-year-old adolescents with asthma. Nineteen mothers participated in either a focus group or individual interviews, and a content analysis was conducted on the data. Parents expressed negative emotions and various concerns about their teens' transition readiness and asthma management. A need for early transition training for both adolescents and parents was discussed. Overall, the complexity and challenges associated with the healthcare transition of adolescents with asthma take a toll on parents, particularly when their teens are not adequately prepared to manage asthma independently. Parents need appropriate anticipatory guidance regarding the transition and skills to navigate changing roles and negotiate asthma care responsibilities with their teens. Timely interventions and support strategies for both adolescents and parents are needed to ensure the successful healthcare transition of adolescents with asthma.

Associations between peer experiences and health outcomes among adolescents and young adults with asthma

OBJECTIVE

Although peer relationships become increasingly important across adolescence and early adulthood, research examining links between peer relationships and the health outcomes of young people with asthma is scarce. Using a large sample of adolescents and young adults (AYAs) with asthma, the current study assessed whether positive and negative peer experiences are associated with AYAs' asthma control, asthma self-efficacy, and internalizing symptoms.

METHODS

In this cross-sectional study, a national sample of 440 diverse adolescents and young adults with asthma completed an online survey. Questionnaires assessed general and asthma-specific peer experiences (i.e. peer victimization; peer support; asthma-related peer problems) and health indicators (i.e. asthma control; asthma self-efficacy; internalizing symptoms). Regression analyses were performed to examine associations between peer experiences and health while controlling for participant age, gender, race/ethnicity, and age of asthma diagnosis.

RESULTS

Results from separate regression models indicated that adolescents who experienced greater peer victimization, less peer support, and more asthma-related peer problems also reported worse asthma control, lower asthma self-efficacy, and more severe internalizing symptoms. Follow-up exploratory analyses indicated that peer victimization and asthma-related peer problems were the strongest predictors of asthma control and internalizing, whereas peer support and asthma-related peer problems were the strongest predictors of asthma self-efficacy.

CONCLUSIONS

This study underscores connections between peer relationships and health outcomes among AYAs with asthma. Interventions that leverage peer support and mitigate peer stress may offer a developmentally appropriate approach for mitigating physical and psychological distress among adolescents and young adults with asthma.

Health-related quality of life decreases in young people with asthma during the transition from adolescence to young adulthood: a birth cohort study

BACKGROUND

During the transition from paediatric to adult healthcare there is a gap between asthma guidelines and actual management with decreased healthcare consultations and dispensations of asthma medications after the transition to adult healthcare among young people with asthma. How health-related quality of life (HRQoL) develops during the transition from adolescence to young adulthood is unclear. Our aim was therefore to investigate HRQoL among young people with asthma during the transition to adulthood. Further, to assess if level of asthma control and physical activity influence any potential association between asthma and HRQoL.

METHODS

The study population consisted of 2268 participants from the ongoing Swedish population-based prospective birth cohort BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology). HRQoL was measured using the instrument EQ-5D-3 L and three general questions. The EQ-5D-3 L consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The EQ-5D-3 L instrument and questions on general health, symptoms and treatment of asthma, and lifestyle factors were based on data from follow-ups at 16 and 24 years. Cross-sectional analyses were made.

RESULTS

At the 24-year follow-up, the adjusted median values of EQ VAS were lower compared with at the 16-year follow-up; among both participants with asthma (80 vs. 85, p < 0.01) and those without asthma (80 vs. 87, p < 0.01). At the 24-year follow-up, participants with uncontrolled asthma had a lower adjusted median EQ VAS score than peers with controlled/partly controlled asthma (75 vs. 80, p = 0.03). Further, young adults with asthma who did not fulfil the WHO recommendations on physical activity had lower EQ VAS scores than peers who did (70 vs. 80, p < 0.01).

CONCLUSION

HRQoL is lower in young adulthood than in adolescence. Young adults with asthma having uncontrolled disease or who are physically inactive appear to be particularly vulnerable.

Youths with asthma and their experiences of self-management education: A systematic review of qualitative evidence

AIMS

To identify and synthesize the available evidence of youths with asthma and their experience of self-management education.

DESIGN

Systematic literature review of qualitative studies with meta-synthesis of findings.

DATA SOURCES

We searched five databases, CINAHL Complete, Embase, MEDLINE (EBSCO) PsycINFO, ASSIA and the Global Index Medicus (formerly the WHOLIS). Initial search in September 2019 and updated in July 2020 and July 2022.

REVIEW METHODS

The systematic review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Qualitative data were extracted, meta-summarized and then meta-synthesized.

RESULTS

Eighteen studies were identified for inclusion in this review and three themes were identified: The theory and practice gap, contemporary health-seeking preferences and the psychosocial impacts of living with asthma.

CONCLUSION

The needs of youths with asthma are specific and must be measurable against the change in asthma outcomes for this group. They have unmet self-management educational needs that stakeholders, involved in their care and support, should address. Education and practice policy should focus on youth-centric approaches. Through meaningful engagement with youths, stakeholders can identify their support needs, requirements and preferences to successfully underpin the theory and practice of self-management education.

IMPACT

This review synthesized evidence of youths with asthma and their experiences of self-management education, highlighting their specific self-management information needs. The findings highlight several implications for healthcare professionals in education, practice and research. This age profile is under-explored and further research into this population would work towards filling the theory and practice gap and highlighting the identified psychosocial issues faced by this group.

Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study

This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16-20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents' asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.

Healthcare use in commercially insured youth with mental health disorders

BACKGROUND

The objective of this study is to describe age-related patterns of outpatient healthcare utilization in youth and young adults with mental health disorders.

METHOD

We used the IBM^® MarketScan^® Commercial Database to identify 359,413 youth and young adults (12-27 years) with a mental health disorder continuously enrolled in private health insurance in 2018. Exploratory analysis was used to describe patterns of outpatient healthcare use (e.g., primary, reproductive, mental health care) and therapeutic management (e.g., medication prescriptions, psychotherapy) by age. Period prevalence and median number of visits are reported. Additional analysis explored utilization patterns by mental health disorder.

RESULTS

The prevalence of outpatient mental health care and primary care decreased with age, with a larger drop in primary care utilization. While 74.0-78.4% of those aged 12-17 years used both outpatient mental health care and primary care, 53.1-59.7% of those aged 18-27 years did. Most 18-19-year-olds had a visit with an internal medicine or family medicine specialist, a minority had a pediatrician visit. The prevalence of medication management increased with age, while the prevalence of psychotherapy decreased.

CONCLUSIONS

Taken together, this descriptive study illustrates age-related differences in outpatient healthcare utilization among those with mental health disorders. Additionally, those with the most severe mental health disorders seem to be least connected to outpatient care. This knowledge can inform efforts to improve utilization of healthcare across the transition to adulthood.

Issues affecting young people with asthma through the transition period to adult care

Asthma is among the most common medical conditions affecting children and young people, with adolescence a recognised period of increased risk, overrepresented in analyses examining recent increasing asthma mortality rates. Asthma may change significantly during this period and management also occurs in the context of patients seeking increased autonomy and self-governance whilst navigating increasing academic and social demands. A number of disease factors can destabilise asthma during adolescence including: increased rates of anaphylaxis, anxiety, depression, obesity, and, in females, an emerging resistance to corticosteroids and the pro-inflammatory effects of oestrogen. Patient factors such as smoking, vaping, poor symptom recognition, treatment non-adherence and variable engagement with health services contribute to difficult to treat asthma. Significant deficiencies in the current approach to transition have been identified by a recent EAACI task force, and subsequent asthma-specific recommendations, published in 2020 provide an important framework moving forward. As with other chronic conditions, effective transition programmes plan ahead, engage with adolescents and their families to identify the patients' management priorities and the current challenges they are experiencing with treatment. Transition needs may vary significantly across asthma patients and for more complex asthma may include dedicated transition clinics involving multidisciplinary care requiring input including, amongst others, allergy and immunology, psychological medicine, respiratory physicians and scientists and nurse specialists. Across different global regions, barriers to treatment may vary but need to be elicited and an individualised approach taken to optimising asthma care which is sustainable within the local adult healthcare system.

Maintenance of Asthma Control in Adolescents with Severe Asthma After Transitioning to a Specialist Adult Centre: A French Cohort Experience

Background

The prevalence of severe asthma in adolescents is estimated at 6.7%. Transition to adult health services is a vulnerable period for adolescents where there is a risk of poor treatment adherence and loss to follow-up.

Purpose

This retrospective study evaluated the maintenance of asthma control in young severe asthmatics, 6 months and 1 year after transition to a specialist adult centre.

Methods

Patients with severe asthma treated in a paediatric pulmonology centre in the Île-de-France and referred at least 6 months previously to an adult service were included. Asthma control was evaluated by measuring the ACT score and respiratory function. Patients were asked to answer an on-line questionnaire about their experiences during transition.

Results

Fifty-four adolescents with severe asthma underwent transition to the adult service between 2014 and 2021. Thirteen patients (25%) were lost to follow-up after an average of 22.4 months of follow-up. Three-quarters (73%) of patients had well controlled asthma with an ACT score ≥20 during transition and the majority were able to maintain good control and respiratory function (>60% FEV₁ >80%) during follow-up in adult pulmonology. Among the patients that answered the questionnaire, 64.8% were satisfied with the transition process.

Conclusion

Asthma control and respiratory function were maintained 6 months and 1 year after transition to the adult centre in the majority of patients. Most patients were satisfied with the transition process, but several improvements can be proposed, including early discussion of the medical plan and the implementation of procedures to reduce loss to follow-up.

Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour

Objectives

Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers.

Methods

A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains.

Results

In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination.

Conclusions

By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.

A multi-disciplinary approach to the diagnosis and management of allergic diseases: An EAACI Task Force

BACKGROUND

Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied healthcare professionals (AHPs), and general practitioners (GPs), in the management of allergic disease, has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force to explore this issue.

AIM

To investigate the added value of nurses, AHPs, and GPs in management of allergic diseases, in an integrated model of care.

METHODS

A search was made of peer-reviewed literature published between 2010 and December 2020 (Cochrane Library, PubMed, and CINAHL) on the involvement of the various specific healthcare providers (HCPs) in the management of allergic diseases.

RESULTS

Facilitative models of care for patients with allergies can be achieved if HCP collaborates in the diagnosis and management. Working in multi-disciplinary teams (MDT) can increase patients' understanding of the disease, adherence to treatment, self-care capabilities, and ultimately improve quality of life. The MDT competencies and procedures can be improved and enhanced in a climate of mutual respect and shared values, and with inclusion of patients in the planning of care. Patient-centered communication among HCPs and emphasis on the added value of each profession can create an effective integrated model of care for patients with allergic diseases.

CONCLUSION

Nurses, AHPs, and GPs, both individually and in collaboration, can contribute to the improvement of the management of patients with allergic disease. The interaction between the HCPs and the patients themselves can ensure maximum support for people with allergies.

Health-care Transition: A Vital Part of Care, Growth, and Change for Pediatric Patients

Preparing all youth for the transition to adult-oriented care, adulthood itself, and a greater responsibility for their own health and health-care is an essential part of pediatric care. This process, typically described as health-care transition, can occur throughout ongoing pediatric health-care to prepare patients for transfer to an adult clinician and integration into adult care. Gaps remain in practice and in outcomes research regarding health-care transition. This review discusses recent literature, details best practices, and recommends guidance and tools to assist pediatric clinicians in providing a smooth transition process and a successful transfer to adult care for youth with and without special health-care needs.

Uncontrolled asthma from childhood to young adulthood associates with airflow obstruction

Introduction

Lung function development from childhood to young adulthood is important for lung health later in life. We investigated the association between asthma control and lung function from 8 to 24 years of age.

Methods

A total of 668 participants from the population-based BAMSE cohort study, with persistent or incidental asthma and between 8 and 24 years of age, were included. Asthma was defined as controlled or uncontrolled at each examination based on the Global Initiative for Asthma (GINA) criteria. Dynamic spirometry was performed at 8, 16 and 24 years of age. Associations between uncontrolled asthma and pre-bronchodilation forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC) and FEV₁/FVC ratio were evaluated with a generalised estimating equation model, as overall associations and at each examination. Unadjusted and adjusted (for sex, current asthma, allergic sensitisation, body mass index, smoking, smoke exposure, inhaled corticosteroid use) analyses were done; and were thereafter stratified by sex, elevated blood eosinophils (≥0.3×10⁹ cells·µL⁻¹), elevated F_ENO (≥25 ppb), allergic sensitisation and ever/never smoking.

Results

Uncontrolled asthma was associated with a lower overall FEV₁/FVC z-score from 8 to 24 years of age (adjusted regression coefficient −0.11; 95% CI (−0.20 to −0.02; p=0.016). After stratification, this association was primarily seen among females (adjusted regression coefficient −0.170; 95% CI (−0.298 to −0.044; p=0.009) and participants with elevated F_ENO (regression coefficient −0.207; 95% CI −0.342 to −0.073; p=0.002), in contrast to males and participants with normal F_ENO.

Conclusion

Uncontrolled asthma is associated with airflow obstruction from childhood to young adulthood. This highlights the importance of active management of asthma during growth.

Uncontrolled asthma from 8 to 24 years of age is associated with a lower overall FEV₁/FVC z-score. Intensified treatment of symptomatic asthma, especially asthma with elevated F_ENO and in females, could have important implications for future lung health.https://bit.ly/3pHkleN

Non-adherence and sub-optimal treatment with asthma medications in young adults: a population-based cohort study

OBJECTIVE

Pharmacological treatment plays a key role in the management of asthma, but medication adherence is generally low. Our aim was to assess factors associated with dispensing patterns of, and adherence to, asthma medication in young adults with asthma.

METHODS

The study included young adults (age 22-24 years) from the Swedish population-based birth cohort BAMSE (n = 3,064) with linkage to register data on dispensed asthma medications and recorded diagnosis. Dispensing information was collected in January 2014-June 2019 (the study period) to cover the period of questionnaire data. Adherence to asthma medication was defined as refilling a prescription within 18 months.

RESULTS

In total, 234 individuals (7.6%) had asthma (doctor's diagnosis of asthma in combination with respiratory symptoms) and had been dispensed at least one prescription of asthma medication during the study period. Among them, 77% were dispensed a controller medication. The mean number of prescriptions dispensed per individual was higher in males than females (11.0 vs. 7.2; p < 0.01). The proportion of asthmatics with only a short-acting β₂-agonist (SABA) dispensed was 22%, of which 33% were classified as having uncontrolled asthma. Adherence to controller medication was 60% and higher among those with an asthma diagnosis from specialized care than those diagnosed in primary care (RR 1.32 95% CI 1.03-1.69). Sex, socioeconomic status, and non-allergic comorbidity did not affect adherence.

CONCLUSION

Young adults with asthma had few prescriptions of asthma medication dispensed, indicating sub-optimal treatment. A considerable proportion was dispensed only SABA. Furthermore, adherence to controller medication was relatively low.

Characterization of Asthma Trajectories from Infancy to Young Adulthood

BACKGROUND

Development of asthma is complicated by the multidimensional nature of the disease.

OBJECTIVE

To identify and characterize trajectories of asthma from infancy to young adulthood, and their associations with lung function and inflammatory and respiratory markers in adolescence and young adulthood.

METHODS

A latent class analysis was performed in a population-based cohort (N = 4089). Parental and self-reported symptoms of asthma were used to investigate asthma development. We characterized background factors, allergic comorbidity, and IgE sensitization and investigated associations with asthma markers.

RESULTS

A 4-class solution of asthma trajectories was identified: never/infrequent (n = 3291 [80.4%]), early-onset transient (n = 307 [7.5%]), adolescent-onset (n = 261 [6.4%]), and persistent asthma (n = 230 [5.6%]). Uncontrolled asthma was equally prevalent in the adolescent-onset and persistent asthma trajectory groups, at both age 16 (41.7% vs 42.4%; P = .90) and 24 years (53.7% vs 52.4%; P = .81). The persistent asthma trajectory group had a higher proportion of eosinophil counts greater than or equal to 0.3 (10⁹ cells/L) at age 24 years compared with the adolescent-onset trajectory group (31.0% vs 18.5%; P < .01).

CONCLUSIONS

The adolescent-onset and persistent asthma trajectory groups had equal burdens of asthma control in adolescence and young adulthood. However, the persistent asthma trajectory group showed more signs of type 2 inflammation than the adolescent-onset trajectory group. This unbiased approach highlights the need of identifying patients with adolescent asthma to optimize care, because they suffer the same lack of asthma control as those with persistent asthma.

A Gap Between Asthma Guidelines and Management for Adolescents and Young Adults

BACKGROUND

For adolescents, asthma management can be challenging during the transition to adulthood, and changes in health care and pharmacological treatment may occur.

OBJECTIVE

To investigate asthma-related health care consumption and pharmacological dispensation during the transition process.

METHODS

In a Swedish birth cohort study, questionnaire and clinical data from the 16- and 24-year follow-ups were linked to national and regional registries for asthma-related health care consumption and dispensed medications during an 8-year period: 4 years before and after age 18 y, respectively.

RESULTS

In the study population (n = 1808), 14% fulfilled the study definition of current asthma at the 16- and 24-year follow-up and 8% (n = 147) had persistent asthma. Among them, register data showed that in the 4-year period before their 18th birthday, 39% (58 of 147) had at least 1 consultation, similar to 37% (55 of 147) in the following 4-year period. The mean number of consultations before age 18 years was 1.6, compared with 1.0 after age 18 years (P = .02). At least 1 dispensation of any inhaled corticosteroid before age 18 years was found for 73% (107 of 147), compared with 50% (74 of 147) after age 18 years. The mean number of dispensed any inhaled corticosteroid was 3.1 before 18 years and 2.1 after 18 years (P < .01). Only 3% (5 of 147) had a regular dispensation of any inhaled corticosteroid once a year during the 8-year period.

CONCLUSIONS

Health care consultations were fewer than recommended in guidelines and decreased after the transition to adult health care. Almost no one had dispensed regular asthma medications during the 8-year period.

Male sex is strongly associated with IgE-sensitization to airborne but not food allergens: results up to age 24 years from the BAMSE birth cohort

Background

Up to half of the population in high-income countries has allergen-specific IgE antibodies. However, data regarding sex differences of IgE-sensitization from childhood to adulthood is limited.

Objective

To explore IgE-sensitization to common foods and airborne allergens in relation to sex over time in a population-based cohort followed up to young adulthood.

Methods

The Swedish population-based birth cohort BAMSE includes 4089 subjects who have been followed regularly with questionnaires and clinical investigations. A recent 24-year follow-up included 3069 participants (75%). Sera collected at 4, 8, 16 and 24 years were analyzed for IgE-antibodies to 14 common foods and airborne allergens.

Results

At 24 years sensitization to foods had decreased compared to previous follow-ups affecting 8.4%, while sensitization to airborne allergens was more common, affecting 42.2%. Male sex was associated with IgE-sensitization to airborne allergens at all ages (overall OR: 1.68, 95% CI 1.46–1.94) while there was no statistically significant association between sex and sensitization to food allergens (overall OR: 1.10, 95% CI 0.93–1.32). Levels of allergen-specific IgE did not differ significantly between males and females for any of the tested foods or airborne allergens at any age, following adjustment for multiple comparisons.

Conclusion

IgE-sensitization to airborne allergens increases with age up to young adulthood, whereas sensitization to food allergens seems to level off. Male sex is strongly associated with IgE-sensitization to airborne allergens from early childhood up to young adulthood. In contrast, there is little evidence for associations between sex and IgE-sensitization to foods.