Breathing Lessons, Part II

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Nearly 3 million workdays are lost each year because of asthma. Moreover, it is the nation's leading cause of school absenteeism.

Eggleston discounts air pollution, which some researchers have cited as a possible contributing factor. Air quality, he points out, has actually improved in most of the nation's cities. "And yet asthma is increasing," he says. "So I don't think outdoor pollutants are really related to the problem." In fact, he recommends that asthmatics get fresh air as often as possible.

Whatever the reasons for the growing number of asthma cases, the effects are far-reaching. According to the Asthma and Allergy Foundation of America, nearly 3 million workdays are lost each year because of the disease. Moreover, it is the nation's leading cause of school absenteeism.

It's lunch hour on a cold, gray December day, and the health clinic at Harford Heights Elementary is buzzing with activity. Several students have dropped in to be treated for their asthma. One of them, 11-year-old Dominique Williams, was sitting in his classroom when he started to feel dizzy. "And my chest was hurting," he says. Maggie Singleton, the nurse, checks his breathing with a stethoscope. "Right now," she says, "his lungs actually sound quite clear." She determines that the boy doesn't need to use the nebulizer; his inhaler, which he keeps in the clinic, should do the trick.

Meanwhile, a lanky boy named Craig Lyles, dressed in baggy green pants and black Fila sneakers, is hooked up to the nebulizer, a small metal box that emits a steady humming sound. "Craig used to come in every day at noon for this," Singleton says. "But he had a pretty bad attack back in October and ended up being hospitalized. Then his doctor changed his medicine around. So now he comes in only when he needs it, and he takes his other medicine more consistently." Like Dominique, Craig was sitting in his class when he felt the stirrings of an attack, so he hightailed it to the clinic.

After a few minutes, the nebulizer suddenly stops working. "That's weird," Singleton says. "Something must be wrong with the outlet." She picks up the machine, with Craig still attached to it, and moves them both to another room, where she plugs in the nebulizer. Still nothing. Finally, she bangs it with her fist, and it starts humming again. The nurse leaves the room, but a few moments later she hears a loud crash. Craig, who is constantly in motion, has managed to pull the nebulizer off the table and onto the floor. Singleton rolls her eyes. "And I wonder why they don't work," she says. "Craig, honey, you need to sit still, please."

"We think this has been an effective program because of the venue. By making it school-based, you have the asthmatic kids 'captured.' And we can stay in touch with them once they've been identified."

Peyton Eggleston
Johns Hopkins Hospital

"I didn't do that!" he replies. "It was moving by itself!"

Singleton rolls her eyes again.

Fifteen minutes later, Craig is finished. Judy Kandel, the nurse practitioner who runs the clinic, tells the boy, "Will you please go home and tell your mom that you got a treatment here, OK? And that you'll probably need another treatment in a few more hours." Craig nods his answer yes and runs out the door, saying, "I gotta go. Bye!"

Doctors at Johns Hopkins Hospital, about a mile south of Harford Heights, are all too familiar with asthma, which accounts for 10 percent of the emergency room visits to the medical institution. Five years ago, the hospital's office of community health decided to create a program that would address the problem in the immediate neighborhood. Peyton Eggleston was pegged to run the pilot effort, called the Oliver Community School-Based Asthma Program. Eggleston and his staff launched the initiative at four elementary schools, including Harford Heights. With the help of a $50,000 grant from the Abell Foundation, a local charity, the program was inaugurated in 1992. Daphne Morgan, a registered nurse, coordinates the effort out of a small office at the Harford Heights health clinic. The goal is to teach children with asthma how to manage their disease, which in turn will reduce school absences and decrease emergency room and hospital visits.

Every semester, Morgan selects 12 asthmatic students from each school to participate in a pullout course, developed by doctors at Georgetown and Howard universities in nearby Washington, D.C., called the A+ Asthma Club, which consists of six one-hour sessions. Meanwhile, four community health care workers--one for each school--visit the students' homes three times a year to meet with parents, who are taught how to treat their child's asthma, how to keep their home clear of cockroaches and other allergens, and how to access proper medical care. The health care workers provide the families with free mattress and pillow encasings (which help contain dust mites), free peak-flow meters (which measure the speed at which air is blown from the lungs), and free cockroach extermination.

More than 450 children have participated in the program. And while asthma continues to be a huge problem in the Oliver community, the initiative does seem to be making a difference. According to an informal survey, nearly half the program's participants had visited the emergency room for acute asthma at least once in the six months before they entered the program, and 16 percent required hospitalization. During the six months after the program ended, however, only 12 percent visited the emergency room, and only 5 percent were hospitalized.

"We think this has been an effective program," Eggleston says, "and we think it's done a lot more than other asthma programs. And we think it's because of the venue. By making it school-based, you have the asthmatic kids 'captured.' And we can stay in touch with them once they've been identified."

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