Remember when I wrote about how Children’s Hospital in Boston was dealing with the asthma problem?  (What?  You don’t?  Shame on you.  Here is the link ☺ )   As I said then, that’s the sort of practice that needs to be everywhere to manage our overall healthcare costs.  And, now, Children’s National Medical Center (DC) is employing a similar practice.  Which is a very good thing- since DC has among the highest rates of pediatric asthma in the US.  And, one where the area emergency rooms (ER) are the modality of choice far too frequently (in my humble – or not– opinion).

Asthma is one disease where those who are “rich” and those who are “poor” receive completely different treatments.  The poor (typically Black) children end up in the ER- and are about 10X more likely to be there than their richer (typically White) brethren.  And, the key takeaway is that most of those ER visits should never have occurred in the first place.  These visits almost always mean extra days of valuable classroom time are missed, as well.  So, the child’s education is at risk.

Now, I know many researchers claim one of the reasons for this discrepancy is that there are a plethora of asthma specialists in the richer parts of the city- with maybe one practitioner in the poorer sections.  But, the DC area does have a Metro service (bus and subway) that means this should not be an overreaching issue.  The cost for such a doctor’s visit- now, that is an issue.

(That is, until Obamacare kicks in- which is part of the reason that this program is starting now.  Because this care will now be “compensated” and not just an unpaid bill.)

Children’s now has an Asthma Clinic.  Once a child has “visited” the ER, the family is asked to come in for an assessment. (The time frame is short- kept to less than two weeks, so the horror of the visit is fresh in the family’s mind and adherence to any new protocols is more likely.)  And, instead of an in-and-out visit (on the order of 15 minutes), the team (physicians, nurses, and educators) spend close to 90 minutes or so developing a program for the child.

Things like seasonal affects, the impending attack that is typically brought on by a cold- all those issues are new to many of these families.  The effects of different drugs- daily inhalers (steroids) and rescue inhalers (albuterol) and even allergy medicine to preclude those asthma triggers- are explained. The parents and child are taught that shaking the inhaler for five (5) seconds- not a half-hearted flick- means the difference between active drug delivery or not; holding one’s breath for a count of ten and repeating the procedure after waiting 60 seconds are also part of the training.

Nasal sprays, masks (if employed), spacers (to insure the medication is properly inhaled), and nebulizers are among the array of choices presented to the family.  And, the clinic recognizes that this is not a one-time only process; continued reinforcement and training is an absolute requirement.  As opposed to the practice of precluding the child from exercise, parents are told that exercise is critical to insure the development of better lung capability.  (Of course, swimming is an ideal exercise, but that is one more difficult for those with fewer economic resources to include in the regimen .)

Most important is educating the family that asthma is a chronic condition- one that requires continued medication.  One does not stop the inhaler after a few days, because the child is “better”.

Part of the problem (at least in the DC area- but I’ll bet it’s true everywhere) is that the poor live in less-than-adequate housing, replete with poor ventilation, surrounded by environmental triggers (for the asthma).  None of which are under the control of the family.  Fewer still have primary care physicians.

This is why another test program is being developed.  School nurses will now be trained and empowered to deliver the inhaled drugs to students in their schools on a daily basis. To insure more compliance with the maintenance protocols.

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