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Fri April 25, 2014
Getting treatment for asthma is difficult for children living in poverty
At the C.S. Mott Children's Hospital, 11-year-old Brianna Allgood is being tested by a machine called a spirometer. It measures her breathing.
Brianna has asthma. Sometimes she has difficulty breathing. Most of us would have a hard time imagining what that’s like.
“It feels like your chest starts tightening and you’re like and you can’t really breathe much air,” Brianna said.
Vickie Elliot is Brianna’s grandmother. She says she finds herself checking in on Brianna – a lot – just to make sure she’s breathing okay.
“Having a child like that in the home is scary because anything could happen,” Elliot said.
Brianna is luckier than some kids with asthma. Her family can get her to the clinic. They now know how to treat the asthma.
Elliott says it’s made a difference.
“We’ve seen a huge improvement in the last couple of years. She’s not been in the hospital as much,” Elliott said. “This year – knock on wood – she hasn’t been there yet and we’re praying to God that she doesn’t.”
She had been in the hospital three or four times a year until the family fully understood what they had to do.
Making sure Brianna takes her twice-daily medicine and has a rescue inhaler with her at all times helps make sure the asthma is controlled. But medical personnel say making sure kids get their medication and take it correctly can be difficult for some families, especially if they don’t understand how dangerous asthma is.
Karla Stoermer Grossman is a nurse in the Children’s Asthma Wellness program at Mott Children’s Hospital. She says too many families simply accept that their children will have to get emergency help for their asthma.
“I’ve had many, many patients that have told me that, well, you know, little Billy has to be hospitalized three to four times a year and that’s just the way he is. You’re never going to make a difference,” Stoermer Grossman said. “When we are really able to get that patient’s trust and that family’s trust to have them come to clinic visits every three months as we ask them to do, we are able to decrease those hospitalizations to almost zero.”
But to get to zero, some families need help.
That’s where people like Mary Kim come in.
After kids are treated and given medications, Kim visits for follow-up help – checking to see if there are asthma triggers in the home, seeing if everyone understands how to use the medication. Today we’re visiting Jovon White.
Jovon’s mother, Lavetta White, says when she was at the hospital with him, besides being worried about her son, being bombarded with medical terms and explanations, she was given a prescription and medication instructions. It was all a bit much.
“Being at the hospital, you know, you’re with the doctors and the nurses, you know, and they’re in and out and you can only absorb so much. Then when you come home, it’s kind of, you know, gone,” said Lavetta. “You don’t remember what they told you from, you know, all these instructions when you left. So, it was very helpful to have her to come here and, you know, do everything hands-on and show us, you know.”
So, Mary Kim works with Jovon so he understands the difference between the two inhalers he’s been given to use.
The Flovent controller and the albuterol rescue inhalers can cause some confusion. The inhalers look similar. And like a lot of families, Mary Kim says the Whites benefit from the reminder.
“A lot of parents just maybe get a little overwhelmed. There’s a lot of different names for these medications,” Kim said. “And to think that talking to them once within five minutes, ten minutes doesn’t always work. Some people do, but some people don’t.”
Kim says the other trick is to make sure kids take their medication. When they’re feeling okay, it’s sometimes easy to forget. She says she had a private chat with Jovon.
“He started telling, like, in the bedroom I said, ‘Are you taking your medication every day?’ He went, ‘Sometimes I forget.’ I go, ‘That’s okay. Which dose are you forgetting?’ So, that’s all I try to say. ‘Is it the morning one or the night one?’ So, Mom and Dad have to remind him. There’s no way any of my kids can do this on their own. They need someone to remind them.”
The Whites live in an apartment. That makes it more difficult to get all the possible asthma triggers corrected. The apartment complex is not likely to replace all the carpet with hardwood floors, or put special filters on the furnace. So, the Whites do what they can.
For some families, it can get even more complicated.
Back at Mott Children’s Hospital Karla Stoermer Grossman says sometimes families are dealing with domestic violence issues, personal protection orders, sometimes Child Protective Services is involved.
And in some cases it’s simply the chaos of living in a high-crime area, as one family explained to her.
“It was very difficult for them to take daily medications because there’s a lot of violence in their neighborhood. So there was a time when they actually – you had to hide in the bathroom all night because there was bullets being shot all over the place,” Stoermer Grossman said. “And, you know, you’re not going to think about taking medications if you’re worried about a bullet coming through your window.”
And sometimes the health-care system itself can get in the way.
Stoermer Grossman says there are times the medical professionals know a child needs medication for asthma and they need it right now. But, they can’t get it.
“The Medicaid insurances often don’t let you prescribe certain medications because of the cost. And, none of the asthma medications currently out there are generics,” Stoermer Grossman said.
“So, we have problems in that the insurances require prior authorization, which take time. You have to jump through multiple hoops.”
Not much can be done about the insurance companies, or living in a high-crime area, or about family dynamics. But, in some Michigan counties there is help for some of the other issues. Wayne Children’s Healthcare Access Program goes into homes to identify some of the problems that might be aggravating children’s asthma.
Joanna Jackson works with the program through a non-profit called Clear Corps. She says it’s important in the Detroit metro area because children there are twice as likely to have asthma.
“About 20% of Detroit’s children have asthma and it’s definitely an environmental issue. A lot of the homes that we work in we see a lot of hazards that contribute to children having asthma or having those symptoms where they could develop asthma.”
Jackson says mold and moisture issues, along with rodents, are part of the problem.
The feces and body parts of cockroaches, rodents and other pests can be asthma triggers. Fixing moisture problems that cause mold or mildew can be relatively cheap, but too often families don’t have the money to fix them or they live in rental units and can’t get the problems fixed. They also can’t afford the special pillowcases or bed coverings to deal with allergens. It’s all just too expensive.
“Children in poverty are at risk because they don’t have the resources to rid their homes of things like mold and moisture, so it does take a lot of other referrals to help our families to decrease the asthma symptoms in the home,” said Jackson.
That’s where this aid helps make a lot of difference. But not every county in Michigan offers this kind of help to the families with asthmatic kids.
Besides these in-home environmental issues, there are often problems outside. People living in low-income areas often live near highways and factories. There is diesel fuel exhaust, particulate matter coming off tires, and they’re often closer to smokestack pollution. Going outside for some fresh air can be trouble for a kid with asthma because for them there is no fresh air.
In Lansing, the Michigan Department of Community Health is aware of these problems and more. John Dowling works on asthma policy issues. He says poverty also means it can be difficult to get proper and regular treatment for some kids.
“You can also have issues of access to care; maybe they don’t have access to transportation, so it’s difficult to make it to doctor’s appointments. It might be difficult for them to get to a pharmacy to get the proper medications if they have those prescriptions,” Dowling said. “Many might not have a primary-care physician. And, we do see a lot of folks relying on the emergency department for their care.”
And while the Michigan Legislature has recently increased funds for all these issues, Dowling said the state, counties, and cities like Detroit aren’t doing enough to make sure kids with asthma get all the care they need.
Dr. Toby Lewis at C.S. Mott Children’s Hospital is a leading expert on asthma in the state. She says there are sometimes temporary federal research grants to evaluate programs, but it’s never enough.
“Funding for the types of grassroots programs that would really make a difference day to day in families’ lives – there’s really no stable funding source,” Lewis says.
She says Medicaid and private insurance on their own are not enough to meet all the needs to help kids with asthma or other ailments.
“So there’s really not much public health safety net available anymore for all sorts of public health problems, of which I would include asthma as a major one,” Lewis said.
And so many kids living in poverty in cities and in rural communities go without diagnosis of their asthma or they go without proper treatment.
That costs lives.
Asthma is a life-threatening disease. Kids sometimes die from it if they’re not treated.
From 2004 through 2006, there were 393 asthma deaths among children and adults in Michigan , and 30% of asthma deaths were in Wayne County.
And the experts say every one of those deaths was preventable.
That is a high cost for something as simple as follow-up teaching on the proper way to use medication or making sure a home is cleared of the things that trigger asthma attacks.
This story comes from the State of Opportunity documentary “Growing Up in Poverty and Pollution." You can find the full documentary here. Support for State of Opportunity comes from the W.K. Kellogg Foundation, a partner with communities where children come first.
Environment & Science