Barely breathing

Steve HammNovember 15, 2018

Robert Carmon had a rough start to life. Shortly after birth, the New Haven boy developed asthma, a chronic disease that causes inflammation in the lungs and difficulty breathing. His attacks were so severe as an infant that his parents rushed him to the emergency room practically every week. They were terrified he might die.

Today, at age 7, Robert’s asthma has stabilized. With the help of his dad, Chaz Carmon, he inhales a steroid-based medicine each morning and evening, and he carries a rescue inhaler in his backpack in case an asthma attack comes in school or elsewhere.

Robert is a bright and energetic child, yet he’s not able to play organized sports because of his asthma. “It’s hard on him,” says his father. “I just hope he grows out of it.”

Asthma, one of the most widespread chronic conditions in the United States, afflicts approximately 26.5 million people nationwide, or about 8.3 percent of the population. The cause is not known and there is no medical cure. The disease disproportionally affects people who live in economically disadvantaged urban neighborhoods. In New Haven’s Newhallville and Dixwell neighborhoods combined (the Carmons live in Newhallville), an estimated 17 percent of residents report asthma, more than double the national rate, according to the Community Alliance for Research and Engagement.

Connecticut’s asthma rate is worse than the nation’s. It’s 11 percent for children and 10.5 percent for adults, and rising. Neighborhoods in Bridgeport, Hartford and New Haven are among the hardest hit. Automobile exhaust, cigarette smoke and mold and vermin in sub-standard housing are among the triggers.

Leaders of government and health care said the key to making progress in working class neighborhoods is to focus more effectively on some of the medical, social and environment factors related to the disease, and to better coordinate society’s responses. “In these settings, asthma is a symptom of what it means to live in poverty so really you have to change the lives of poor people,” said Dr. Beverley Sheares, associate professor of pediatrics at Yale School of Medicine.

The Emergency department

When children suffer severe asthma attacks, their parents often take them straight to the emergency department of the nearest hospital. That’s the right thing to do, said emergency medicine physicians, because it’s difficult for parents to gauge the seriousness of an attack.

At Connecticut Children’s Medical Center in Hartford, emergency physicians treat from 1,500 to 2,000 children per year for moderate to severe asthma. In the past year, Connecticut Children’s introduced a new process for treating patients more quickly. Previously, it took an average of 75 minutes to treat asthma patients. Now it’s 34 minutes — and the goal is 20. “Kids come in struggling to breathe. To be able to immediately treat them and see a quick turnaround is pretty amazing,” said Eric Hoppa, a pediatric emergency attending physician at Connecticut Children’s.

But emergency physicians say more effective treatment of asthma in the ED is not the long-term solution to the problem. EDs can stabilize people and provide instructions on how to use inhalers and other medications, but they can’t follow them home to monitor their health. That’s why neighborhood clinics and outreach programs are so important.

Clinics and outreach

Economically disadvantaged people typically seek care at community health centers, and Connecticut has a strong network of centers operating in 38 cities and towns. Recently, some of the centers have begun establishing specialized asthma clinics so they can spot the disease earlier, treat it more consistently, and help patients manage it over the long term.

In New Haven, Fair Haven Community Health Center opened its new Respiratory, Airway and Allergy Clinic in June. It’s staffed by a physician certified in treating allergy and asthma, an occupational health specialist, a nurse and a care coordinator who investigates the social determinants of each patient’s asthma. The goal is to help them make adjustments in their lives that will reduce triggers. All of the health center’s patients diagnosed with asthma, and those who show signs or symptoms, are referred to the clinic, which is one of the few of its type in greater New Haven.

The next step for the Fair Haven clinic is forging a formal partnership with Milford Health Department’s Putting On Airs, Connecticut’s home asthma education program, which helps asthmatics and their families follow action plans and reduce the triggers in their homes.

Under Putting On Airs, teams of health workers conduct a series of three home visits with asthma sufferers. The teams typically include a health educator, who makes sure inhalers and other medications are being used properly, and an environmentalist, who looks for dust-mite-invested carpets, moldy bathrooms, mice and cockroaches. Recently, the regional team at the Stratford Health Department, which runs Putting on Airs for much of Fairfield County, added a third member — a community health worker. Two other health districts elsewhere in the state will follow suit in the coming months.

The community health worker on the Stratford team, Millie Seguinot, helps translate between English and Spanish during home visits, explains the use of inhalers in simple language, and looks for social issues that impact a family’s ability to control the asthma.

One Bridgeport family kept canceling appointments with Putting On Airs. Language was an issue. Seguinot visited the mom on her own and learned that she didn’t understand the asthma action plan nor how to administer medications for her daughter on a regular basis. After Seguinot explained things carefully and helped with scheduling, the mom was able to follow the plan and became more comfortable with additional visits from the team.

“It’s important to have somebody that these families can relate to. It might be language, culture, ethnicity or even physical appearance,” Seguinot said.

This story was reported under a partnership with the Connecticut Health I-Team, a nonprofit news organization dedicated to health reporting. (c-hit.org)