Drowning on Dry Land

Rising asthma rates have experts scratching their heads - and children struggling to breathe

The 18-stage game takes kids through their bedroom, school and inner-city neighborhood. The last level takes them to the castle of Dr. Foulair, who has invented antipollution technology to save the earth's air. The kids have to sneak into the dungeon past a sleeping dragon to get the plans, fighting and eliminating asthma triggers along the way.

The game teaches kids how to handle and control their asthma. It takes away their fear and total dependence on adults.

"We're trying to arm them," says Dr. Ross Shegag, a research associate at Baylor College of Medicine and one of the game's creators. "We're making the child a part of the asthma team."

But there are triggers kids can't control or avoid in a school environment. The Partners researchers did a complete environmental assessment of each school. At some they found dirty air vents and open doors letting in dust and moist, moldy air. Most schools have carpets collecting dust or mold. Few have a nebulizer.

The researchers made suggestions for the schools to use more air-quality-friendly products: Get rid of chalkboards and replace them with dry-erase white boards and unscented markers; put in better, higher-quality air filters; and require custodial crews to use less bleach and more unscented germicides. They also suggested schools buy one breathing machine and multiple disposable mouthpieces.

Some schools took the suggestions, and some didn't, says Shellie Tyrrell, project coordinator for the Partners program. Right now there isn't a law to make them comply. Even when the Toxic Substances Control team investigates schools, or homes, it's only advisory, says Jaye Stanley, the program manager at the Texas Department of Health.

Michele Coakley is another advocate educating asthmatics in area schools. As program administrator for the Houston Chapter of the ALA, Coakley speaks to schoolchildren about asthma. She sees more asthmatic students around Pasadena, Pearland, Clear Lake and near the Ship Channel. At every school she asks asthmatics for a show of hands. At La Porte High School 78 out of 110 students raised their hands.

"It's reaching epidemic proportions," Coakley says.

Coakley teaches the Open Airways in the Schools asthma management program sponsored by the ALA and the American Thoracic Society. She passes out peak-flow meters to measure lung capacity, bottles of bubbles to teach kids belly-breathing exercises, and finger puppets and nonfurry toys that won't collect dust. Students fill out worksheets that teach them how to identify triggers and create an asthma action plan so that they know what to do when they're sick. Each night they have to take their notebooks home and have their parents fill out the same worksheets; the programs are educating the kids and their caretakers.

Over at the Gregory-Lincoln Education Center in the Fourth Ward, nurse Carolyn Cullors is already well versed in asthma management. Now that the weather's colder, five kids come in every day to use one of the school's 11 neatly labeled inhalers, most just before PE.

At the school, where almost every child is black or Hispanic and most of them poor, Cullors has gone from one or two inhalers 11 years ago to a three-inch binder filled with "asthma action plans." It includes who to call and what medicine to give each child when they're sick.

Cullors sees the problems unique to an inner-city school: Kids run out of medicine at home, so they take the school inhaler home and never bring it back. Many parents can afford only one inhaler, which their kids try to bring to school and take home every day. (Kids aren't allowed to carry inhalers on campus because they often let other students take hits.) Or sometimes the medication that students give Cullors is expired.

Cullors had one 12-year-old girl with severe asthma who was living with her dad in a homeless shelter. To treat her asthma, the father just gave her over-the-counter Primatine Mist.

"I had nightmares about her," Cullors says. She talked to the girl's pastor, called Children's Protective Services and made appointments with a free clinic. The father always picked her up and said he'd take his daughter to the doctor, but he never did.

The federal government and other agencies are beginning to hear the wheeze of inner-city asthma. Last year, in the Clinton administration's first agency-wide effort to attack the problem, First Lady Hillary Clinton released a $68 million asthma initiative, "Asthma and the Environment: A Strategy to Protect Children," funded by the Environmental Protection Agency and the Department of Health and Human Services. The money has been divided among school-based intervention and education projects, air-pollution measurement programs and competitive grants to states to identify and treat asthmatic children enrolled in Medicaid.

And the NIH is spending $118 million this year to conduct further research into asthma. Closer to home, the Texas Gulf Coast Asthma Coalition is attempting to reduce the prevalence, morbidity and mortality of the disease. The coalition's aim is to get patients -- especially lower-income, minority patients -- into continuing care and to eliminate emergency room visits and hospital stays.

The coalition is also trying to educate the public. Last May the group held an Asthma Awareness Day at the Museum of Health and Medical Science. About 600 inner-city children and their parents showed up; earlier, the consortium held a screening day in which physicians sat outside Randalls supermarkets. About 250 people showed up, many of whom didn't know they had asthma. Coalition officials plan to hold more screening dates and to lobby for clean-air legislation.

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