The problems of treating adolescent asthma: what are the alternatives to inhaled therapy?

The prevalence of asthma in children and adolescents continues to increase world-wide, with asthma remaining the most common chronic illness of childhood. Morbidity is high in the latter age group, indicating that many adolescents with asthma symptoms are not receiving appropriate treatment for their condition. Inadequate symptomatic control should alert the physician to the possibility of non-compliance, which is not limited to those patients with a poor understanding of their condition. Psychosocial problems, such as isolation and low self-esteem, are inherent in adolescents with asthma due, in part, to the highly visible nature of symptoms and the method of delivery of current inhaled therapy. Compliance with therapy in adolescents in particularly low if the dosing regimen is more than twice daily, with poor inhaler technique contributing to ineffective control. Failure to take asthma medication can result in asthma exacerbations and increased disease severity, with the resultant need for powerful medication and hospitalization (incurring substantial patient and healthcare costs). Although better management techniques, such as tailoring medication and individualizing treatment regimens may improve compliance in this group, there is an obvious need for alternative treatment options. An effective and well tolerated oral tablet therapy, with a simple unobtrusive regimen, would provide a potential solution to the high level of non-compliance seen in this age group. The leukotriene receptor antagonists offer a practical alternative amongst existing oral therapies, and their efficacy and simple oral dosing regimen may prove valuable in increasing compliance in adolescents.