Bernardo Sousa-Pinto, MD, PhD

Credit: Universidade do Porto

Better asthma and rhinitis control is reported among adolescents aged 13 - 18 years compared to young adults and adults, according to recent findings, although similar levels of adherence to medication occur over every one of these age groups.¹

These findings resulted from a cross-sectional study designed to assess real-world data using a digital health assessment. The research was led by Bernardo Sousa-Pinto, MD, PhD, from the faculty of medicine’s department of community medicine at the University of Porto in Portugal.

Sousa-Pinto and colleagues noted that the period of adolescence, 10 - 17 years of age or so, involves specific health conditions unique to that time. They added that a US Institute of Medicine and the US National Research Council report suggested this group should be considered distinct compared to adults over 26 years of age.²

“Evaluating such differences may be particularly relevant, not only to assess medication adherence with real-world data but also to help understand the role of digital tools in the asthma and allergic rhinitis (AR) management of younger patients,” Sousa-Pinto and colleagues wrote.
“In this study, the overall aim was to compare adolescent and young adult MASK-air® users with adult users on their AR and asthma symptoms and control levels, as well as on their adherence.”

Background

The investigators used a cross-sectional study design, implementing information from ‘MASK-air.’ This was a mobile health application crafted for adults and adolescent patients with rhinitis and/or asthma, made available within 27 countries around the world.

The research team assessed 3 age ranges, labeled as adolescents aged 13–18 years, young adults aged 18–26 years, and adults aged >26 years. The team compared demographic data, reported on these subjects’ symptoms, use of medication, and adherence to treatment.

The study participants were European MASK-air users who were also over the age of digital consent, allowing the team to evaluate their data between 2015 - 2022. These subjects were placed into distinct groups, labeled by the investigators as individuals with "possible asthma," "no evidence of asthma," or "probable asthma," which they based on self-reported symptoms and use of treatments.

MASK-air was made to ensure that data privacy was implemented in addition to compliance with GDPR, with information being put in anonymously and with the geolocation data being blurred. Monitoring each day involved an evaluation of allergy symptoms’ effects and of treatment use among participants, allowing computation of combined symptom-medication scores and assessment of adherence.

Adherence to the app used by the subjects was defined by the investigators as the proportion of days in which it was used from the very first utilization, up until December 2022. Participants’ adherence to medication was determined for each of the drug classes, with the team looking at reported implementation for at least a single day, and adherence weeks being defined by them as ≥80% medication utilization reported in 6 or 7 days.

The investigators used the combined symptom-medication score, visual analogue scales on asthma or rhinitis, and the electronic daily control score of patients’ asthma (e-DASTHMA) to evaluate subjects’ symptoms and control. Multivariable regression models were also used by the research team for comparisons.

Findings

Overall, the investigators looked into the adherence rates of 965 adolescent subjects over a span of 15,252 total days. They also evaluated those of 4595 subjects labeled as young adults over 58,161 total days and 15,154 subjects labeled as adult users over 258,796 total days.

The research team’s statistical analysis, through their multivariable models, indicated that there was not a major difference in the subjects’ adherence to rhinitis treatments or to asthma treatments among the specified age ranges. The team’s findings further demonstrated that there was comparable adherence to the app among all 3 age ranges.

Notably, the investigators did find that the adolescent group had lower reported scores on the Visual Analog Scale as far as global allergy, asthma, and ocular symptoms. This was also shown to be the case with their lower Composite Symptom Medication Score compared to both young adults and those in the adult age range.

“These results suggest that adherence to medication may not be so different in adolescents compared with patients of other age groups,” they wrote. “In addition, we did not observe worse allergy control or higher risk of asthma underdiagnosis/underreporting in adolescents compared with patients of the remaining age groups.”

References

1. ^{Sousa-Pinto B, Valiulis A, Melén E, et al. Asthma and rhinitis control in adolescents and young adults: A real-world MASK-air study. Pediatr Allergy Immunol. 2024; 35:e14080. doi:10.1111/pai.14080.}
2. ^{Bonnie R, Stroud C, Breiner H, et al. Investing in the Health and Well-Being of Young Adults. 2015. Accessed October 31, 2023. https://www.ncbi.nlm.nih.gov/books/NBK284791/.}