A 14-year-old boy is brought to the office by his mother for a 6-month checkup for asthma. Although the patient's asthma is generally well controlled with long-acting agents, he has episodes of exercise-induced bronchoconstriction for which he was prescribed a short-acting beta agonist. His mother became concerned after the physical education teacher called from school saying that her son was refusing to participate in class. When asked about this, the patient said that it was easier to avoid exercising than to use an inhaler at school. Family history is significant for chronic obstructive pulmonary disease (COPD) in his maternal grandfather, heart disease in his father, and generalized anxiety disorder in his mother. Vital signs and physical examination are within normal limits. Which of the following factors would most likely increase this patient's adherence with bronchodilator administration?

Question

A 14-year-old boy is brought to the office by his mother for a 6-month checkup for asthma.  Although the patient's asthma is generally well controlled with long-acting agents, he has episodes of exercise-induced bronchoconstriction for which he was prescribed a short-acting beta agonist.  His mother became concerned after the physical education teacher called from school saying that her son was refusing to participate in class.  When asked about this, the patient said that it was easier to avoid exercising than to use an inhaler at school.  Family history is significant for chronic obstructive pulmonary disease (COPD) in his maternal grandfather, heart disease in his father, and generalized anxiety disorder in his mother.  Vital signs and physical examination are within normal limits.  Which of the following factors would most likely increase this patient's adherence with bronchodilator administration?

Quizplus · Accepted Answer

Adolescence involves the developmental tasks of separating from parental figures and finding one's own place in society, which includes beginning to take responsibility for one's physical health. This exploration is often accompanied by rebelling, pushing limits, and having a strong need to fit in with a peer group, all factors that may contribute to low treatment adherence rates. In particular, adolescents with chronic medical conditions may hide their illness due to feeling self-conscious and different from their peers. Factors associated with better treatment adherence rates include close peers with complementary behavioral practices, positive family functioning, school involvement, physician empathy, and immediate benefits of treatment. Another factor affecting adolescent treatment adherence is that the prefrontal cortex (center of executive function) does not fully develop until the third decade of life. Compared to adults, adolescents are less able to weigh the risks and benefits of their decisions or to anticipate that negative consequences may occur. (Choices A and D) Although education and written instruction are important in increasing adherence, adolescents struggle to conceive of possibilities outside their immediate experience and do not anticipate negative consequences happening to them. The desire to improve long-term asthma symptoms or to prevent chronic obstructive pulmonary disease is unlikely to be a major motivating factor. (Choice B) Although learning about role models (eg, famous athletes) with asthma might be helpful, similar peer behavior is more likely to decrease this patient's embarrassment about using an inhaler in the school setting. (Choice C) Physician education about the patient's illness is unlikely to be as strong a factor in adherence as peer acceptance. As adolescents strive to become more independent, they may rebel against authority figures, including physicians. (Choice F) Although parental attitudes and support are important in helping adolescents maintain adherence, making the patient feel responsible for causing his mother's concern is inappropriate and unlikely to facilitate adherence. Educational objective: Adolescents have low treatment adherence rates due to issues with autonomy, rebellion against authority, increased self-consciousness, and a lack of understanding of potential risks. Peer behavior has a strong influence on adherence due to adolescents' desire to fit in with their social groups. __________ References: [Adolescence and asthma management: the perspective of adolescents receiving primary health care]. (http://www.ncbi.nlm.nih.gov/pubmed/25479845) The adolescent with asthma. (http://www.ncbi.nlm.nih.gov/pubmed/23972334)

A 14-Year-Old Boy Is Brought to the Office by His