The adolescents with asthma are a distinct group of patients with different problems and needs compared to children and adults. Specific issues of asthma in adolescence are the variability of the clinical spectrum, the presence of particular risk factors for the persistence of symptoms, underdiagnosis and undertreatment of the disease. Refusal of the sick role, denial of symptoms, carelessness about dangerous inhalation exposure, erratic self-medication, overexertion without taking precautions against exercise-induced asthma, and a poor relationship between patients, their families, and often doctors are the main obstacles to successful management of asthma in this critical age. There are also major problems of compliance for these patients. The goal of optimal quality of life will be achieved only if the physician thoroughly understands the adolescent's needs and provides optimal care.

Asthma is a chronic disease that has a significant impact quality of life, which is particularly important in adolescence. We will discuss aspects of epidemiology, the clinical spectrum, diagnostics, and management of asthma in adolescence. In particular, we will highlight the psychological implications of having asthma during this developmental period. Data published in the past 10 years, since we last reviewed the subject, will be the main focus of this paper. The care of the teenager with asthma should take into account the rapid physical, emotional, cognitive, and social changes that occur during normal adolescence. The diagnostic process may be more difficult since teenagers tend to deny their illness. Thus, both under-diagnosis and under-assessment of asthma severity may lead to under-treatment and potentially avoidable morbidity and even mortality. Conversely, teenagers may be often misdiagnosed as having asthma or their asthma severity may be overestimated leading to inappropriate and sometimes excessive treatment. Educational programs, environmental avoidance measures, proper use of medications along with a skilled approach, and a caring attitude of health providers are all very important for successful management. Pediatr Pulmonol. 2017;52:129-138. © 2016 Wiley Periodicals, Inc.

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The effect over time of regular treatment with montelukast (MNT) in inhibiting exercise-induced bronchoconstriction (EIB) has never been evaluated in children. The aim of the present study was to examine the preventive effect of MNT against EIB in children at different time-points over a 4-week treatment period.Thirty-two asthmatic children (aged 6-12 yrs) were enrolled in a double-blinded, randomised, parallel group design to receive a 4-week treatment with MNT (5 mg chewable tablets administered once daily in the evening) or placebo. Exercise challenge was performed at baseline and after 3, 7 and 28 days of treatment, 20-24 h after dosing.MNT was significantly more protective than placebo against EIB at each time. The mean percentage drop of forced expiratory volume in one second (FEV1) was 24.6, 13.6, 12.0 and 11.6 for MNT, and 24.4, 22.4, 21.8 and 21.0 for placebo, at baseline and after 3, 7 and 28 days, respectively. For each drug, no significant difference in the percentage drop of FEV1 was found between different days.Regular treatment with montelukast provided significant protection against exercise-induced bronchoconstriction in asthmatic children over a 4-week period with no tolerance to the bronchoprotective effect.KEYWORDS: Exercise-induced bronchoconstriction, montelukast, tolerance E xercise-induced bronchoconstriction (EIB) is a common manifestation of asthma in children and can interfere in their daily activities. The pathogenetic mechanism of EIB is not completely clear, but the release of inflammatory mediators from airway mast cells appears likely [1]. Although leukotrienes (LTs) have been inconstantly recovered from urine after exercise [2], the evidence for the role of these mediators in EIB derives from the bronchoprotective effect of anti-LT drugs [3].Montelukast (MNT), a specific antagonist of cysteinyl-leukotriene (Cys-LT) receptors, showed a consistent effect against EIB in children when administered either as a single dose [4,5] or as regular treatment [6]. In adults, a 12-week treatment with MNT attenuated the fall in pulmonary function following exercise with no tolerance to the bronchoprotective effect [7]. No study has evaluated the effect over time of regular treatment with MNT in inhibiting EIB in children. The present authors therefore examined the effect of once-daily MNT on EIB at several time-points during a 4-week treatment period. PATIENTS AND METHODS SubjectsA total of 32 children aged 6-12 yrs with mild-tomoderate asthma [8] were enrolled into the current study. Patients were recruited from the Depts of Paediatrics, at the University of Perugia and the University of Naples, Italy. The study protocol was approved by the institutional review boards of the two participating centres. Informed consent was obtained from patients and their parents.At screening, all patients had a forced expiratory volume in one second (FEV1) of at least 75% of predicted and a decrease in FEV1 of at least 12% from the baseline after a standardised exercise challenge. Patients were not e...

Biological effects of MNT delineate a complex picture of gene activation and repression, probably induced by Cys-LTR blockade. The induction of apoptosis in allergen-specific T cell population, as a final result, appears fundamental in the treatment of asthma.