Transition to adult care in cystic fibrosis: The challenges and the structure.

In developed countries, it is projected that there will be a 70% increase in the number of adults living with Cystic Fibrosis (CF) between 2010 and 2025. This shift in demographics highlights the importance of high-quality transition programmes with developmentally appropriate integrated health care services as the individual moves through adolescence to adulthood. Adolescents living with CF face additional and unique challenges that may have long-term impacts on their health, quality of life and life-expectancy. CF specific issues around socially challenging symptoms, body image, reproductive health and treatment burden differentiate people with CF from their peers and require clinicians to identify and address these issues during the transition process. This review provides an overview of the health, developmental and psychosocial challenges faced by individuals with CF, their guardians and health care teams considering the fundamental components and tools that are required to build a transition programme that can be tailored to suit individual CF clinics.

Diagnosis and management of asthma in adolescents.

OBJECTIVES: In this review we explore some of the issues surrounding the diagnosis and misdiagnosis of asthma in adolescents and suggest a management approach which might facilitate the provision of optimal treatment in order to minimise morbidity from asthma in this vulnerable and often difficult-to-manage age group. RESULTS: We highlight important diagnostic traps which occur in the adolescent age group, including the misdiagnosis of asthma in young people presenting with exercise-related symptoms or cough, and stress the importance of considering alternative diagnoses, including vocal cord dysfunction. We explore how adolescence impacts on asthma management and emphasise the importance of an understanding of normal adolescent development and an awareness of high-risk indicators in developing a strategy to optimally manage a young person with asthma. We also illustrate how psychosocial functioning may impact on both perceived asthma severity and quality of life as well as interfere with optimal asthma control both directly and by increasing non-adherence. A suggested management strategy for adolescents is provided which emphasises a supportive approach to help facilitate optimal control of asthma by involving the young person in management decisions about their asthma. Specific mention is made about smoking cessation assistance and the interrelationship between physical activity, obesity and asthma. Finally we discuss the importance of an appropriate transition process to prepare the young person for transfer from child-centred care to adult-centred care. CONCLUSION: Many different factors is of outmost importance when diagnosing adolescents with shortness of breath; furthermore, management of asthma need a supportive approach in both paediatric and adult setting.

Alcohol, drugs and Australian young people.

Experimentation with alcohol and other drugs is often seen as a normal part of adolescent development. The harm associated with substance misuse in young people include injury, violent behaviour, sexual risk taking, drink-driving, overdose, toxicity and death (1-4). Australian young people are drinking alcohol and using illicit substances at an earlier age than previous cohorts (5). hey are more likely to binge drink, have poly-substance use and are at risk of co-morbid mental health problems (1-3). The reasons young people use drugs are complex and varied. An effective response to illicit drug use by young people has to be holistic, as complex and varied as the needs it addresses. It must seek to prevent minimize and manage harm caused by drug use and must be provided to and involve young people in the context of their family, peer group, school and community. Reaching out to young people with drug and alcohol problems is everyone's responsibility. Australia has developed specific prevention and early intervention programs for young people at risk of substance abuse however, further research and development is still needed for effective prevention, early intervention and treatment programs.