Adolescent treatment compliance in asthma

The term compliance is defined in the dictionary as ‘to consent’ or ‘to do as asked’. With adolescent behaviour these two definitions are not the same thing: many adolescents will consent to treatment in the clinic but do not do as asked when they return to normal day-to-day life. The term adherence in relation to treatment is also widely used and is defined as ‘wilful intention’. Non-adherence would therefore be the wilful intention not to do something. Ordinarily, the word compliance refers to taking the correct dose of prescribed medication at the correct intervals. In real life doses are often omitted and the intervals between doses are commonly longer than they should be; a rarer form of non-compliance is over-consumption of medication. Yet compliance affects many other aspects of the management of chronic conditions, such as avoidance of aggravating factors, monitoring, appointment-keeping, prevention or applying an emergency plan of action when needed. The term concordance has also been introduced to reflect an alliance of equals, professional and patient, rather than one-sided obedience1. The direct involvement of patients in decision-making is now central to policy in the National Health Service. However, the concordance concept is not discussed further in the current review because of the scarcity of evidence-based data on its application to asthma treatment. Here we review the complex issues of compliance with asthma treatment in adolescence and how they can be assessed, understood and addressed.