Asthma Self-Management is Sub-Optimal in Urban Hispanic and African American/Black Early Adolescents with Uncontrolled Persistent Asthma

Abstract

Introduction Youth as young as 11 are given responsibility to manage their asthma. Yet, little is known regarding early adolescents’ asthma self-management behaviors. This study characterizes urban early adolescents’ asthma self-management behaviors and perceived responsibility to manage asthma, exploring demographic differences and examining the relationship between asthma responsibility and disease management. Methods 317 Hispanic and Black early adolescents (mean age=12.7) with persistent, uncontrolled asthma reported prevention and symptom management steps, and responsibility for asthma care. We used Poisson, cumulative logistic, logistic, and linear mixed-effects regression models to assess relationships between demographic predictors, prevention and management behaviors, and responsibility for asthma care. Results 50% took 7–9 prevention steps; few saw physicians when asymptomatic or took daily medication. When symptomatic, 92% used medication to treat symptoms, 56% sought medical attention. Controlling for asthma responsibility, fewer older youth reported observing how they feel when asthma is likely to start, observing symptom changes, or asking for help. More boys reported taking medication daily or upon trigger exposure. Controlling for age, gender, and race/ethnicity, those reporting more asthma responsibility were less likely to report taking management steps, seeking preventive care, asking for help, or going to a doctor/hospital for their asthma. Conclusions Early adolescents’ asthma self-management is suboptimal. With increasing age, they are less observant regarding their asthma and less likely to seek help. Although they perceive themselves to have greater responsibility for managing their asthma, early adolescents do less to care for their asthma, suggesting they are being given responsibility for asthma care prematurely.

Asthma Self-Management Goals, Beliefs and Behaviors of Urban African American Adolescents Prior to Transitioning to Adult Health Care

“…Although aware of the need to assume greater responsibility for their asthma care, in this study adolescents still needed reminders or directions from caregivers regarding carrying rescue inhalers, getting prescriptions refilled, or taking action when asthma symptoms arise. Bruzzese et al (2012) findings indicated deficiencies and discrepancies among youth in their response to acute asthma symptoms, administering medications prior to exposure to known triggers, and remembering to carry medications when outside the home. The same investigators also found that as youth grew older, asthma self-management often declined.…”

Every parent tells a story: why non-adherence may persist in children receiving guideline-based comprehensive asthma care

“…The second study, which was based on electronic monitoring of adherence, showed lower adherence in children with more responsibility [21]. In contrast to common belief [16], children below the age of 10-12 years seem to be unable to take responsibility for their own taking of medicine [33,34]. To identify and overcome this barrier to adherence, parental beliefs about the self-management responsibility of their child should be discussed during follow-up visits, along with the associated lack of motivation to achieve good adherence and ineffective problem-solving behavior.…”

Asthma control in adult patients treated with a combination of inhaled corticosteroids and long-acting beta-2 agonists: a prospective observational study

“…Despite huge progress in asthma management over the last decades, sat isfactory levels of asthma control are not univer sal. 11,12 Apart from the few truly refractory cases, failure to achieve or maintain optimal control has been attributed to inappropriate dosing or drug selection, patient noncompliance, or deficient in haler technique. [12][13][14][15] It remains an important is sue because suboptimal levels of asthma control are a risk factor for asthma exacerbations.…”