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Health providers target Detroit's child asthma woes

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Health providers target Detroit's child asthma woes

Picture of Karen Bouffard

A Detroit News analysis of Michigan Department of Community Health data found an average of five children die annually of asthma in the city, including nine in 2006 and eight in 2007. But promising projects are underway to combat childhood asthma in Detroit, such as home visits by asthma educators.

Karen Bouffard wrote this report for The Detroit News a 2013 National Health Journalism Fellow. Other stories in the series include:

(Photo: Photos by Clarence Tabb Jr. / The Detroit News)
(Photo: Photos by Clarence Tabb Jr. / The Detroit News)
Sunday, December 7, 2014

Six-year-old Micheal Washington has asthma, like more than 20,000 other Detroit kids.

His family lives in a brick bungalow built in 1924. As in many older houses, it's prone to mold, dust and other allergens that can make him wheezy and short of breath.

A Detroit News analysis of Michigan Department of Community Health data found an average of five children die annually of asthma in the city, including nine in 2006 and eight in 2007.

But promising projects are underway to combat childhood asthma in Detroit, such as home visits by asthma educators like Elizabeth Milton, who teaches preventive measures to Micheal's mom, Cassandra Debrowsky, while providing the moral support often needed by parents who care for kids with chronic diseases.

"I'm trying to get her past the fear that her child could die," Milton said. "Every hospitalization for asthma is preventable."

The 2014 Asthma Capitals study by the Asthma and Allergy Foundation of America ranked Detroit the 10th worst city in the nation for asthma sufferers, both children and adults. The study looked at 100 cities and graded them on 13 asthma risk factors, including air pollution, poverty rates and visits to emergency departments.

"No child should die from asthma, unless it's the very rare child who has really severe asthma," said Dr. Herman Gray, vice president for children's health services at the Detroit Medical Center.

"It boils down to accessing the appropriate level of care and using it as you should, both in terms of making your home as safe as you can and meeting with your pediatrician."

Most Detroit children with asthma receive little or no treatment, according to Dr. Elliott Attisha, who runs a mobile health clinic that cares for children at schools in Detroit. Asthma, an inflammation of the small and large airways that transport oxygen to the lungs, causes tightening of the chest, coughing, wheezing and shortness of breath, and can kill — a risk that increases when proper medication isn't available or used.

Twelve-year-old Samuel Maldonato saw Attisha for a checkup during one of the mobile clinic's recent weekly visits to Dixon Elementary School.

"Today I was in gym playing basketball, and all of a sudden I couldn't breathe well," Samuel said.

"I was breathing like heee-aaa, heee-aaa," he said, demonstrating how hard it was to draw air into his lungs.

Like many kids Attisha sees, Samuel has some medication for his asthma, but not the complete list of medicines required to keep his asthma under control.

Rise nationwide in asthma

"For many of these kids, they're not getting adequately managed because transportation is an issue," Attisha said inside the 38-foot motor home. It's retrofitted as a full pediatric office on wheels, with a laboratory, refrigerator, exam rooms and an office. It stops at Cody High School and Thirkell Elementary-Middle School on other weekdays during the school year.

"(Samuel) doesn't have his day controller and he's out of his Albuterol — that's the rescue medication," Attisha said. "He was never given a controller because he hasn't been in to see his doctor."

In the past decade, there has been an increase in Michigan and nationwide of children having asthma sometime in their lifetime, according to the Centers for Disease Control and Prevention. The proportion of asthmatic children nationwide has slowly risen during the last 10 years of data available, while the percentage of Michigan children has spiked upward in bursts during the same period.

Asthma is triggered by pet dander, dust mites, cockroach feces, car exhaust and other pollutants. Stress and genetics also may play a role.

Asthma is more common in urban areas, where there's often more air pollution, and where families often live in older homes filled with allergens like mold and dust mites.

Detroit's asthma problem is exacerbated by extreme poverty, difficulty in using public transportation to visit doctors and a shortage of primary care physicians. Poverty is a known risk factor for the disease, and Detroit has the lowest median family income among 50 cities ranked in the Annie E. Casey Foundation's annual Kids Count report — $19,800 a year compared with the national average of $60,700.

School nurses keep watch

Two mobile health clinics, including Attisha's, are among projects underway to improve the health of Detroit kids. The clinics are part of the Children's Health Project of Detroit, a partnership between Henry Ford Health System and the New York City-based Children's Health Fund. Molina Healthcare and the Michigan Department of Community Health also contribute. A second unit was added last year with help from the W.K. Kellogg Foundation.

Three Henry Ford Health System nurses work in Detroit Public Schools with funding from the Michigan Department of Community Health. They are Attisha's eyes and ears inside the schools, monitoring how kids are doing and sending them to the clinic if needed.

St. John Providence Health System runs nine school-based clinics in Detroit Public Schools, each staffed by a nurse, a medical assistant and a mental health professional.

On a recent Tuesday, 11-year-old Sommer Jenkins stopped by Attisha's clinic to pick up a bag of three medications she needs to control her asthma. The bag contained an instruction sheet showing photos of her medications alongside suns, moons, smiley faces and frowny faces — to indicate if the medicine should be taken in the morning or at night, when she's feeling good or not so well.

"I have to take two inhalers and my nose spray," the Dixon sixth-grader said.

Milton, the asthma educator, visits families in their homes, where she teaches parents how to eliminate asthma triggers and manage their child's disease. She is a certified asthma educator with Better Life Learning, a Detroit-based financial and health services organization that provides case management services for people on Medicaid health care program for low-income earners.

Debrowsky said learning about the disease, including when and how little Micheal should use his rescue inhaler, has helped her feel confident in caring for her son.

"(Milton) tells me if anything happens I am prepared, I have the inhaler," she said. "I wish they would have started (Milton's home visits) a little sooner. They should start it as soon as somebody is diagnosed."

This story was originally published in .

Photo Credit: Clarence Tabb Jr./The Detroit News

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