Improving adherence (Tables 2, 4 and 5)
There are numerous data documenting poor adherence to treatment during adolescence. This is therefore an important issue to consider. HCP should make time to explore barriers which may be related to the patient, particularly their understanding and preconceptions, competing activities, their support or medication regime. Simplifying medication regimes, such as the use of a single inhaler combining inhaled corticosteroid and long-acting β2 agonists, may be recommended to improve adherence (Grade C)(Table 2).27 Several studies indicate that low self-efficacy (confidence in performing a specific activity) is related to poor medication adherence, both in AYA with asthma and/or food allergy.28,29,30-33 One controlled study showed that text reminders to take medication could improve treatment adherence in AYA with asthma 34; however, the number of participants was small and this finding needs to be confirmed by larger studies. Other types of reminders, such as prompts to take medication, mobile applications and web-based applications, monitors or routines can be recommended to improve adherence, symptom control and quality of life (Grade B)(Table 2).35-38 One study with a large sample showed a positive effect of cognitive behavioural therapy (CBT) using a multi-systemic approach on asthma treatment adherence, as well as on asthma knowledge, self-management and symptom control in adolescents. Cognitive behavioural therapy can be recommended to improve adherence (Grade B)(Table 4).39-42 Also, data suggest that amending family routines to give AYA time to fit in management behaviours may be recommended to improve adherence with medication in AYA (Grade C)(Table 5).43,44 Finally, avoidance strategies such as dietary restrictions and label reading are also very important but there is little literature to guide the best approach to improving patient adherence to these strategies.