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.