Asthma

Teens with chronic illnesses find it hard to stick to treatment

Teenagers with chronic illnesses face special barriers that may interfere with how well they adhere to their medical treatment, according to a new review in the Journal of Adolescent Health.

According to the World Health Organization, adherence is the extent to which a person's behavior—for example, taking medication—corresponds with agreed recommendations from a health care provider; non-adherence can have serious consequences for one's health.

The review analyzed 28 studies in which teenagers with a range of chronic conditions reported barriers to taking their medication. The review identified multiple barriers including relationships with peers, parents, and health care providers; issues particular to adolescence, such as wanting to be normal and wanting to control their own lives; as well as forgetfulness or unwanted side effects.
"Many barriers seem to be the same across very different conditions in adolescence despite significant differences in treatment burden," noted Boisen. Adolescence as a phase of life appears to affect medical adherence more than the type of chronic illness present, she said.
"This article looked at studies that asked young people to reflect as best they can on their own experience," said Peter Scal, MD, MPH, assistant professor at the University of Minnesota Medical School in Minneapolis. Keeping the teenager engaged with their own treatment may depend on collaboration and on good communication with compassionate health care providers, he explained. "Young people do want to have a caring connection with an adult."
Physicians who treat teenagers with chronic conditions need to understand how adolescence affects how they view their disease and treatment, and how to communicate with teenagers so that they can better follow their treatment regimens, suggest the review authors.
"There is an urgent need for interventions targeted to adolescents as these patients seem to have particular difficulties in adhering to medical treatment," Boisen added. Health care providers need to be aware of the crucial role that relationships with peers and parents play, she added. "An adolescent's sense of normality as a part of their construction of identity is worth paying special attention to," she said.

Kids with asthma still exposed to secondhand smoke

 

(Reuters Health) - Despite public health campaigns, too many people are still smoking around little kids with asthma, say U.S. researchers.
According to national data from 2003 to 2010, half of all children ages 6 to 19, even those with asthma, have been exposed to secondhand smoke.
For kids ages 6 to 11, even low levels of second hand smoke were linked to more missed school days, trouble sleeping, less physical activity and more wheezing, the authors write in Academic Pediatrics.
The fact that kids with asthma are still inhaling others' smoke is a real problem, said Dr. Karen M. Wilson, who studies children's' exposure to secondhand smoke at Children's Hospital Colorado in Aurora.
"Secondhand smoke consists of particulate matter, and chemicals, both of which induce an inflammatory response in the airways, which can cause an asthma attack," said Wilson, who was not involved in the study.
Limiting physical activity is also dangerous because it increases the chances a child will become obese, which worsens asthma, she told Reuters Health.
For older children, secondhand smoke was not linked to those negative symptoms.
"We speculated that this may be because similar levels of exposure may mean different things at different ages," Dr. Lara Akinbami said.
"Adolescents may have more sporadic exposure (hanging with friends) compared to younger children who may be more chronically exposed at home," Akinbami, who led the study at the National Center for Health Statistics in Hyattsville, Maryland, told Reuters Health by email.
Other research has indicated that only smoking in one room of the house is not enough to protect kids, Akinbami said.
Secondhand smoke did not seem to worsen asthma symptoms for black children, but they tend to be exposed to more smoke and to have worse symptoms to start with, Akinbami said.
The study included a very small number of black children who were not exposed to secondhand smoke, which could have made it difficult to compare smoking and nonsmoking homes, she added.
"I think the most important factor is that even low level exposure - the kind of exposure that might happen with a parent who smokes outside - can have negative consequences," Wilson said.
"Not smoking at all, and limiting exposure from other sources, such as neighboring apartments, is the best way to protect children with asthma," she said.
The report notes that over the past several years secondhand smoke exposure has dropped for adults more than for kids.
"This is because the clean indoor air laws are designed to protect individuals in workplaces, which includes bars and restaurants," Amy Ferketich, a tobacco control researcher at The Ohio State University in Columbus, said.
"Children tend to be exposed to (secondhand smoke) in homes and cars, and these places are not included in most clean indoor air laws and policies," Ferketich, who was not involved in the study, said.
Though most adults already know that smoking around kids is not a good idea, more can be done, according to Wilson and the other experts.
All recommended that clean indoor air policies be extended to cover multi-unit housing.
"Resources, such as state quitlines, need to be well promoted, and provide comprehensive cessation services," Wilson said. "Parents should work with their health care providers, and their children's providers, to reduce exposure and quit themselves, in order to protect their children."
SOURCE: bit.ly/17roFie Academic Pediatrics, online September 10, 2013.

Healthy Kids Still Face The Risk Of Death From Flu (STUDY)

 

 

By: By Rachael Rettner, Senior Writer
Published: 10/28/2013 07:28 AM EDT on LiveScience
Over the last decade, many children who tragically died from flu were previously healthy kids, without chronic medical conditions, a new study finds.
Between 2004 and 2012, a total of 830 U.S. children died from flu, the study found. Of these, more than 40 percent did not have a medical condition such as asthma or heart disease that would put them at high risk for flu complications.
What's more, previously healthy children were nearly twice as likely to die from the flu before they were admitted to the hospital, or within three days of symptom onset, compared with children who had high-risk medical conditions and got the flu. [6 Flu Vaccine Myths]
The study underscores the fact that all children, regardless of age or pre-existing medical conditions, can potentially develop severe complications from the flu, the researchers said.
"Healthy kids are at risk, too. I think that's something that a lot of people don't recognize," said study researcher Dr. Karen Wong, of the Centers for Disease Control and Prevention (CDC). "People can get very sick very quickly, even if they don't have an underlying medical condition."
The findings highlight the importance of flu vaccination for all children ages 6 months and older, the researchers said. Of the 511 children who died and who were eligible for vaccination, just 16 percent had received a flu shot.

The findings also suggest that children who develop severe illness from the flu, who are hospitalized or who are at high risk for complications (such as those less than 2 years old) should receive treatment with antiviral drugs as soon as possible, the researchers said.
The study analyzed information on child flu deaths reported to the CDC. During the study period, the deadliest flu season for children was 2009 to 2010; over that time, 282 children died. The mildest flu season was 2011 to 2012, in which 35 deaths occurred.
The majority of deaths, 57 percent, occurred among children with high-risk medical conditions. Of these, the most commonly reported condition was a neurological disorder, such as cerebral palsy, with 33 percent of these children having a neurological condition. This was followed by lung disorders (26 percent), asthma (16 percent) and genetic disorders (12 percent).
It is especially important that children with high-risk medical conditions receive flu shots before flu season begins, the researchers said.
It's not clear why previously healthy children were at greater risk for death soon after symptom onset. But healthy kids were also more likely to have a bacterial infection along with their flu infection, which may have contributed to the differences in outcomes between the two groups, the researchers said.
The study is published today (Oct. 28) in the journal Pediatrics.