Asthma and Its Impact in Adolescents

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Allergy and Immunology".

Deadline for manuscript submissions: closed (25 October 2022) | Viewed by 23364

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Guest Editor
National Centre for Respiratory Pharmacoeconomics and Pharmacoepidemiology, 37124 Verona, Italy
Interests: asthma; cough; inhalation devices and their usability; pharmacoeconomics of respiratory diseases
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Special Issue Information

Dear Colleagues,

Bronchial asthma is a chronic disease that limits the quality of life of adolescents and causes a high socio-economic impact to their families and the health-care system. Allergic inflammation represents the most frequent cause of asthma in adolescents, frequently related to a familial predisposition. The incidence of asthma has increased dramatically during the last few decades, particularly in urban areas of developed countries, but also in developing countries, due to their peculiar social, economic, and environmental conditions. Morbidity and mortality of bronchial asthma is still significant all over the world; however, instances are still increasing in several countries, independent of the widespread growth of specific biological, epidemiological, pathophysiological, pharmacological, and clinical knowledge. Moreover, appropriate diagnostic tools are now available and of acceptable cost in the majority of countries. Robust international behavioral and interventional guidelines have extensively penetrated all continents with the aim to significantly reduce the morbidity and mortality of asthma in children and adolescents. The main goals of these actions were, and still are, oriented towards optimizing asthma control and the quality of life of these young patients. In other words, to improve their daily life and their relational and school activities), and to contain the socio-economic burden of the disease, mainly due to hospitalizations and GP and/or Specialist visits; diagnostics, pharmacological and non-pharmacological treatments (direct costs) together with school (or work) absenteeism or presenteeism (indirect costs). Nevertheless, despite these huge efforts, bronchial asthma is still underestimated. In particular, the awareness of asthma is still dramatically low in adolescents and teenagers, who tend to neglect and disregard their health status, and refuse or abandon the treatments prescribed, especially if long-lasting, thus leading to uncontrolled asthma or life-threatening relapses. A further current (even if dated) critical point in adolescents is the educational approach and the appropriate use of inhalation devices. In conclusion, several crucial challenges are still ongoing in adolescent asthma, despite modern omics in the pandemic era. In any case, we must be aware that the final results of our actions always stem from the most updated scientific knowledge. The aim of the present Special  Issue is to highlight and update the role of major factors capable of influencing and optimizing the definition of asthma and its management in adolescents.

I look forward to receiving your contributions.

Dr. Roberto W. Dal Negro
Guest Editor

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Keywords

  • bronchial asthma
  • asthma impact
  • adolescents

Published Papers (12 papers)

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Editorial

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2 pages, 149 KiB  
Editorial
Editorial for “Asthma and Its Impact in Adolescents” Special Issue
by Roberto W. Dal Negro
Children 2023, 10(11), 1811; https://doi.org/10.3390/children10111811 - 15 Nov 2023
Viewed by 611
Abstract
Bronchial asthma is a chronic disease related to the atopic condition in most cases but also to other factors (such as infectious diseases; social, economic, environmental, and occupational conditions; exposure to biological irritants; and/or chemical aggressions) [...] Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)

Research

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8 pages, 569 KiB  
Article
Persistent Asthma at School Age: Associated Factors in Preschool Children with Asthma
by Kantisa Sirianansopa, Kanokpan Ruangnapa, Pharsai Prasertsan, Kantara Saelim and Wanaporn Anuntaseree
Children 2023, 10(1), 33; https://doi.org/10.3390/children10010033 - 24 Dec 2022
Viewed by 1298
Abstract
Most patients with childhood asthma present their first symptoms at preschool age. Identifying modifiable risks and protective factors at an early age may help develop asthma prevention and control strategies. This study aimed to identify factors at preschool age that are associated with [...] Read more.
Most patients with childhood asthma present their first symptoms at preschool age. Identifying modifiable risks and protective factors at an early age may help develop asthma prevention and control strategies. This study aimed to identify factors at preschool age that are associated with persistent asthma at school age. This retrospective observational study included preschool children with asthma from 2015 to 2020 at a university hospital in Southern Thailand. In total, 189 eligible participants (70.9% boys; median age, 7.6 [6.7, 8.5] years) were included. Wheeze characteristics included early transient wheeze, persistent wheeze, and late-onset wheeze that accounted for 55%, 27.5%, and 19.5% of the patients, respectively. Approximately 20% of the participants had persistent asthma. Breastfeeding was a protective factor (odds ratio [OR] 0.4 [0.2, 0.9], p = 0.04). The modifiable risk factors were siblings living in the same household (OR 2.6 [1.1, 6.2], p = 0.02) and residence in an industrial area (OR 3.8 [1.4, 10.5], p = 0.009). Additionally, presence of allergic rhinitis was associated with an increased risk of persistent asthma at school age (OR 3.6 [1.6, 8.2], p = 0.002). Early therapeutic interventions targeting modifiable factors provide a window of opportunity to prevent persistent asthma at school age. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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9 pages, 473 KiB  
Article
Effects of Adherence to Once-Daily Treatment on Lung Function, Bronchial Hyperreactivity and Health Outcomes in Adolescents with Mild-to-Moderate Asthmoka: A Twelve-Month Survey
by Roberto W. Dal Negro and Paola Turco
Children 2022, 9(12), 1854; https://doi.org/10.3390/children9121854 - 29 Nov 2022
Cited by 3 | Viewed by 976
Abstract
Adolescents with asthma are usually insufficiently adherent to regular inhalation treatments, thus limiting their effectiveness. The aim of this study is to investigate the role of adherence to single-inhaler long-acting LABA/ICS dry-powder combination o.d. in affecting lung function, bronchial hyperreactivity, and health outcomes [...] Read more.
Adolescents with asthma are usually insufficiently adherent to regular inhalation treatments, thus limiting their effectiveness. The aim of this study is to investigate the role of adherence to single-inhaler long-acting LABA/ICS dry-powder combination o.d. in affecting lung function, bronchial hyperreactivity, and health outcomes over a twelve-month survey of a group of non-smoking adolescents with mild to moderate asthma. Methods: Age, gender, BMI and atopy, forced expiratory volume in 1 s (FEV1), maximum mid-expiratory flow (MMEF), and maximum expiratory flow at 25% of lung filling (MEF25) were assessed via a Boolean selection process from the institutional database at recruitment, as well as after 6 and 12 months, together with the incidence of exacerbation, school days that were taken off, GP and specialist visits, and systemic steroid and/or antibiotic courses. Adherence was checked monthly via a direct telephone call. Statistics were calculated with an ANOVA trend analysis, assuming p < 0.05. Results: Two well-matched sample groups of 54 subjects each were obtained. The mean annual adherence to treatment ranged from 48.2% doses ± 10.9 sd to 79.3% doses ± 8.8 sd (p < 0.001), regardless of age and gender. Only adolescents that adhered to the o.d. ICS/LABA inhalation regimen progressively achieved complete control of all lung function parameters (FEV1: 0.001; MMEF: p < 0.002; MEF25 < 0.001; <0.001), minimized their bronchial hyperreactivity (p < 0.001), and optimized all health outcomes (p < 0.001—p < 0.002) over the survey duration. Discussion: A good adherence to treatment is essential for asthma management, particularly in young patients. Factors that are totally independent of the complexity of the therapeutic regimen adopted (namely, only a once-daily inhalation in the present survey) probably represent the major reasons limiting the adolescents’ adherence. Cultural, educational, behavioral, and psychological factors are frequently involved, are difficult to control, and can present barriers to adolescents’ asthma management. Further studies aiming to deeply understand and possibly remove the reasons for such adolescents’ attitudes are needed, in cooperation with actions oriented in this direction by families, educators, and health professionals. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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13 pages, 272 KiB  
Article
Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study
by Hyekyun Rhee, Lindsay Batek, Tanya Wallace-Farquharson and Laurene Tumiel-Berhalter
Children 2022, 9(10), 1573; https://doi.org/10.3390/children9101573 - 18 Oct 2022
Cited by 2 | Viewed by 1430
Abstract
This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16–20 years with asthma. Forty-one adolescents participated [...] Read more.
This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16–20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents’ asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
12 pages, 703 KiB  
Article
Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study
by Shingo Yamada, Takao Fujisawa, Mizuho Nagao, Hiroshi Matsuzaki, Chikako Motomura, Hiroshi Odajima, Toshinori Nakamura, Takanori Imai, Ken-ichi Nagakura, Noriyuki Yanagida, Masatoshi Mitomori, Motohiro Ebisawa, Shigenori Kabashima, Yukihiro Ohya, Chizu Habukawa, Minako Tomiita and Masahiro Hirayama
Children 2022, 9(10), 1516; https://doi.org/10.3390/children9101516 - 04 Oct 2022
Viewed by 1371
Abstract
Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low [...] Read more.
Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low or declining lung function during the treatment. Methods: We enrolled children with asthma who had been treated throughout three age periods, i.e., 6–9, 10–12, and 13–15 years old, at seven specialized hospitals in Japan. Clinical information and lung function measurements were retrieved from the electronic chart systems. To characterize the lung function trajectories during each age period, we evaluated the forced expiratory volume 1 (FEV1) with % predicted values and individual changes by the slope (S) from linear regression. We defined four trajectory patterns: normal (Group N) and low (Group L), showing %FEV1 ≥80% or <80% throughout all three periods; upward (Group U) and downward (Group D), showing S ≥ 0 or S < 0%. Logistic regression analysis was performed to compare factors associated with the unfavorable (D/L) versus favorable (N/U) groups. Results: Among 273 eligible patients, 197 (72%) were classified into Group N (n = 150)/U (n = 47), while 76 (28%) were in Group D (n = 66)/L (n = 10). A history of poor asthma control, long-acting beta2 agonist use, and a lower height Z-score during 13–15 years were associated with an unfavorable outcome (Group D/L). Conversely, inhaled corticosteroid (ICS) use during 10–12 years and high-dose ICS use during 13–15 years were associated with a favorable outcome (Group N/U). Conclusion: We identified several factors that are associated with unfavorable lung function changes in pediatric asthma. Attention should be paid to the possible relationship between yearly changes in lung function and poor asthma control, use of ICS (and its dose) and use of LABA. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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12 pages, 1087 KiB  
Article
Asthma Comorbidities: Frequency, Risk Factors, and Associated Burden in Children and Adolescents
by Salvatore Fasola, Giuliana Ferrante, Giovanna Cilluffo, Velia Malizia, Pietro Alfano, Laura Montalbano, Giuseppina Cuttitta and Stefania La Grutta
Children 2022, 9(7), 1001; https://doi.org/10.3390/children9071001 - 03 Jul 2022
Cited by 3 | Viewed by 1780
Abstract
Identifying asthma comorbidities in children is fundamental for improving disease management. We aimed to investigate the frequency of allergy-related comorbidities in children and adolescents with asthma, and to identify associated risk factors and disease burden. Between September 2015 and December 2018, 508 asthmatic [...] Read more.
Identifying asthma comorbidities in children is fundamental for improving disease management. We aimed to investigate the frequency of allergy-related comorbidities in children and adolescents with asthma, and to identify associated risk factors and disease burden. Between September 2015 and December 2018, 508 asthmatic patients (5–17 years) were consecutively enrolled. Parents answered a standardized questionnaire on the history of disease and risk factors. Comorbidities were classified based on the involvement of respiratory and/or extra-respiratory districts: asthma only (A, 13%), asthma with respiratory comorbidities (AR, 37%), asthma with extra-respiratory comorbidities (AER, 10%), and asthma with both respiratory and extra-respiratory comorbidities (ARER, 40%). Multinomial logistic regression showed that membership in the AR group was significantly associated with a maternal history of asthma (OR = 3.08, 95% CI: 1.23–7.72), breastfeeding ≥ three months (OR = 1.92, 1.06–3.46), early mold exposure (OR = 2.39, 1.12–5.11), and current environmental tobacco smoke exposure (OR = 2.06, 1.11–3.83). Membership in the AER group was significantly associated with the female gender (OR = 3.43, 1.54–7.68), breastfeeding ≥ three months (OR = 2.77, 1.23–6.22). ARER was significantly associated with all the aforementioned exposures. Patients with AR reported exacerbations in the last 12 months more frequently (p = 0.009). Several personal and environmental risk factors are associated with comorbidities in asthmatic children and adolescents, possibly worsening the disease burden. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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11 pages, 645 KiB  
Article
Application of a Cold Dry Air Provocation Test in Pediatric Patients with Asthma
by Ji Young Ahn and Bong Seok Choi
Children 2022, 9(6), 920; https://doi.org/10.3390/children9060920 - 19 Jun 2022
Viewed by 1469
Abstract
Asthma is a chronic inflammatory airway disease characterized by reversible airway obstruction and airway hyperreactivity. We proposed a cold dry air (CDA) provocation test and investigated its application in pediatric patients with asthma. We enrolled 72 children and adolescents older than 5 years [...] Read more.
Asthma is a chronic inflammatory airway disease characterized by reversible airway obstruction and airway hyperreactivity. We proposed a cold dry air (CDA) provocation test and investigated its application in pediatric patients with asthma. We enrolled 72 children and adolescents older than 5 years who presented to our hospital with chronic cough, shortness of breath, and wheezing. We analyzed the results of allergy, pulmonary function, methacholine provocation, and CDA provocation tests. The FEV1 change 5 min after the provocation was recorded as CDA5 dFEV1; that after 15 min was recorded as CDA15 dFEV1. PT10 was the provocation time causing a 10% decrease in FEV1; a decrease of >10% in dFEV1 was considered a positive CDA test. Among the 72 subjects, 51 were diagnosed with asthma. A positive CDA test in patients with asthma correlated with non-eosinophilic asthma. In patients with asthma, sputum eosinophils and eosinophil cationic protein (ECP) levels of the patients with a positive CDA test were significantly lower than those of patients with a negative test. CDA5 dFEV1 correlated with PC20 and total immunoglobulin E. CDA15 dFEV1 correlated with PC20, sputum eosinophils, and ECP. PT10 became shorter as the peripheral blood eosinophil, FVC, FEV1, FEV1/FVC, and FEF25-75 decreased. The CDA provocation test showed airway hyperreactivity to non-specific stimuli, a high correlation with non-eosinophilic asthma, and the possibility of assessing asthma severity via PT10. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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Review

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15 pages, 1330 KiB  
Review
Novel Lung Growth Strategy with Biological Therapy Targeting Airway Remodeling in Childhood Bronchial Asthma
by Mitsuru Tsuge, Masanori Ikeda and Hirokazu Tsukahara
Children 2022, 9(8), 1253; https://doi.org/10.3390/children9081253 - 19 Aug 2022
Cited by 2 | Viewed by 3115
Abstract
Anti-inflammatory therapy, centered on inhaled steroids, suppresses airway inflammation in asthma, reduces asthma mortality and hospitalization rates, and achieves clinical remission in many pediatric patients. However, the spontaneous remission rate of childhood asthma in adulthood is not high, and airway inflammation and airway [...] Read more.
Anti-inflammatory therapy, centered on inhaled steroids, suppresses airway inflammation in asthma, reduces asthma mortality and hospitalization rates, and achieves clinical remission in many pediatric patients. However, the spontaneous remission rate of childhood asthma in adulthood is not high, and airway inflammation and airway remodeling persist after remission of asthma symptoms. Childhood asthma impairs normal lung maturation, interferes with peak lung function in adolescence, reduces lung function in adulthood, and increases the risk of developing chronic obstructive pulmonary disease (COPD). Early suppression of airway inflammation in childhood and prevention of asthma exacerbations may improve lung maturation, leading to good lung function and prevention of adult COPD. Biological drugs that target T-helper 2 (Th2) cytokines are used in patients with severe pediatric asthma to reduce exacerbations and airway inflammation and improve respiratory function. They may also suppress airway remodeling in childhood and prevent respiratory deterioration in adulthood, reducing the risk of COPD and improving long-term prognosis. No studies have demonstrated a suppressive effect on airway remodeling in childhood severe asthma, and further clinical trials using airway imaging analysis are needed to ascertain the inhibitory effect of biological drugs on airway remodeling in severe childhood asthma. In this review, we describe the natural prognosis of lung function in childhood asthma and the risk of developing adult COPD, the pathophysiology of allergic airway inflammation and airway remodeling via Th2 cytokines, and the inhibitory effect of biological drugs on airway remodeling in childhood asthma. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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12 pages, 330 KiB  
Review
Lung Function Tests, Quality of Life and Telemedicine: Three Windows on the Multifaceted World of Asthma in Adolescents
by Eleonora Nucera, Angela Rizzi, Chiara Agrosì, Franziska Michaela Lohmeyer and Riccardo Inchingolo
Children 2022, 9(4), 476; https://doi.org/10.3390/children9040476 - 30 Mar 2022
Cited by 3 | Viewed by 2053
Abstract
Asthma is a heterogeneous disease usually characterized by chronic airway inflammation and recognized as the most prevalent chronic illness among children. Despite this, the knowledge as to how asthma affects adolescents is still scarce. One of the main management problems of asthmatic adolescents [...] Read more.
Asthma is a heterogeneous disease usually characterized by chronic airway inflammation and recognized as the most prevalent chronic illness among children. Despite this, the knowledge as to how asthma affects adolescents is still scarce. One of the main management problems of asthmatic adolescents is the poor adherence to pharmacological and non-pharmacological treatments. The assessment of respiratory function and the impact on quality of life are still two crucial challenges in the management of asthmatic adolescents. Additionally, the COVID-19 pandemic has prompted physicians to explore complementary management strategies including telemedicine technologies. This review aims to provide an update on the contribution of respiratory functional tests, how asthma affects quality of life of adolescents and, finally, how telemedicine contributes to the management of adolescent asthmatics during the COVID-19 pandemic. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
11 pages, 459 KiB  
Review
Heterogeneous Condition of Asthmatic Children Patients: A Narrative Review
by Cristiano Caruso, Stefania Colantuono, Stefania Arasi, Alberto Nicoletti, Antonio Gasbarrini, Angelo Coppola and Loreta Di Michele
Children 2022, 9(3), 332; https://doi.org/10.3390/children9030332 - 01 Mar 2022
Cited by 2 | Viewed by 2176
Abstract
Currently, asthma represents the most common chronic disorder in children, showing an increasingly consistent burden worldwide. Childhood asthma, similar to what happens in adults, is a diversified disease with a great variability of phenotypes, according to genetic predisposition of patients, age, severity of [...] Read more.
Currently, asthma represents the most common chronic disorder in children, showing an increasingly consistent burden worldwide. Childhood asthma, similar to what happens in adults, is a diversified disease with a great variability of phenotypes, according to genetic predisposition of patients, age, severity of symptoms, grading of risk, and comorbidities, and cannot be considered a singular well-defined disorder, but rather a uniquely assorted disorder with variable presentations throughout childhood. Despite several developments occurring in recent years in pediatric asthma, above all, in the management of the disease, some essential areas, such as the improvement of pediatric asthma outcomes, remain a hot topic. Most treatments of the type 2 (T2) target phenotype of asthma, in which IL-4, IL-5, and IL-13 modulate the central signals of inflammatory reactions. Although, there may be an unresolved need to identify new biomarkers used as predictors to improve patient stratification using disease systems and to aid in the selection of treatments. Moreover, we are globally facing many dramatic challenges, including climate change and the SARS-CoV2 pandemic, which have a considerable impact on children and adolescent asthma. Preventive strategies, including allergen immunotherapy and microbiome evaluation, and targeted therapeutic strategies are strongly needed in this population. Finally, the impact of asthma on sleep disorders has been reviewed. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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11 pages, 258 KiB  
Review
Isn’t There an App for That? The Role of Smartphone and Tablet Applications for Asthma Education and Self-Management in Adolescents
by Antonia O’Connor, Andrew Tai and Kristin Carson-Chahhoud
Children 2021, 8(9), 786; https://doi.org/10.3390/children8090786 - 09 Sep 2021
Cited by 6 | Viewed by 2381
Abstract
Asthma is one of the most common chronic diseases worldwide, with a substantial proportion of the asthma population being children and adolescents. Self-management is recognized as a key component to asthma management, with multiple international guidelines emphasizing the need for adequate self-management skills [...] Read more.
Asthma is one of the most common chronic diseases worldwide, with a substantial proportion of the asthma population being children and adolescents. Self-management is recognized as a key component to asthma management, with multiple international guidelines emphasizing the need for adequate self-management skills for good asthma control. Unfortunately, the uptake amongst young people and adolescents is low, with often suboptimal engagement to self-management education and skills contributing to poor adherence to medication as well as poor perception of asthma symptoms. Innovative solutions to deliver education and self-management to adolescents are clearly needed. mHealth is the use of mobile devices such as smartphones and tablet devices to improve healthcare and has been used in multiple chronic diseases. This review articles explores the current use of mHealth in asthma, specifically smartphone and tablet applications as a generation-appropriate, accessible delivery modality for provision of asthma education and self-management interventions in adolescents. Current evidence gaps are also highlighted, which should be addressed in future research. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)

Other

9 pages, 407 KiB  
Perspective
Vaping in Asthmatic Adolescents: Time to Deal with the Elephant in the Room
by Grigorios Chatziparasidis and Ahmad Kantar
Children 2022, 9(3), 311; https://doi.org/10.3390/children9030311 - 24 Feb 2022
Cited by 2 | Viewed by 2711
Abstract
Adolescence is a period characterized by developmental, psychological, and psychosocial alterations, with a major impact on youths’ attitudes and perceptions. Adolescents with asthma may not comply with treatment and may develop risky behaviors, including smoking, vaping, and other substance use, leading to unanticipated [...] Read more.
Adolescence is a period characterized by developmental, psychological, and psychosocial alterations, with a major impact on youths’ attitudes and perceptions. Adolescents with asthma may not comply with treatment and may develop risky behaviors, including smoking, vaping, and other substance use, leading to unanticipated exacerbations and consequences. Vaping has become extremely popular in this age group, and studies have suggested that it has potential adverse effects on asthmatic airways. More well-designed studies are needed to confirm the initial worrying data, and action must be taken by both medical officers and health authorities to deal with the elephant in the room and curb the vaping pandemic. The aim of this paper is to provide a review of the current knowledge regarding the effect of vaping on adolescents with asthma and to propose actions to restrain this fast-growing trend. Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
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