For asthma patient Jazmin Bello, gym class was something to dread. Whenever she pulled her inhaler from her locker, the teasing would begin, with kids asking, “Do you have swine flu?” or “Is it contagious?”
But she had to puff on her inhaler before exercise or risk an attack that might leave her panicked and gasping for breath — and possibly making a trip to the emergency room.
Now a junior at NOVA Academy Early College High School in Santa Ana, the 16-year-old recalls, “I didn’t feel like a normal kid.”
Asthma affects children more often than adults and most often minority children living in poverty. As much as 40 percent of black and Hispanic children’s risk of asthma is from exposure to indoor allergens — mold, smoke and cockroaches, for example — that could be reduced or eliminated, according to a report from the Asthma and Allergy Foundation of America.
The good news is that asthma treatment has evolved over the years to rely on “controller” medicines, which are most commonly administered through inhalers, that can prevent the illness from flaring up. But these medications, which can be complicated to use and expensive, must be taken every day to work. And young asthma sufferers need regular contact with their doctors, who coordinate with school nurses to effectively manage their disease.
These challenges led Dr. Stanley Galant of Children’s Hospital of Orange County to launch the Breathmobile in 2002.
The Breathmobile is an asthma clinic on wheels, a recreational vehicle with two small offices in which to see patients. There are two in Orange County, and they travel to 24 locations, serving largely Latino populations. There is also an effort underway to bring the Breathmobile to Vietnamese-American children in Garden Grove.
“We’ve been extremely successful,” Galant said of the Breathmobile’s efforts. “We can reduce emergency department visits by 60 to 80 percent.” The key, he said, is using the vans to reach patients in their own communities, taking the time to interact with patients and their families, and doing so in the patients’ or parents’ language.
“The main answer is trust,” Galant said. “If you spend seven minutes with the patient, it’s not going to build trust. We spend eyeball time with patients, 45 minutes to an hour. Patients like us and feel that we’re simpatico and it’s not some Caucasian that doesn’t speak their language dictating and being condescending.”
The continuity of care in friendly settings helps doctors confront a recurring problem in asthma treatment: patients wanting to stop taking their daily medicines when they’re feeling well or, in Jazmin’s case, when they are self-conscious teenagers. But the medicine is key to reducing the inflammation that narrows lung passages.
Face time with patients also allows doctors and nurses to discuss the variety of inhaled medicines available, the number of devices that can be used to inhale them and the different types of breathing techniques required.
Seven-year-old Christina Magana shows how “eyeball time” can pay off. She had only rave reviews of her doctor, Olga Guijon.
“She’s kind, she’s nice, and she’s beautiful,” Christina said. “She told me asthma is serious and there are germs that can get you sick every day, so wash your hands.” Viruses can trigger asthma, so the change of seasons warrants particular attention to hygiene.
Christina takes her medicine twice a day, and her mother contacts the school nurse if she needs a dose during the school day. As a result, Christina declared, “I always breathe well.”
But not all asthma problems can be solved at the Breathmobile. In cases that don’t show improvement, doctors prescribe home visits, which Consuelo Carcel, a nurse and certified asthma educator, has made repeatedly.
Carcel said the problems often arise from congested living situations. When two or more families share a two-bedroom apartment, the combination of numerous showers and cracked pipes almost guarantees the growth of mold, a common asthma trigger, alongside tobacco smoke and cockroaches.
Santa Ana children who live in these toxic indoor environments often suffer more because their parents don’t feel safe taking them outside. A 2004 study published in the Journal of General Internal Medicine showed that neighborhoods that lack community cohesion and are perceived as dangerous seem to aggravate asthma.
The theory is, “If residents feel uncomfortable walking outside or leaving windows open to fresh air, they may be continually exposed to high levels of indoor allergens such as dust mites or cockroaches,” the study showed.
Carcel tries to help patients stuck in substandard living conditions by arranging for a doctor’s note to the landlord, and the Breathmobile staff has distributed pillowcases and mattress covers to protect against mites. She’s even advised families to store clothes and toys in plastic containers and tap food banks temporarily so they can save money for a vacuum cleaner.
On a national level, experts estimate asthma causes billions of dollars in medical costs and is a significant cause of emergency-room visits.
Locally, county data show that one of the most common reasons for children 1 to 4 going to an emergency room is bronchiolitis, a condition that can turn out to be asthma.
Asthma costs also extend beyond doctor fees and medicine. UCLA researchers estimated asthma caused 1.2 million lost days of work and 1.6 million missed school days in California in 2007.
If families are diligent about checkups, kids like Jazmin will stay in the classroom and out of the emergency room, according to Breathmobile doctors.
At a Breathmobile appointment earlier this month, Guijon gave Jazmin a handy, smaller spacer — a type of inhaling device — and medicine that she can fit discreetly into her purse. Guijon took the time to assemble the device and attach it to the inhaler, and she asked Jazmin to do the same while she observed.
For Jazmin, personal care goes a long way. As she said of Guijon, “She actually, like, cares.”
Amy DePaul is a freelance writer and lecturer in the UC Irvine Literary Journalism program. You can reach her directly at depaula@uci.edu