Asthma Weighs Heavily on O.C. Children

It was just last week that 10-year-old Yvett Ulloa ran the mile in under 12 minutes at Portola Hills Elementary School. While her time wasn’t at all special, it was remarkable that the young asthmatic could finish the gym class test at all.

“Before she had treatment for her asthma, she couldn’t even walk that mile because she would get tired and cough and was so short of breath,” said her mother, Raquel Ulloa of Trabuco Canyon.

The problem is not unique to Yvett, who has had her share of wheezy days and nighttime trips to the emergency room. Asthma is on the rise in Orange County and throughout the country, particularly among children. The chronic disease, which blocks airways and impairs breathing, is the leading cause of absences from school nationwide and has been steadily increasing since 1982, according to experts.

The disease is drawing particular attention in Orange County, where a recent survey by health officials found that the asthma rate for children is more than twice the national average. Los Angeles County also is considered a hot spot for asthma.

Doctors and allergists offer a range of possible explanations for the higher incidence here, including heavy landscaping with shrubs and plants that flower year-round. Others say the elevated rate in Orange County could partly reflect increased awareness among parents and better diagnosis.

There’s no doubt, however, about how serious the illness can be for school-age children.

“If you don’t feel well, you don’t perform or learn well, and you are not getting the lessons in school,” said Sandy Landry, a pediatric nurse practitioner and head of health programs for the Orange County Department of Education. “They miss out on life. They don’t feel like going out and participating in sports. Not being healthy is not nice. It’s a real bummer for kids.”

The problem is especially acute among poor families that live in crowded and aging apartments with more dust, mites, cockroaches and molds--all of which can trigger asthma, doctors and health experts said. Low-income children suffer more from the disease because they are less likely to have insurance and get proper care for what is largely a treatable chronic illness.

“Asthma is a poster disease for the access-to-health-care problem we have in this country,” said Dr. Joseph Scherger, who heads the family medicine department at UCI College of Medicine.

The disease has drawn attention among Orange County school nurses who met in December 1996 to discuss the problem, Landry said. The need for a more systematic approach to dealing with schoolchildren who have the disease also was driven home by the deaths resulting from severe asthma attacks of two South County youngsters in the 1990s, several school officials said.

“We kept seeing more and more asthmatics, and half of them aren’t properly medicated,” Landry said. “It is a groundswell.”

The size of the problem is demonstrated by the Orange County Health Needs Assessment, a survey of 5,000 people countywide funded by the county Health Care Agency, county hospitals and other health care providers.

The survey found that 18.5% of children in the county have been diagnosed with asthma. The rate nationwide is 7.5%, according to a 1999 report by the American Lung Assn. In addition, 9.1% of Orange County adults said they have the illness, compared with 5.7% nationally.

The survey also found that low-income asthmatics were seven times more likely than those with high incomes to report that their disease is having “a very serious impact” on their lives. “That appears to be a function of who is getting treatment,” said Pam Austin, director of the Health Needs Assessment.

Raising Awareness

Asthma is an inflammation of the airways. Attacks usually are caused by an allergic reaction but also are sometimes triggered by exercise, pollution, even laughing or cold temperatures. People with asthma have extra-sensitive bronchial paths. During an attack, the muscles around these airways tighten, and the airways get inflamed and filled with mucus.

Current treatment includes periodically taking inhaled and oral medicines--such as albuterol--that treat symptoms such as wheezing, as well as daily use of maintenance medicines that reduce inflammation of the airways and make them less reactive.

The most common problem for school-age children who continue to suffer is not being diagnosed or not taking their medication, experts said. In other cases, youngsters continue to have problems because they are not getting proper treatment with maintenance medication--such as inhaled steroids--even though they may have a primary-care physician, said several school nurses and allergy specialists.

One goal of health experts, school nurses and several hospital programs is to improve asthma awareness and education among parents, children and school staff. In the last two years, schools and hospitals have created a number of programs to better deal with the problems of asthmatic children.

The county Department of Education this year began a pilot program at three central county schools to determine how best to identify youngsters with asthma. Children in all three schools will answer a nine-question survey. Doctors and nurses will follow up with exams to identify the asthmatics. Those who are not getting treatment will get exams and medicine.

Officials hope the questionnaire will enable educators and parents to recognize when frequent coughs, wheezing or repeated colds indicate the child has asthma, and to steer that child to treatment.

In South County, Mission Hospital Regional Medical Center teamed up with Saddleback Valley Unified School District to pay for a part-time nurse at six elementary schools, including one in Mission Viejo, where a fourth-grader died of an asthma attack in the late 1980s. The program, which began in 1997, has provided medicine and treatment to several children, and medical evaluations and support services to more than 160. In addition, more than 700 parents and school staff members have participated in workshops or education programs.

The idea is to create an environment where children with asthma know they will be safe and where they can get help if they have an attack, said Connie Carcel, a registered nurse and the asthma educator for the program.

“What you get is a secure, wholesome, happy little guy who is not scared to come to school,” she said. “Their anxiety level goes down. It improves their learning and their self-image. The program also teaches their classmates how to be supportive so they are not isolated.”

That’s the case for Yvett, who described how three months ago she was evaluated by a physician and placed on inhaled steroids.

“Before that I would have attacks and it made me scared,” she said. “When I ran, I was always afraid that I would get an attack and wouldn’t be able to breathe.”

She considered the recent mile run a triumph.

“I felt very good. I took my medicine before I ran and it helped,” she said. “I did pretty good even though I finished last. I expect I will get better and better.”

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Trouble Breathing

Asthma rates for Orange County children are more than twice the national average; one factor may b heaving landscaping with shrubs and flowers that bloom year-round. What happens when asthma attacks:

Common allergens (pollen, animal dander) affect airways in the lungs (bronchial tubes). The bronchiolar wall muscle contracts, leaving a smaller opening for air.

Source: “The Human Body”