Asthma in Adolescence

The Pathophysiology of Asthma

Asthma is a chronic lung disease characterized by airway inflammation and bronchoconstriction, or the tightening of the muscles surrounding the airway passages. Inflamed airways are hyperresponsive to environmental conditions, and bronchoconstriction occurs when the airway is exposed to certain triggers. These triggers vary among individuals and include exercise, viral infections, and allergens. Bronchoconstriction is associated with asthma symptoms, which include wheezing, chest tightness, and a dry cough. Pharmacotherapy for asthma includes medications from two categories: (1) long-term control medications, which are taken daily over an extended period of time to reduce the underlying inflammation, and (2) quick-relief medications, which are taken for prompt but temporary relief of bronchoconstriction and symptoms (National Heart, Lung, and Blood Institute [NHLBI], 1997).

Asthma is a dynamic disease with symptoms that can vary across the life span, across individuals, and across seasons (Clark & Gong, 2000). As a result, to successfully manage asthma, individuals require not only knowledge of asthma but also a repertoire of behavioral strategies to cope with their changing disease. Patients must systematically assess their symptoms on a regular basis, set reasonable goals for asthma management, and monitor the effectiveness of their behavioral strategies to meet these goals. In addition, it is recommended that patients have written treatment plans detailing how to change medications in response to shifts in symptoms (NHLBI, 1997).

Asthma in Adolescence

Contrary to popular opinion, children do not outgrow asthma. Adolescents (11 to 17 years old) have a higher prevalence of asthma and asthma attacks than their younger counterparts aged 0 to 10 (Centers for Disease Control, 2000). While the death rate due to asthma is low in minors compared with adults, the rate of near-death asthma attacks among minors is highest in 12- to 15-year-olds (Randolph & Fraser, 1998). This increased risk in adolescents may be due to their unique stage of psychosocial development, which presents both challenges and opportunities for effective asthma management.

Cognitive Development and Asthma Management

Adolescent cognitive abilities differ both quantitatively and quantitatively from that of children. With adolescence comes the ability to think logically and abstractly (Beyth-Marom & Fischhoff, 1997). Unlike younger children's more concrete operational thinking, adolescents are able to think beyond immediately observed events and consider long-term consequences, applying if-then statements (Beyth-Marom & Fischhoff, 1997).

These skills can be used by adolescents to comprehend the pathophysiology and treatment of asthma (Bruzzese et al., in press). While they cannot directly observe or feel the airway inflammation that underlies the bronchoconstriction and accompanying symptoms, adolescents are able to imagine and understand that the inflammation exists. Adolescents can also reason that to minimize airway inflammation, a medication that reduces the inflammation (i.e., a longterm control medication) is needed. They can understand how controlling their asthma can lead to a future with an improved quality of life, and they can set long-term goals to help achieve this life.

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