Taking a breather: Students with asthma get help learning to live full lives

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Nathan Wright, an eighth-grader who lives in Penn Hills, has always wanted to play football. He dreams of playing as a defensive end or defensive tackle in college and in the NFL.

So far, he hasn’t been able to play. He’s been preoccupied with his struggle against asthma. Since he was 3 months old, the disease has kept him away from most sports, interrupted his classes at school, and kept him from visiting friends and relatives who have pets. Every once in a while, it causes a terrifying attack, triggered by heat, dust, pollen, animal hair, or seemingly nothing.

“I felt like I was dying,” Nathan said, describing one attack that happened in a Walmart. “Like I was about to pass out, go into a coma.”

Nathan’s doctor doesn’t think it’s safe for him to join his middle school’s football team, so he practices workout drills with his friends. He’s hoping that he’ll be able to play this fall: a new drug he’s taking, Zolair, has reduced the frequency of his attacks.

There are thousands of youngsters like Nathan in Allegheny County, where more than 21,000 public school students had asthma in the 2008-09 school year, according to a 2012 report from the Pennsylvania Department of Health. Like most large cities, Pittsburgh has a high rate of the disease, with pollution and poverty increasing the risk for local children.

Asthma has become more common among Allegheny County’s public school students in recent years, rising from 10.2 percent in the 2003-04 school year to 12.1 percent in 2008-09.

The reason for the increase isn’t clear, said Deborah Gentile, director of research in the Allegheny Health Network’s Division of Allergy, Asthma and Immunology. Part of it might be due to the poor economy. The recession drove down incomes, and low-income children are at higher risk of asthma. They’re more likely to live in poor housing with asthma triggers such as cockroaches, mice and dust. It’s also more common for them to be in a home where someone smokes indoors.

Stress is also an asthma trigger, and low-income children often lead stressful lives, Dr. Gentile said, dealing with problems including crowded housing, lack of sleep and unsafe streets.

With help from hospitals, universities and nonprofits, local researchers have developed a fleet of programs to attack the asthma problem. One of their goals is to teach children and parents about ways of handling the disease. Many people don’t realize that asthma requires constant treatment, such as a daily dose of medicine, Dr. Gentile said. Instead, they rely on the occasional visit to the emergency room.

“We have the specialists here, and we have the medicine, but the patients aren’t buying into it as a chronic condition that needs daily treatment,” she said.

That could be why Allegheny County has such a high rate of children visiting the emergency room because of their asthma. Between 2006 and 2010, 95.3 percent of the visits Allegheny County children made to the hospital for asthma were through the ER, according to the 2012 Department of Health report. That was the highest rate in the state, well above the average of 61.8 percent.

Jennifer Elliott, an assistant professor in the Mylan School of Pharmacy at Duquesne University, helps run asthma camps that use games to teach schoolchildren about the disease. In her six years of doing the camps, she’s learned that students respond better to hands-on activities. She rotates them between 12 stations of 10 minutes each, covering important parts of asthma treatment.

About 70 students from the Woodland Hills School District attended the camp last week. Some of them played a game like Pictionary in which they drew pictures of asthma triggers. They met with students from the pharmacy school who taught them about proper inhaler use.

“The overall message we want the kids to go home with is just because you have asthma doesn’t mean you can’t be as active as your friends, at home and in sports,” said Ms. Elliott, who holds a doctor of pharmacy degree.

The camps have changed in the past few years. Before, any children who signed up could attend. Now, the camp acts as a field trip for a local school. That way, Ms. Elliott and her colleagues can reach children whose parents don’t have the time, energy, or desire to sign them up.

Studying asthma

Anna Marsland, an associate professor in the department of psychology at the University of Pittsburgh, researches the stress that sparks and worsens asthma attacks.

“It’s unbelievably frightening to have a full-blown asthma attack and think you’re about to die,” she said.

With funding from the National Heart, Lung and Blood Institute, she teaches the children ways to calm themselves down, such as breathing deeply and slowly. It’s important for them to control their thinking, she said, to remind themselves that they’ve been in this situation before and know what to do.

She also tries to fight negative perceptions that children with asthma sometimes have about themselves — that they’re different from other kids, and disliked because of it. That can add to their stress, she said.

Often, she hooks up the children to biofeedback equipment that measures signs of stress, such as the temperature of their palms. Our palms become cold when we’re stressed out, and when the children see that happening, they realize the significance of their stress and the effectiveness of the techniques they’ve learned.

Dr. Gentile is working to improve identification of asthma among local students. In January, she and other researchers received a $415,000 grant from Heinz Endowments to, among other things, screen 150 students from the Woodland Hills School District for the disease, using breathing tests and questionnaires.

With about two-thirds of the students screened so far, she’s diagnosed about six or seven students who weren’t aware they had asthma. When the study is finished, she hopes to expand it to more school districts. Her goal is for schools to administer asthma screens regularly, like scoliosis and hearing tests. The screens would give researchers better data about the prevalence of asthma, which is much needed, Dr. Gentile said.

“People don’t recognize there’s a problem,” she said. “You’re not getting the numbers correct, and you’re not getting patients the help they need.”

Looking beyond their current research, local experts have ideas to expand the fight against asthma. Dr. Gentile thinks Allegheny County should have a better electronic network between doctors and other care providers, so they could inform each other when a patient needs treatment for chronic asthma.

And there’s the “breathmobile.” Dr. Elliott is looking for funding to buy a Winnebago RV that would travel between local schools to screen and treat students for asthma, as well as other health problems like obesity. The idea comes from Los Angeles, which has been doing it since 1995.

As for Nathan, he and his family are delighted about his improvement with Zolair, which he only got access to after a long struggle with his insurance company. But he’s taking the maximum dosage, and his parents are worried that it will become less effective as he gets older.

He’s hopeful about playing football this fall. But if he can’t, he has another dream to pursue. He wants to go to the University of Pittsburgh to become a doctor, so he can help other people with asthma.

Richard Webner: rwebner@post-gazette.com or 412-263-4903.

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