Abell Salutes: The Community-Based Asthma Program

July 1995 / Salutes / Health and Human Services

it manages children to manage their asthma — and lead normal lives again.

“Mommie, am I going to die?”…

More than 200 young people from ages two to 12 in four Balti­more elementary schools who couldn’t function because at times they couldn’t breathe, now can do both. They are the victims of the malady known as asthma, but they are the beneficiaries of a small miracle known as the Oliver Com­munity School-Based Asthma pro­gram. Let them tell you how, for them, the program has let them live more normal lives.

Davon (eight): “I would be run­ning, and then I couldn’t breathe. I got scared. They took me to the emer­gency room of Hopkins. I said to my Mom, ‘Mommie am I going to die?’”

Tavon: (six): “It was so bad I couldn’t catch my breath. It hap­pened often in very cold weather. My mother would have to keep me home from school…”

Angelesia (ten): “When asthma acts up, it’s frightening. You walk around scared. You never know when your breathing is going to stop. But the program has changed all of that for us.”

Davon: “When my asthma acts up, when I can’t breathe, I just go inside somewhere, I take my medi­cine and I stay calm. But it doesn’t happen to us much any more. Used to be, a lot of us missed school often. We don’t miss school because of our asthma.”

Angelesia: The program provides us with medicine — it’s important to take it, and with certain breathing devices, and it’s important to use them. We carry all of it with us, or we’re never far from them.”

Davon: Our whole house has changed. The program got my parents to stop smoking. We threw out all our stuffed animals. We even had to get rid of Spike — our dog. But now we can breathe…we run and play with the other kids, and we go out in most any kind of weather.”

Angelesia: “The program has changed our lives…”

The Oliver Community School­ Based Asthma program was initiated in 1993 with an Abell grant to Johns Hopkins University. It is a pilot project designed to demonstrate the effectiveness of a working part­nership between neighborhood schools and outreach efforts of Johns Hopkins. The project’s objectives are to reduce the incidence of child­ hood asthma in Baltimore’s inner city; to reduce absenteeism and hospital emergency room usage; and to increase the community based sup­ port available to parents dealing with asthma-related problems.

In Baltimore, 12 percent of Bal­timore City’s first graders and 11.2 percent of eleventh graders have asthma, reflective of national trends of asthma among inner city youth. Asthma is the cause of 6.1 percent of pediatric admissions at Johns Hopkins, making it the most common admitting diagnosis for children. Sixty-seven percent of the children receiving homebound teaching in Baltimore City through the Chronically Health Impaired Program are enrolled for asthma related problems.

The costs of asthma related hos­pitalization and emergency room visits are great. If asthma can be better managed by children and their parents with minimum use of emer­gency hospital services, public costs to support the asthma population and the number of difficult episodes ex­perienced by children would be decreased. It would follow that school attendance and attention in class would likely improve.

The more than 200 students, identified through teachers, school nurses and health department records, attend educational sessions in schools. Their pulmonary function is monitored by a nurse. Parents attend the last session and receive separate adult-oriented education. Community health workers, recruited from among the parents con­duct home visits and assist families with environmental problems.

The two-year old program serves students in four Baltimore City el­ementary schools who have been identified as in need of the program: Harford Heights, Dr. Bernard Harris, Sr., Johnson Square, and Madison Square. Dr. Peyton Eggleston, Pro­fessor of Pediatrics at Johns Hopkins University Hospital, is the director; the initiative is sponsored by the hospital and The Abell Foundation, and costs $180,000 annually.

According to Daphne Morgan, a nurse in the program working at Harford Heights, “Experts say asthma is the number one reason children miss school, show up in emergency rooms, and are admitted to hospitals.

“Although a minor problem in the suburbs, physicians describe asthma as out of control in cities like Baltimore, because of problems such as deteriorating housing and pollution.”

Among the first group of children evaluated after participation in the program, 63 percent had missed school because of asthma before entering the program, and only five percent the semester after the inter­vention. The follow-up evaluation of over 150 children showed that almost half of the children had vis­ited the emergency room for acute asthma at least once before the program and 16 percent reported a hospitalization; after enrollment in the program, only 12 percent had visited an emergency room and five percent were hospitalized.

In addition to the classroom ses­sion and home visiting program, families are served by a hotline in the Johns Hopkins Pediatric Emergency Room and a pharmacy safety net, a program designed to ensure the availability of necessary medications that has been created working through local pharmacists.

Not inconsequentially, the pro­gram has resulted in meaningful sav­ings to hospitals participating in the program. In the fall of 1994, 114 children had adequate follow-up data. Before the program they reported a total of 56 emergency room visits and 29 hospitalizations for asthma in the previous six months. When evaluated six months after the program, this same group reported 13 emer­gency room visits and six hospital­izations. Hospital costs to serve this group before the operation of the program were $136,750; afterwards, $29,000. The savings ($107,750) are over the annual cost of the program.

Continuation of the program has been underwritten by a grant through Johns Hopkins from the Health Ser­vices Cost Review Commission of Maryland.

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Perhaps little Davon, an eight year old first grader at Harford Heights Elementary School, speaks the gratitude of all of the children in the program: “I learned how and when to take my medicine. I learned how to relax and stay calm. I learned how to live a normal life.”

These children, once frightened, are now confident. They can breathe easier.

And because they can, we can, too.