Experts: More solutions needed to address urban asthma
Although steps are being taken to help Detroit kids affected by asthma, experts say much more needs to be done to treat the disease and reduce the highly stressful childhood experiences that exacerbate it.
Short- and long-term strategies to reduce Detroit’s number of asthmatic children will need to address kids’ circumstances and emotional needs in addition to their medical requirements, experts said.
Some initiatives already are underway, such as in-school and mobile health clinics treating Detroit Public Schools children; grief therapy groups; and efforts to evaluate kids for stress and provide therapeutic services.
But children also need better insurance coverage of asthma medications and mental health services, clinicians said, as well as assistance to families struggling with poverty or other social issues that are making kids sick.
Elizabeth Secord, division chief of allergy, asthma and immunology at DMC Children’s Hospital of Michigan, described how decisions by state-funded Medicaid health maintenance organizations can interfere with treatment.
“I had a patient (recently) who has been in the ICU twice, in the hospital five times this year and has severe persistent asthma,” Secord said.
The patient failed to follow doctor’s orders on treatment for the disease, she said, “so we have just arranged for home delivery of medication.
“(The child’s) Medicaid plan refuses for him to continue on the combination inhaled steroid and long-acting Beta2 agonist (which relaxes and expands the airway), which is indicated for his severity of asthma because the medication was not picked up last month. We had to restart with a mild inhaled steroid and step up after he ‘fails’ therapy.”
Rosalind Wright, a leading researcher on asthma and the physiological effects of stress on children, wants to make physicians, parents and teachers more aware about the potentially severe health consequences of stress on children.
Wright’s studies have discovered that the toxic health effects of stress can start in the womb. In one study, she tested the cord blood of infants born to mothers who experienced stress during pregnancy and found they were born with immune systems primed to develop asthma.
“It is critical that we disseminate this information beyond the research journals,” said Wright, a pulmonologist and professor of pediatrics at the Icahn School of Medicine at Mount Sinai Health System in New York City.
“This means doing a better job educating our health care providers on the role of stress in childhood asthma. Health care providers need to talk to their patients and particularly pregnant women and young families about the importance of managing stress as we may actually reduce the onset of disease.”
Among the existing programs, Henry Ford Health System treats kids with asthma at seven in-school clinics and two mobile health clinics that visit the 97-school Detroit public education system. If a child’s insurance doesn’t cover the required medication, Henry Ford provides it for free.
Parents often don’t have transportation to get to a pharmacy, so medications are sent home in the child’s backpack. Since kids often administer their own medicines, they get pictorial directions on how to use them. For children who can’t read, suns and moons, smiley faces and frowny faces, indicate whether to take the medicine in the morning or at night, every day or only when they struggle to breathe.
Dr. Elliott Attisha, the Henry Ford Health System pediatrician who treats kids at Detroit Public Schools, said the school system could do more to facilitate treatment. Currently, parents fill out paper cards with emergency contacts and health information, but they’re typically filed away in a drawer in the school office until there’s an emergency. The information should be keyed into electronic records, he said.
“If there was an electronic record, teachers could get a printout of all the children with asthma at the beginning of the year — they should have this information,” Attisha said. “If the school and the teachers don’t know which kids have asthma, how will they know how to respond when there is an emergency?”
St. John Providence Health System provides grief therapy for Detroit kids and families who have experienced a death or witnessed a violent crime. Sessions took place last year during school hours at 23 Detroit Public Schools. Family sessions are held weekly at Connor Creek Community Center on Detroit’s east side. Children and adults meet separately for age-appropriate therapy.
Easter Seals of Michigan recently launched an online tool for parents, teachers and clinicians to determine if children may be suffering from the effects of stress. Easter Seals professionals use their responses to determine if a particular child should be referred for an in-depth evaluation. Depending on the results, children are provided with psychological, occupational and other therapies.
“We need to change our thinking about the interventions needed to reduce asthma morbidity in these families and communities,” Wright said. “This includes processes that we may not typically think of as an ‘asthma intervention.’
“This may include policies and legislation that lead to safer housing and neighborhoods, better day care options for families, stronger schools providing educational opportunities that break the poverty cycle.
“It will be important to think about how to partner more traditional medical care providers with allied health care providers such as psychologists and social workers.”
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