sign101

New
2011
7 special situations
7.1 AsthMA in AdolesCents
7.1.1 DEFINITIONS
Adolescence is the transitional period of growth and development between puberty and
adulthood, defined by the World Health Organisation (WHO) as between 10 and 19 years of
age. 864
There is international agreement on best practice for working with adolescents with health
problems outlined in consensus publications. 865-867 Key elements of working effectively with
adolescents in the transition to adulthood include: 868
seeing them on their own, separate from their parents or carers, for part of the consultation, and
discussing confidentiality and its limitations.
For diagnosing and managing asthma in adolescents, the evidence base is limited. Much recent
research has focused on the prevalence of asthma and ecological risk associations rather than
on diagnosis and management of asthma in adolescents.
7.1.2 PREvALENCE OF ASTHMA IN ADOLESCENCE
Asthma is common in adolescence with a prevalence of wheeze in Western Europe in the past
12 months (current wheeze) in 13-14 year olds of 14.3%. 869 For more severe asthma (defined
as ≥4 attacks of wheeze or ≥1 night per week sleep disturbance from wheeze or wheeze
affecting speech in the past 12 months) the prevalence was 6.2%.
There is evidence of under-diagnosis of asthma in adolescents, with estimates of 20-30%
of all asthma present in this age group being undiagnosed. 869-872 This has been attributed to
under-reporting of symptoms. A number of risk factors have independently been associated
with under-diagnosis including: female gender, smoking (both current smoking and passive
exposure), low socioeconomic status, family problems, low physical activity and high body mass
and race/ethnicity. 872 Children with undiagnosed frequent wheezing do not receive adequate
healthcare for their illness872 and the health consequences of not being diagnosed with asthma
are substantial. 873,874
Although feasible, there is insufficient evidence to support screening for asthma in
adolescents. 875,876
; Clinicians seeing adolescents with any cardio-respiratory symptoms should consider
asking about symptoms of asthma.
7 sPeCiAl situAtions
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