Drowning on Dry Land

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

The night he moved to Houston in 1979, Dr. Roosevelt Alcorn witnessed his daughter's first asthma attack. They were staying at the Roadrunner Inn on Main Street because he had to get to the hospital early in the morning for an interview. The pediatrician's 13-year-old daughter started breathing hard and wheezing. He thought it would pass, but it just got worse. So he took her to Texas Children's Hospital's emergency room.

Twenty years later, in the same ER, Alcorn is on call every month and a half as an attending physician treating dozens of asthmatic minority children.

"There's all sorts of horror stories," Alcorn says. "Kids have been brought in almost gone. And sometimes they pull them back, and sometimes they haven't."

Sometimes the children don't even make it to the hospital. Alcorn recalls his former pastor, whose asthmatic daughter was found dead in the hallway. She had a nighttime attack and didn't want to wake her father. She died outside the restroom trying to get to her inhaler.

Alcorn has seen parents who don't have cars or who don't have cars that can make it from the Fifth Ward to the Medical Center. Sometimes they get stuck on the on-ramp by the George R. Brown Convention Center with no cell phone and a sick kid. Others don't have a phone in their house to call 911. Some parents are poor but not poor enough to qualify for Medicaid.

"They die like flies," Alcorn says. "We're losing them here with the best. Most of these kids are within shouting distance of the Medical Center. Think about the kids who aren't that close."

Hispanic asthmatics and their parents face even more barriers to getting treatment. Some don't speak English; some aren't citizens, so they can't qualify for Medicaid; and some parents are so afraid of being deported that even if their child is a citizen, they don't sign them up for Medicaid. That's often why Hispanic asthmatics wind up in the ER: People don't ask for money or Medicaid up front.

But doctors want their patients to avoid ER visits. The retired Alcorn has created the Medical Mobile-Dental Outreach Clinic, a 53foot doctor's office inside an 18-wheeler. Alcorn's clinic goes into poor neighborhoods to do free Medicaid physicals and dental exams, but the physician wants to expand its mission to cover asthma patients. As a result, the mobile clinic plans to assist the CDC-funded project School Asthma Screening and Prevention. The truck, program officials say, will carry a team of researchers to local elementary schools, where they'll do asthma screenings and give out medicine and educational materials. If the parents can't get the kids to the hospital, the breath mobile will bring fresh air to them.

"We've gotta stop 'em before the horse gets out of the barn," Alcorn says. "Once the horse is out of the barn, it's hard to corral him again. Heaven only knows how successful we're gonna be, but we gotta do something."

Alex loves his toy cars, trucks and miniature monster men. He plays in mud, throws pebbles into puddles and runs around the park. But Darleen can't let him go outside too often.

"We don't know what's out there," Darleen says. He went to the park with her brother, and he was fine. He went back the next day and had an attack. She doesn't know if there's something in the air or the trees, but she doesn't want to find out.

"He can't even really play really hard," Darleen says. "He gets laughing really hard and running with the kids, and then he starts coughing."

Alex turned four last month, and as he gets older Darleen worries more about what she's going to do. Alex has to go to school, she says. He has to. But more immediately, she worries about the cold weather triggering an attack. Alex is usually sick around the holidays, she says.

The week before Christmas Alex got sick.

Around 10 p.m. he started sniffling. Then he started coughing. Darleen gave him breathing treatments, but they didn't work.

Around 1 a.m. she called Alex's case manager, nurse Lasserre. Darleen had a few vials of albuterol -- the "rescue" medicine -- but not enough to get him through a full-blown attack. The nurse called in a prescription to an all-night pharmacy and told Darleen to start giving Alex the steroids stored in her kitchen cabinet.

Lasserre wanted to call in some antibiotics, but Darleen couldn't afford them. The mother lay awake listening to Alex cough and worrying that he was headed to the hospital.

The next day, around 10:30 a.m., Lasserre called and said she had some samples of Biaxin. Darleen couldn't get a ride to the clinic, so Lasserre gave them to Darleen's sister-in-law, who works at the hospital. The medicine seemed to work. Alex kept coughing, but not as hard or as often. He felt well enough to want to play. But Darleen popped Mulan in the VCR and tried to get him to lie down.

Alex recovered in time to enjoy Christmas, and he made it through New Year's and his birthday.

"We just hope that as he gets older he'll get stronger," Darleen says. She wants Alex to be a normal boy.

A normal boy who can't play outside.

E-mail Wendy Grossman at wendy.grossman@ houstonpress.com.

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