ER asthma visits down as patients learn to manage disease

There was a time when Kiyoshi Martinez sat on the sidelines. During recess he'd watch as his classmates conquered the jungle gyms, slid into first base and made goals on the soccer field.

It was a time when the school nurse kept his inhaler on hand, ready to rescue him in case of an emergency.

He went to the doctor's office every day after school to get an allergy shot. All of this just to help him control his asthma. "Why is this happening to me?" he would ask himself.

Martinez remembers one night in second grade when he was trying to sleep and was hit by one of his worst asthma attacks. He wheezed, coughed uncontrollably and felt his chest tighten.

He said he could physically feel the air move down his windpipe except there was not a whole lot of air moving. His father rushed him to the hospital.

"I'm just sitting there and then I'm breathing through this little plastic thing stuck in my mouth and it had a salty feeling down your throat, and I remember thinking, 'This is just absolutely miserable,'" he said.

He can't recall how many times he went to the emergency room because of asthma.

Today the 23-year-old communication specialist says he has a handle on his disease. He's now able to do many of the things his friends enjoy: sports, going to bars, even participating in the annual Chiditarod, a 5-mile shopping cart race through the windy city.

But he still has restrictions. A rescue inhaler is always with him when he exercises. When he's sick he uses a milder inhaler in the morning.

When a friend has a cat or a dog, he knows to go outside and get some fresh air. Martinez has learned to live with his condition. And he's not the only one.

Although the number of children with asthma has increased across the nation, overall hospitalizations for the disease in Illinois have dropped 30 percent from 1993 to 2004, according to the Illinois Department of Public Health.

Local health experts say asthma education and management strategies may be the reasons for the decline.

The increase of asthma cases may also be due to the improvements in screening asthma in children. Experts stress that treating kids at an early age reduces the risk of later damage to the lungs and gives them a better chance to live active lives as adults.

What is asthma?

Consider this. Imagine a highway without much traffic; the cars are speeding along without any obstructions.

Then comes rush hour. It's stop-and-go. The lanes are merging, and no one is getting through.

That's what it feels like for asthmatics. The cars along their highway - their airway - are in a traffic jam. The muscles around their airways tighten, making it harder to breathe. The airways themselves swell, causing mucus to thicken, again forcing the asthmatic to wheeze and cough.

"It's like suffocating," Martinez said. Dr. Raoul Wolf, a pediatric allergist at La Rabida Children's Hospital says several factors can "trigger" asthma: weather changes, viral infection, allergens from cats and dogs, poor air quality, mold, smoking, dust mites and cockroaches.

The most common indicators a child has this disease are difficulty breathing and repeated coughing. But the exact cause of asthma is unknown.

Managing Asthma

For families with asthmatic children, education is essential to managing the disease. Rodger Peck, a nurse, is helping educate those families. He has been making his rounds for six years on Chicago's South Side in a Winnebago.

The vehicle is a converted clinic that treats kids with asthma. Inside it looks like any other recreational vehicle. There's a comfy couch, revolving armchairs that rock, even a kitchenette with matching dining set. But it's the walls that give it away.

They are covered with posters of lungs, asthma education charts and images of pharmaceutical products.

On this Tuesday morning, Peck is on his way to a children's center in Pilsen. There he meets a 17-month-old boy who's had a cough since the beginning of December - a possible indication he has asthma.

Along with the boy are his mamá and his abuela, his grandma. The three generations have come to the Asthma Van to learn more about the illness.

Peck is part of the Mobile CARE Foundation that treats more than 4,300 children in Chicago with asthma. The foundation works closely with the La Rabida Community Asthma Program for Children.

Both organizations have been visiting schools, screening kids and educating families - many on Medicaid or uninsured - for more than a decade.

"One of the biggest problems with providing health care in indigent populations is getting people to come. This has always been a problem," La Rabida's Wolf said. Mobile CARE and La Rabida's asthma programs began around the time Illinois asthma hospitalizations started their decline in the early '90s.

These organizations teach how to recognize the disease in children and about the various factors that can trigger asthma symptoms.

Learning what triggers these attacks and how to use proper medications may be the reason fewer kids are going to emergency rooms for asthma attacks, said Dr.Ruchi S.Gupta, a pediatrician at Children's Memorial Hospital.

"Increasing your awareness and knowledge are the main things you can do," said Gupta, who is also a professor at the Feinberg School of Medicine.

Stephen Samuelson, executive director of Mobile CARE, agrees. Along with education and improved medications, physicians are gaining a better understanding on how to use their resources, he said.

"If you have the right education, the right tools and the right treatment, the quality of life of patients and their families increases dramatically," Samuelson said.

One success story is Kiyoshi Martinez.

"I think I'm a lot better off probably because I was diagnosed relatively early and started getting treatment really young and now it's a lot easier to live with [asthma]," Martinez said. "It's not something that's an inconvenience in my life."