bittman asthma

Childhood Asthma: a new approach

by Barry Bittman, MD

It’s a few minutes after 2:00 am. Is it a horrible monster choking me or am I really suffocating?

Gasping for air, I lunge for my bedside inhaler and nervously take a few puffs. Sitting up in bed with my back against the wall to support my chest, I begin to perspire. Soon I’m soaked. Within a minute I know the medication isn’t working and I’m in big trouble. Nervously I puff again and again until every part of me is shaking. My chest hurts, I’m trembling and my heart is racing. I can barely speak. It feels like a noose around my neck and my chest is burning. I wish I could throw up, or fall back to sleep … and never have to wake up again.

Anything would be better than making my way into my parents bedroom and looking at their faces. Sitting in that cold car filled with cigarette smoke, I press my arms into the seat, tense every muscle in my body and suck air with my last ounce of energy. If I let go even for a moment, I’ll never make it to the Emergency Room.

Trying to figure out why¾ that’s the hardest part. It’s my fault¾ I must have done something wrong. After all, bad things happen to bad people. It’s my time to suffer. Maybe it’s my last.

What you’ve just read is not fiction. Unfortunately, it’s what I remember most about my early childhood.

The sadness, however, in writing these words is not based on the countless asthma attacks I experienced, or even the fact that I missed most of my first 2 years of school. For there is a much greater issue at hand. It centers around the fact that 40 plus years later, increasing numbers of children throughout the world continue to experience the very same feelings. In fact, asthma is still the most common chronic illness in childhood.

According to the Centers for Disease Control and Prevention (CDC) 1998 report, asthma rates in our nation have increased 75% since 1980. Among very young children, the incidence has risen 160%. These figures translate into more than 17 million Americans including approximately 6 million children under the age of 18. In 1995, asthma resulted in an estimated 10.4 million doctors’ office visits, 1.8 million emergency room visits and 446,000 hospitalizations. The CDC estimates that health care costs for asthmatics will likely reach $14.5 billion this year. Asthma often results in 10-30 missed school days each year based upon its severity. According to the National Institute of Allergy and Infectious Disease, loss in productivity by working parents caring for children who miss school due to asthma is estimated at $1 billion a year.

While these statistics have caused shock waves in many arenas, all is not well on the treatment front. Despite the National Asthma Education and Prevention Program (NAEPP) Report of the Second Expert Panel on the Guidelines for the Diagnosis and Management of Asthma (1997), medical treatment practices vary considerably. A joint task force of the American Academy of Allergy, Asthma and Immunology and the NAEPP have therefore established a “Call to Action,” a series of collaborative initiatives that has the potential to make a difference. One of the most important is “building ongoing bridges and networks with doctors, schools, coaches, parents, school nurses, respiratory therapists, pharmacists, and community/national asthma organizations.”

We have taken an additional step. Recognizing the fact that beyond these health statistics is a disheartening and often unnecessary picture of suffering, frustration and compromise that affects not only the child, but also the entire family, our team of healthcare professionals is introducing a collaborative, integrative program designed to meet the specific needs of each child and family.

Our program is called, EMPOWER and it’s based upon the 1997 NIH/NAEPP guidelines for asthma management. Offered as a series of 6 group and individual sessions, our goal is to inform, educate and motivate parents and children to maximize practical “whole person” asthma care while enhancing communications and interactions with their doctor and healthcare team.

Based upon a delightful series of entertaining and educational sessions, our program “empowers” the child and family to work closely with their physician to develop an effective asthma management strategy. Based upon a cartoon-like guide, EMPOWER focuses on setting goals, discovering triggers and recognizing symptoms. We also work together to prevent and treat attacks using the latest and best-suited asthma tools and medications. Healthy eating, stress management, coping skills development and establishing a collaborative approach with educators, coaches and other contacts is emphasized.

Each child (in an age specific manner) participates in a series of creative interactive sessions utilizing hands-on demonstrations, music and imagery. Children, working with their parents, progressively learn to regain control using a series of approaches carefully designed to improve quality of life, reduce attacks and promote self-esteem. During our last session, a personalized action plan is created, and each child is awarded a black belt by our healthcare team.

It is our wish that children will never have to wake up with the anxiety, expectation and fear that their next breath might be their last¾ Mind Over Matter!