Clinical and therapeutic aspects of allergic asthma in adolescents During the last 10 years, several epidemiological studiesdealingwithasthmaandallergicdiseases, mainly based on questionnaires, have been per- formed all over the world. The European Com- munityRespiratoryHealthSurvey(ECRHS)(1), the National Health And Nutrition Examination Study (NHANES) (2) and the International Study of Asthma and Allergies in Children (ISAAC) (3) are probably the most known large population-based studies. All these studies, although carried out with different methods and questionnaires, showed consistently that the prevalence of asthma ranges between 5% and 15% in the general population, and that the overall prevalence of asthma is constantly increasing or, at least, not decreasing (4). More- over, several studies focused on the paediatric population, as in this age range the disease ÔasthmaÕ is quite more difficult to diagnose and manage, and a detailed study of asthma in children can help to find important predictors for the subsequent outcome in adult life (3). Nevertheless, at present, little is known about the characteristics of asthma in adolescence in the real life (5). Adolescence is characterized by rebelliousness, unpredictability and seeking for autonomy and independence from parental authority. This is associated with consequent problems concerning management, perception of diseaseandadherencetotherapy.Itisinfactwell known that adolescents usually refuse their illness, do not seek for medical advice or do not want to use inhalatory medications and consequently have a very poor compliance with Lombardi C, Gani F, Landi M, Boner A, Canonica GW, Passalacqua G. Clinical and therapeutic aspects of allergic asthma in adolescents. PediatrAllergyImmunol2003:14:453–457. Ó2003BlackwellMunksgaard Little is known about the management of asthma in adolescents. We aimed at evaluating these aspects, through a specific questionnaire, in the real life of adolescents with allergic asthma.The questionnaire was administered to a group of adolescents after a diagnosis of allergic asthma. The diagnosis was based on history, clinical examination, pulmonary function tests and allergy tests. One hundred and fifteen adolescents (65 males, mean age 16.5 years) fulfilled the criteria for allergic asthma. The questionnaire explored demography, family his- tory, clinical history, previous diagnosis, therapy, attitude towards therapy and social aspects. The mean actual FEV 1 was 87 ± 10%. Methacholine challenge was carried out in 79 patients and was always positive(PD20 < 1200 lg),whereas36patientsunderwentreversibility test. According to GINA guidelines, severity of asthma resulted inter- mittent in 62, mild persistent in 31, moderate in 19 and severe in three patients. In 61% of cases teachers were not aware of the disease. Asthma was managed by general practitioners, allergists and pulmo- nologists, but PFT/allergy tests had never been performed in 14% of patients. Forty-two per cent of the adolescents received no therapy at all,andonly15%ofthosewithpersistentasthmawerereceivingastable treatment.Seventy-fourpercentofadolescentspreferredtheinhaled,as against the oral, route. From a clinical and functional point of view, asthma in adolescents did not differ from other age ranges. Nevertheless, the management (diagnosis and therapy) emerged to be unsatisfactory from many points of view. Carlo Lombardi 1 , Federica Gani 2 , Massimo Landi 3 , Attilio Boner 4 , Giorgio Walter Canonica 5 and Giovanni Passalacqua 5 1 Allergy and Respiratory Unit, Department of Internal Medicine, S. Orsola Hospital, Brescia, 2 Allergy Unit, San Luigi Hospital, Orbassano, Turin, 3 Paediatric National Healthcare Unit, Turin, 4 Department of Paediatrics, University of Verona, Verona, 5 Allergy and Respiratory Diseases, Department of Internal Medicine, University of Genoa, Genoa, Italy Key words: allergic asthma; adolescence; management; treatment Giovanni Passalacqua MD, Allergy and Respiratory Diseases, Department of Internal Medicine, Pad.Maragliano, L.go R.Benzi 10, 16132 Genoa, Italy Tel.: +390103538908 Fax: +390103538904 E-mail: passalacqua@unige.it Accepted 11 May 2003 Pediatr Allergy Immunol 2003: 14: 453–457 Printed in UK. All rights reserved Copyright Ó 2003 Blackwell Munksgaard PEDIATRIC ALLERGY AND IMMUNOLOGY 453