Nathaniel Perez is typical of many children who are served by the Children's Hospital Primary Care Center in Turtle Creek.

He has asthma, a chronic lung disorder.

Now 4, Nathaniel developed wheezing and a runny nose as an infant.

"I took him to the emergency room three times a year," said his mom, Susan Adams, 43, of North Versailles. "Overnight, his eyes would just glaze over.

"Now if he coughs, I rub him with Vicks VapoRub and prop his head up until he feels better."

In addition to taking Pulmicort and Albuterol, Nathaniel needs a dust-free environment, so mom thoroughly cleans and dusts their home every week.

Nathaniel has not needed the emergency room this year. He watches "Mickey Mouse" and rides his scooter just like many other healthy 4-year-olds.

His condition warrants concern, though. And he is not alone in the area in which he lives.

When doctors at the Turtle Creek clinic studied patient billing codes, they found that a whopping 13 percent of the children treated there have asthma.

That is twice the national rate.

More than 6 million children nationwide have asthma. Although there is a genetic predisposition to that disorder, the children being treated in Turtle Creek are more likely to have asthma due to environmental factors.

Years of industrial pollution have contributed to poor air quality in that area.

Dr. Marin Kiesau conducted patient focus groups and found that many of the children live in homes with smokers.

"Second-hand smoke is known to cause asthma, seasonal allergies and eczema." Dr. Kiesau said.

On Friday, Children's Hospital's Division of General Academic Pediatrics announced a pilot project to address the childhood asthma problem in the Turtle Creek area.

Rep. Paul Costa, D-Wilkins, presented hospital officials with a $10,000 state grant that will be used to fund The Asthma Quality Improvement Program.

AQuIP is designed under guidelines established by the National Institutes of Health for the diagnosis and treatment of asthma.

Developed under the leadership of Drs. Alejandro Hoberman, Debra Bogen and Kiesau, AQuIP includes specific steps to improve home management of that condition and to ensure that patients are seen by a physician at regular intervals and are taking medications to prevent asthma attacks.

Normal funding sources, such as the National Institutes of Health, were not available for this initiative. It is not typical for the state to fund these types of programs.

"Rep. Costa was quick and generous," Dr. Kiesau said. "He took specific interest in his community."

Rep. Costa represents the 34th District, which comprises parts of Pittsburgh's 14th Ward, Wilkins and North Versailles, and all of Braddock, Braddock Hills, Chalfant, Churchill, East McKeesport, Edgewood, Forest Hills, North Braddock, Rankin, Swissvale, Turtle Creek and Wilmerding.

"My district has the highest rate of asthma in Allegheny County," he said. "Factors are hygiene, low income and indoor smoking."

Dr. Hoberman, chief of General Academic Pediatrics at Children's Hospital of Pittsburgh, referred to a 45-page book of guidelines established by The National Heart, Lung and Blood Institute in 2007. The guidelines identify asthma triggers, yet many community-based primary care physicians do not adhere to those guidelines.

"Modifying provider practice behavior to adhere with published guidelines is expected to improve patient asthma control, quality of life and satisfaction with medical care," Dr. Hoberman said.

"In addition to provider practice behavior change, effective daily control of childhood asthma is dependent on adequate and appropriate patient/family education on how to care for their asthma."

The Turtle Creek clinic is a training site for medical students and residents.

Dr. Bogen, associate professor of Pediatrics at Children's Hospital, said, "We know that when you train physicians, they will practice that way all of their lives.

"This is a quality improvement initiative. We want to teach trainees to be adaptive and learn new strategies.

"Our clinic serves over 1,000 patients in this region. The patient population is over 85 percent publicly insured. The clinic is an active training site for Children's Hospital pediatric and medicine-pediatric residents and medical students from the University of Pittsburgh School of Medicine."

Dr. Sanjay Lambore is the medical director of the facility. Other key individuals involved are Dr. Reed Van Deusen and nurse Dorcas Caldwell.

For more information about the Children's Division of General Academic Pediatrics, go to www.chp.edu. For more information on the treatment of childhood asthma, go to the Children's Asthma Center at www.chp.edu/asthma.