By Nina Gregory
Contributing Writer

Asthma is the leading cause of hospitalization for children in New York City from birth to 14 years old, according to the New York City Department of Health and Mental Hygiene (DOHMH). But, while rates of childhood asthma hospitalization have decreased 44% in the past decade, the DOHMH reports geographic disparities persist, and the South Bronx is one of the worst examples.

"Childhood asthma is a severe problem, particularly in the South Bronx," said Laura Lee Munson, communications associate at the American Lung Association (ALA) in New York City. "There are rates as high as one in four children there. That's 25 percent. That is not good." The city in general, the ALA reports, has asthma rates of about 8.8 percent.
In Highbridge, an informal coalition of schools, health care advocates and providers are working to help children and their parents or caregivers better manage symptoms and decrease emergency room visits, hospitalizations and school absences.

After being diagnosed, children are given an Asthma Action Plan to help them manage their disease. Often, a nurse from the Visiting Nurse Service of New York will be provided.

The nurse conducts home, environmental and health assessments, looking for things that trigger an asthma attack, particularly allergens in the home, said Carol Odonah, director of Community Care for Children, a part of the Visiting Nurse Service. "Then, the nurse would educate the family about how to manage those triggers, which in some instances is to remove them from the home or cover them - mattress covers, pillow covers - so that you create a barrier between the dust mites and contact with the asthmatic child.

"And," she continued, "Pets are a big thing. Carpets are often not good for people with asthma. For children, stuffed animals aren't the best thing,
either. But, the nurses understand you can't just go in and tell people to get rid of everything they have an attachment to, so they work with the family to prioritize what the biggest triggers are and how to manage them."

School-based clinics are becoming more common to provide better access to health care, especially for the uninsured, said Josefina Martinez, a physician's assistant at PS 126. Lack of insurance is one of the biggest barriers to health care in low-income and immigrant communities, according to the Centers for Disease Control and Prevention. Martinez said about 30 percent of students at her school have a history of asthma and that it's her number one concern.

"We request the Asthma Action Plan from their pediatricians, and everyone with a history is supposed to have one on record," she said. "If a child doesn't have a pediatrician, we can also provide them primary care services and create an Action Plan."

While the students are initially educated by their diagnosing physician in how to manage their asthma, both Martinez and Munson said it is often difficult for children to follow medication schedules and recognize elements that may trigger an asthma attack.

To help children better implement their Asthma Action Plan - and to prevent emergency hospital visits by properly treating symptoms before they progress to life threatening - the ALA started the Open Airways for Schools program. They meet with students weekly for about a month to go over how and when to take medication, how to monitor their respiratory functions and how to identify triggers. The program also works with the school to eliminate environmental triggers like school bus emissions, that cause asthma attacks. She added that the ALA's primary concern right now is flu season.

"The Lung Association does strongly recommend that people with asthma get a flu shot," especially in areas like Highbridge. "Everyone's cramped in an apartment building and flu runs rampant. When people with asthma get the flu, they tend to have much more serious complications because asthma is a reparatory illness."

Both parents and children can get free flu shots and in late September, the ALA launched a flu shot locator to help people find out where. For information call 1-800-LUNGUSA or check online at www.lungusa.org.