Focusing consultation on areas where AYA say they are not confident may be recommended to improve self-management including adherence (Grade C, Evidence level IV) Focusing consultation on areas where AYA say they are not confident may be recommended to improve self-management including adherence (Grade C, Evidence level IV) Focusing consultation on areas where AYA say they are not confident may be recommended to improve self-management including adherence (Grade C, Evidence level IV)
Strength of recommendation: Weak recommendation based on low risk of bias in cross-sectional 28,30 and qualitative studies29,31-33. These included AYA with both asthma28,33 and food allergy29-32. Other considerations: Barriers to self-management associated with poor self-efficacy should be identified so that specific measures can be taken to overcome these.7 References: Rhee28, Saleh-Langenberg30, Jones31, Jones29, MacAdam32, Holley33
Formulation of a personal action plan with the AYA and their family to enable them to self-manage their allergy and asthma may be recommended (Grade C, Evidence level 1-IV) Formulation of a personal action plan with the AYA and their family to enable them to self-manage their allergy and asthma may be recommended (Grade C, Evidence level 1-IV) Formulation of a personal action plan with the AYA and their family to enable them to self-manage their allergy and asthma may be recommended (Grade C, Evidence level 1-IV)
Strength of recommendation: Weak to moderate recommendation based on high risk of bias in one randomized controlled trial46 and on low risk bias in cross-sectional studies29,31,45. These included AYA with both asthma46 and food allergy29,31,45. Other considerations: Smartphone based personalized action plan may lead to improvement in asthma control test46. Other formats may be preferred by some AYA. A plan should be in used from before adolescence and be regularly reviewed by all patient’s HCPs. References: Perry46, Jones29, Jones31, Warren45
Peer-led interventions are recommended to improve asthma related quality of life, asthma knowledge, and to reduce asthma related doctor visits and school absence (Grade A, Evidence level I) Peer-led interventions are recommended to improve asthma related quality of life, asthma knowledge, and to reduce asthma related doctor visits and school absence (Grade A, Evidence level I) Peer-led interventions are recommended to improve asthma related quality of life, asthma knowledge, and to reduce asthma related doctor visits and school absence (Grade A, Evidence level I)
Strength of recommendation: Strong recommendation based on low47,51 and moderate risk of bias 48-50 interventional studies focusing on AYA with asthma. Three studies assessed the impact of the Triple A programme47,48,51. Other considerations: Peers included in the studies were older AYA from similar backgrounds, either with or without asthma, trained to ‘teach’ allergic teens. This approach is also likely to be useful for other allergic conditions. There is the potential that peers model suboptimal behaviours; good selection and training processes are needed. References: Al-Sheyab47 , Gibson48, Rhee49, Rhee50, Shah51
Supporting the AYA, family and the wider community to allow the AYA inclusion in social events (e.g. sports, celebrations, holidays) may be considered (Grade D, Evidence level IV) Supporting the AYA, family and the wider community to allow the AYA inclusion in social events (e.g. sports, celebrations, holidays) may be considered (Grade D, Evidence level IV) Supporting the AYA, family and the wider community to allow the AYA inclusion in social events (e.g. sports, celebrations, holidays) may be considered (Grade D, Evidence level IV)
Strength of recommendation: Weak recommendation based on low risk of bias in a cross-sectional study55 and qualitative studies52-54. These included AYA with either asthma53-55 or food allergy52. Other considerations: Aim for better participation, less bullying and gaining fitness. For example, there are sports, such as swimming, that less likely to trigger asthma. Adopting specific strategies may allow AYA with food allergy. or asthma to safely participate in trips, parties and other social events. References: Winn55, Mackenzie52, Mammen54, Mammen53
Motivational interviewing can be recommended to improve asthma symptoms and quality of life (Grade B, Evidence level I) Motivational interviewing can be recommended to improve asthma symptoms and quality of life (Grade B, Evidence level I) Motivational interviewing can be recommended to improve asthma symptoms and quality of life (Grade B, Evidence level I)
Strength of recommendation: Moderate recommendation based on one randomised controlled asthma trial56. Motivational interviewing has been demonstrated to be effective across many areas and is likely to also be helpful with allergy. Other considerations: This needs the active involvement of the AYA. Motivational interviewing includes strategies to increase motivation, shared decision making and goal setting. Reference: Seid56