Adolescents report better rhinitis, asthma control than older patients

Key takeaways:

• Adults reported higher median electronic daily control scores for asthma than adolescents.
• The age groups reported similar antihistamine and inhaled corticosteroid use for allergic rhinitis.

Adolescents experienced better control of their rhinitis and asthma than young adults and adults, although all three age groups reported similar medication adherence, according to a study published in Pediatric Allergy and Immunology.

These findings may inform future research about how adolescents achieve control in their allergic diseases, Bernardo Sousa-Pinto, MD, PhD, researcher, Center for Health Technology and Services Research, and colleagues wrote.

The researchers examined data collected between 2015 and 2022 by the MASK-air (DG Santé) mobile app, which records daily respiratory allergy symptoms and medication use reported by users with rhinitis and/or asthma.

Designed to help these patients monitor their disease control, MASK-air was named an Organisation for Economic Co-operation and Development Best Practice for chronic diseases in 2023.

“We have validated the questions of the app, and we also wanted to assess its use in different age groups,” Sousa-Pinto told Healio.

A year ago, the researchers studied the app’s potential among an elderly population. In this study, the researchers assessed adolescents and young adults to differentiate these populations.

“In fact, there are some aspects in respiratory allergic diseases that need to be considered in younger patients,” Sousa-Pinto said.

For instance, adolescents often experience uncontrolled asthma because of poor adherence to therapy, smoking and mental health conditions, among other factors. But adolescents and young adults also may be more prone to using digital health solutions to improve self-management.

“Therefore, we wished to explore if there were differences in app use and medication adherence between adolescents, young adults and adults, as these could lead to improved care among younger patients,” Sousa-Pinto said.

Study design, results

Users included 965 adolescents (49.9% girls), aged 13 to 17 years, with 15,252 days; 4,595 young adults (56.3% women), aged 18 to 26 years, with 58,161 days; and 15,154 adults (48.4% women), aged 27 to 64 years, with 258,796 days.

Average days recorded per user included 15.8 for adolescents, 12.7 for young adults and 17.1 for adults. Also, 22.2% of adolescents, 18.8% of young adults and 19% of adults reported data to the app at least 6 days a week.

“We observed that adolescents reported similar app and medication adherence, but better rhinitis and asthma control compared with young adults and older adults,” Sousa-Pinto said.

Sousa-Pinto called these results surprising because the researchers expected adolescents to exhibit better adherence to using the app, since they were expected to be more prone to using digital health tools, but worse medication adherence.

For example, all three age groups reported similar median values for VAS for global allergy symptoms, VAS nose and combined symptom-medication scores (CSMS), the researchers said.

However, the researchers continued, median VAS asthma, VAS eye and electronic daily control score for asthma (e-DASTHMA) increased meaningfully from the adolescent age group through the young adults and then the adults, with effect sizes ranging from 0.33 to 0.75.

User-maximum VAS levels were not part of this trend, the researchers said. Also, the researchers noted significant differences in VAS global allergy symptoms, eye and asthma as well as in CSMS between the age groups in multivariable models.

All three age groups reported similar frequencies in medication use for allergic rhinitis, with effect sizes of less than 0.2. Similarly, there were no meaningful differences in percentages of days with asthma medication use, including 23.7% for adults and 17.3% for both adolescents and young adults (effect size, 0.16).

Adults had a higher percentage of days using inhaled corticosteroids (ICS) and long-acting beta agonists (LABA) at 15.1% than adolescents at 5.2% (effect size, 0.34) and young adults at 8.1% (effect size, 0.22).

The researchers also classified 4,256 users with “no evidence of asthma,” “possible asthma” or “probable asthma.” Proportions of users with these classifications were similar between the three age groups, the researchers said.

Comparisons between the age groups revealed no major changes in VAS asthma and e-DASTHMA median maximal values. There also was a trend for increased overall median values in VAS asthma and e-DASTHMA among older patients, especially for patients with probable asthma, the researchers said.

Rates of adherence to oral H₁ antihistamine treatment for allergic rhinitis included 40.8% for adolescents, 35.5% for young adults and 35.8% for adults. ICS adherence rates included 34.8% for adolescents, 27.4% for young adults and 34.9% for adults. These percentages did not indicate any trends, the researchers said.

Azelastine-fluticasone rates of adherence for allergic rhinitis included 21.1% for adolescents, 41.2% for young adults and 31.1% for adults. Effect sizes included 0.44 between adolescents and young adults and 0.23 between adolescents and adults.

ICS adherence rates for asthma included 36.8% for adolescents, 33.9% for young adults and 43.6% for adults, which the researchers called similar. ICS and LABA adherence rates included 28.2% for adolescents, 38.3% for young adults and 64.1% for adults, with small and moderate effect sizes.

All three age groups indicated higher VAS asthma and SABA use totals during weeks when they adhered to ICS or ICS-LABA treatment than weeks when they did not adhere to this treatment, the researchers said.

Finally, the researchers said, multivariable models indicated no significant associations between age groups and adherence for any medication class.

Conclusions, next steps

Although adolescents reported better disease control, the researchers said, there were no meaningful differences between the age groups in medication adherence. These findings may inform future research into how adolescents achieve this control.

“The results indicate that [mobile health] tools can be used by adolescents and young adults to adequately monitor their disease control,” Sousa-Pinto said. “In addition, the results suggest that medication adherence may not be worse among patients of these age groups.”

For more information:

Bernardo Sousa-Pinto, MD, PhD, can be reached at bernardosousapinto@protonmail.com.