Bringing Asthma Treatment Directly to Children
Rutgers’ Felesia Bowen continues her crusade to eliminate social barriers to care
Felesia Bowen knows that asthma-related deaths are rare but believes even one is too many and cringes when she recalls the death of a New Jersey elementary school child who died four years ago because his asthma symptoms weren’t recognized soon enough.
“People have become complacent because asthma is so common,” said Bowen, assistant professor and director of the Center for Urban Youth and Families at Rutgers School of Nursing. “But no one should be dying from asthma.”
Armed with a three-year, $350,000 grant she received as one of Robert Wood Johnson Foundation’s newest nurse faculty scholars, Bowen is establishing Newark’s first community-based primary care asthma center in partnership with Perth Amboy’s Jewish Renaissance Medical Center’s (JRMC) School-Based Clinics and with funding support from the Hearst Foundations.
The Centers for Disease Control reported in 2008 that approximately 8.6 percent of New Jersey’s children (younger than 18) have asthma. In its 2008-2013 strategic plan for asthma, the New Jersey Department of Health and Senior Services reported that residents of Essex County (which includes Newark) experience more adverse effects from asthma than residents of other areas of the state.
Beginning this month, JRMC’s mobile van, staffed by a pediatric nurse practitioner and medical technician, will visit children at Sussex Avenue and Avon Avenue Schools in the South Ward and First Avenue School in the North Ward.
Participants in this pilot program will be examined and receive evidence-based care, including lung function testing via spirometry and exhaled nitric oxide. Some of the participants will receive care and a home visit with education for parents and an individualized plan to decrease asthma triggers. In addition, participants will be able to contact an emergency after-hours asthma specialty team who can assess symptoms, order medication and emergency treatment if a child is in distress, and schedule a next-day follow-up visit with the asthma center.
“Right now having to commute to treatment centers with asthma specialists can represent a barrier for children in urban areas,” Bowen said. “Some children will need care from a pediatric pulmonary or allergy specialist. Our team will help with access to them and be here to assist during interim visits.”
The project marks the next step in Bowen’s continuing research and her history treating children with asthma, from her days as a primary care pediatric nurse practitioner to her role as a mother of three children who have been able to control their own asthma with medication and regular monitoring.
Though asthma-related deaths are rare – with the Centers for Disease Control reporting 157 children under 15 died in the United States in 2009 from asthma – an estimated seven million children nationwide suffer from asthma. The chronic lung disease that inflames and narrows the airways and can cause recurring periods of wheezing, chest tightness, shortness of breath and coughing afflicts a larger number of blacks and Latinos and causes more asthma-related deaths in these minority communities.
Bowen said asthma-related deaths underscore the need to adhere to established guidelines for treatments with inhaled steroids, regular check-ups, asthma education and lung function tests. Following the guidelines and maintaining clean, trigger-free homes will generally allow most children to enjoy athletics, music or any other recreational pursuits without interruption, she said.
The best way to treat juvenile asthma symptoms and decrease the rate in urban areas, Bowen believes, is by educating children and parents on how to recognize and treat asthma symptoms. “Education does make a difference,” said Bowen. “Sometimes we are not treating children with asthma according to best practice. In the early spring and fall when asthma tends to flare up, providers may need to step up treatment.”
Bowen – who is being mentored by William Holzemer, dean of the School of Nursing, Robert Laumbach, associate professor of environmental and occupational medicine at Rutgers Robert Wood Johnson Medical School, and Fay Gary from Case Western Reserve University – is hopeful that her findings will demonstrate the advantages of community-based asthma care and lead to increased funding to expand such efforts.
“We have wonderful medications and non-invasive diagnostic tools,” she said. “The research has demonstrated over and over again that with education and proper treatment, children with asthma can lead normal lives.”