Mothers of Asthmatics
- Saturday, September 5, 2009, 15:53
- Asthma
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- founder of the organization Mothers of Asthmatics, mother and caretaker of her own children – three of whom have asthma.Now, I know you’ve been hard at work for years as a crusader working to improve the health of children suffering from asthma. Can you tell me what has driven you in this mission, even going as far as to create the Mothers of Asthmatics?
- Nancy:
- Well, like a lot of other crusaders, there is a deeply personal story. Of my four children, three have asthma. And because of one of them -my daughter Brooke -I discovered that the others [had] it and myself as well. [Brooke] was my third child, and she was born with severe asthma, food allergies, eczema. She had chronic nasal problems. You know, she was my only daughter, and I wanted to have this little pink, ruffly baby girl.And all that was dashed with these hives and sickness and constant worry about, [how to] take care of this tiny little angel? And it was six years of rushing her in and out of hospitals and doctors’ offices, and putting her on medications that caused ulcers in her stomach and, you just feel so horrible.
As a parent, you’re trying to do everything right, and you’re afraid that [what] you’re doing is going to have some measure of harm. Six years of worrying that she could die [and] trying to figure out how to get by day to day was horrendous.
When we got into a drug study program at Georgetown University Hospital, that’s when things started to change. We were given a peak flow meter, and this was 16, 17 years ago. Back then, peak flow meters were [only] available [if you] were in a drug study program. But a peak flow meter was what I used to measure her lung function at home every single day. I would write that number down on this chart they gave me to keep track of all her medications.
- Erin:
- Nancy, can I interject and ask you a question for those who may not know. What is a peak flow meter?
- Nancy:
- A peak flow meter is a handheld tool that the child or adult can blow into, and it measures the force of air that you can get out of your lungs. And if you are having trouble getting air out, this instrument will pick up even the slightest sensitivity before your brain even recognizes that you’re having trouble. So, by using this device, I was able to see if her medications were working, how her symptoms were responding and I was able to communicate this back to the doctor.
- Erin:
- And you were part of a study at Georgetown, you said?
- Nancy:
- Yes. And my daughter was on an experimental medication there, one that did not make it in the United States but is [used] everywhere else today. She did very well on this program. What it taught me was that there was this wealth of information happening in our ivory research towers of the country. And here I’d been struggling to find out–
- Erin:
- Anything to help your child.
- Nancy:
- Exactly. I’d been actively searching, and I couldn’t find it. And here it was in the research, so I figured, “You know what? I’m going to write about this for other patients in my doctor’s office.” So, I started a little newsletter to bridge that research directly to families. A newspaper reporter picked up on the story, and ever since that time, 15 years ago this month, the organization has been, publishing a newsletter and having a national reach. We also publish a magazine and books and a variety of materials for families.
- Erin:
- That’s so great that you would take an initiative to create such a valuable resource.
- Nancy:
- It started out as Mothers of Asthmatics. I had no idea that it was going to be a national organization, and so I was writing it from a mother’s heart. I had all these children with asthma in my family. That’s how the name got started. But we actually do service [children and] adults as well. About half of our members are adults, and the other half are parents of children with asthma and young people with asthma and allergies. People can get in touch with us through our Web site, http://www.aanma.org. That stands for Allergy and Asthma Network Mothers of Asthmatics. Contact us that way, or [call] 800-878-4403. We’re happy to help.
- Erin:
- Now, what kinds of services do you offer?
- Nancy:
- We have a magazine [and a] newsletter that [are] very popular, so people who join will receive something in their mailbox every single month. It’ll either be the newsletter or the magazine, and these are filled with useful tips like how to coordinate your child’s care at school, or how to participate in a registry if you’re pregnant – what to do in an emergency. We had one whole issue on how to deal with pets at home when you have pet allergies.
- Erin:
- Well, you know, that’s one thing I wanted to ask you, too, because you mentioned that Brooke had allergies as well as asthma. Do kids with asthma often also suffer from allergies?
- Nancy:
- Eighty percent of all people who have asthma have allergies.
- Erin:
- No kidding.
- Nancy:
- Eighty percent. And that’s a conservative figure, I’m told. But if you look at the way health care is provided today, you have very little time in the doctor’s office to uncover the medical history and get down to the nitty-gritty of what’s happening in asthma. So many times we’re just treating the symptoms instead of the cause. If you identify allergens in your home because of testing or because it’s clear to you that these allergens are causing your symptoms – you can eliminate them.
- Erin:
- Does it force you to really change your lifestyle, though? Do you have to get rid of the family dog? What are the most challenging aspects of raising a child with asthma, and dealing with these allergies as well?
- Nancy:
- Well, pets would be one of the [main] challenges parents face, but just because you have allergies doesn’t mean that your pet is the one that you’re allergic to. Urine is one of the major allergens that come along with a cat, and so, if you’re allergic to cats, you definitely have to deal with that or you can create a very unhealthy situation for your child and for yourself. If you have allergies to your animals, then yes, you do need to decide what you’re going to do. There are lots of alternatives, [but] one of them includes finding a new home for your pet.
These are things that we as an organization help families sort through. I wrote a book called “A Parent’s Guide to Asthma,” and it’s available in bookstores and also through our organization. But there’s one whole chapter on dealing with pet allergies, and it is a complex issue – one that takes a lot of sensitivity and caring. There are no black and white answers.
But the biggest challenge of raising children with asthma is the constant guessing, “Am I doing this right? What is the long-term impact of using this medication on my child? Will my child grow right? Will my child develop intellectually okay? Why does my child behave this way every time I give him this medication?”
These are all these questions that just plague us with doubt as parents, and so that’s why we’re here as an organization. Most of us have been through this, and we understand. And I’ll tell you what. Out of my three kids that have asthma, the hardest one to control his symptoms is not the one with the severe problem. It’s my youngest, who has a very mild form, and he doesn’t want to acknowledge that he has asthma.
- Erin:
- So, in other words your youngest has the lightest case but is searching for reasons that would make him symptomatic.
- Nancy:
- His problems are so few and far between, he compares himself to his sister who’s so severe, and he goes, “Mom, this is just no big deal.” However, anyone can have an asthma attack that is life threatening, no matter if they rarely have asthma [attacks] or they have symptoms that they take medicine for every single day. It is a challenge, and we talk about mild asthma being a major problem for that reason alone. In fact, in Japan [a] study came out recently that said the majority of Japanese who die of an asthma attack – children and adults alike – have been diagnosed with mild asthma.
- Erin:
- Gee. How do you tell [people] to avoid these kinds of attacks, particularly if they have a mild condition because I would imagine if it’s more severe, you’re more aware of it and therefore more on the alert.
- Nancy:
- Yes, you’re right If your asthma is severe and you’re dealing with it on a daily basis, then you are far better prepared than someone who rarely has an attack and then suddenly they’re faced with one – and they’re not sure what to do. I tell people that all asthma is serious.
There’s two parts to asthma. There’s the noisy part that you see and feel. Then there’s the quiet part that’s there every single day, but it’s just not noticed. And that part is called inflammation, the inflammation that’s inside your breathing tubes – the cells that line your breathing tubes, swell, fill with fluid, and leak. They burst open and leak the chemicals that are inside those cells. When they break out of the cells, they cause greater irritation in your airways, and coughing.
- Erin:
- Is this swelling chronic? I mean, is it something that needs to be treated every day?
- Nancy:
- Well, for many people, yes, it does, and for other people, no, it doesn’t. But only a skilled physician, such as an allergist or pulmonologist, [can] make that determination for a patient with asthma. So, the key thing to remember is just because you don’t see symptoms every single day doesn’t mean that you don’t need to know how to take care of them when they arrive.When someone gets a diagnosis of asthma, they need to take a proactive approach from that moment on. It doesn’t matter whether it was the first attack or the tenth attack. Proactive means you ask the doctor for an explanation of what happened.
- Erin:
- And if you don’t understand, make sure you do.
- Nancy:
- Exactly, before you leave because the more you understand, the better able you’ll be to prevent it from happening again. The very next thing is [to] ask for a written management plan, “What do I do every day? What do I do if [feel an] episode coming on?” And also, “What do I do if nothing I’m doing is working?” So, [learn] how to recognize an asthma emergency, know when to call 911.
- Erin:
- Well, what is an asthma management plan exactly, Nancy?
- Nancy:
- [Each person has] different symptoms and signs, so, they all have different management plans. The management plan is a written plan of action that’s provided by your physician, and it says, “This is what you do every day. This is what you do when you’re starting to see symptoms. This is what you do if treating those symptoms is not working and you need more help. This is what you do if you’re scared.”Your plan also needs to include, “Do you have allergies? Do you have sinusitis? Do you have any other condition that is contributing to your asthma?” If so, “What are you supposed to do about that?” So, there is no “one size fits all” form or treatment plan. It all must be customized to the individual.
- Erin:
- So, it includes triggers, medications, allergies. Now, then you send your child off to school, and they are spending the majority of their time away from you. How can you deal with their asthma management plan? What happens when you take it to school?
- Nancy:
- This is a very traumatizing time for parents. Every fall we get calls from parents who are just out of their minds because their child’s asthma was so well controlled. Then they send their kid to school, And there’s a class pet such as in one school, there’s a cat that’s allowed to roam through the entire school. In other cases it’s a hamster in the classroom. The cafeteria [can pose a risk to] children [who] are exquisitely allergic to milk or peanuts, and they will anaphylax – their airways will shut down very rapidly – and [they] can die. We have produced a school pack for parents and school educators, and that has been very helpful. [It's] also available through the organization [and] our Web site. We’ve heard for 15 years from families about the nightmares that they were having, so we conducted a survey of the schools to find out the burning issues. We found that 61 percent of the schools do recognize that there is an increase in their students with asthma over the past three years.
- Erin:
- So, it seems to be on the rise?
- Nancy:
- Yes, definitely, and they’re taking notice of it. Forty-one percent of the schools surveyed do not allow children to carry their asthma medications on their person while they’re at school. And these schools do not always have a nurse on staff, so [there can be a problem when] the child goes to the clinic to get their inhaler.
- Erin:
- This has to do with the zero tolerance policy, no drugs on kids absolutely.
- Nancy:
- Exactly. And yet, as reported by these administrators, [something] like 56 percent of the schools allow class pets, 76 percent use chemical sprays and pesticides.
- Erin:
- I would imagine dust and mold is a problem because our schools are aging and the infrastructure has been falling apart for years now.
- Nancy:
- Absolutely. And 36 percent of them say their schools are carpeted [and] carpeting holds molds and dust and all types of pet dander. So these are issues that parents are faced with. The good news was that the majority [of the respondents] knew that asthma could lead to death. Seventy-one percent said they want educational materials for their clinics and for their libraries. They want training for their personnel, and they want to do a good job for our students.
So, as parents, teachers, physicians and policy makers, we need to come together to structure healthy learning environments. And what is healthy as a learning environment for students with asthma is healthy for absolutely everyone.
- Erin:
- Well, I would think that they would want to because, as I understand it, asthma is the number one reason for school absenteeism and, of course we want these kids in the classroom.
- Nancy:
- Absolutely.
- Erin:
- Sometimes do children’s asthma get worse because they transition to school? Does that often happen? Do they often have flare-ups? And how do you handle that medication problem?
- Nancy:
- Well, the medication problem is a real challenge. In Virginia, we recently were able to get legislation that permits children to carry their inhalers at school. [The legislation] basically reinforced a federal law that already gives students this right – the Americans with Disabilities Act. And this information is also in our school education packet. Every child with asthma has a right to carry their inhaler on their person. The schools just need to establish policies that make that safe for all students. I mean, the student must be responsible for keeping their inhaler under control and not sharing it with other students. They must be old enough and trained by their physicians [in] how to take care of their inhaler and [understand when] it needs to be refilled. So, there’s all this intricate stuff that at first they seems overwhelming when you’re trying to coordinate a child’s care at school.
But as a mother of four children, three of whom have asthma and allergies and other kinds of health problems, I am very encouraged that it can be done. Just take things one step at a time, and don’t try to do too much at once.
- Erin:
- Well, and remember that communication with that school nurse, the doctor or the teacher is the key.
- Nancy:
- Absolutely.
- Erin:
- Now, going back to the realm of care for the children. Asthma obviously doesn’t go away and may even become worse at a certain point in children’s lives, right?
- Nancy:
- Oh, yes.
- Erin:
- So, how can parents make sure that they’re getting the best medical care for their child, because HMOs, [may make it] difficult to get referrals to specialists, and many families have to use public health [agencies]? What would you suggest for parents who are beginning to navigate the system so that they can be advocates for their children?
- Nancy:
- It’s a good question, Erin, and one with not a lot of easy answers. [Our] organization, [Mothers of Asthmatics] helps families do just that in different ways. But in many cases it’s an individual thing because your HMO rules do change [sometimes annually]. And even [with] your “normal” health insurance, you find out one year they’re covering your prescriptions 100 percent [and] the next year [the type] of medications they’re going to cover [may change]. So, you have to spend more time navigating your health care system, and parents don’t always have that [time]. We have two-income families and single moms and single dads trying their best to make ends meet.
However, it [helps] to know what you’re looking for. For example, I knew that I wanted Brooke to be able to sleep through the night without an asthma attack. I wanted her to go to school and not miss more days than the next kid. I wanted her to be able to run [and] ride her bike. I wanted her to be able to spend the night at a friend’s house. These were all things that I put up at the top of my wish list, and I said to my doctors, every time I met them, “These are the things I want to see happen. “
That’s where I recommend that every family start. Define your goals and don’t accept anything less.
And you [may] have to slug your way through. It’s heartbreaking to talk to families who are denied access to an allergist, or they’ll say, “Nancy, I never knew that my child could actually see an allergist because the doctor never suggested we see one. So, I kind of figured, A, I didn’t need one; B, if I really did need one, he would have recommended one.”
And what’s sad is I talk to families whose children have died from asthma. I’m thinking of Vicky Modica and her son, Mikey. Mikey died, about three years ago, when he was 8, of an asthma attack that could have been prevented.
She didn’t know [asthma could be fatal]. She told me things like, “Nancy, I was doing everything I was told to do. I did everything.”
But what she was not told is that Mikey should see an allergist. She was not told that Mikey needed a medication to treat the inflammation on an ongoing basis. So, she was just treating him when he was having these attacks, and when he died, he was just being a normal kid. He was just playing and looked fine – had a little cough and a sniffle going – but the attack that killed him was one that came without warning.
Another mother called me the other day, and she said her son was playing at the computer, and he said, “You know, mom, I need a breathing treatment,” and he stood up to take his because he’s 11-years-old and that’s what he normally did. And she said she saw he was turning blue, got the breathing treatment on him – but was not enough. She said later, “He didn’t look like he was going to die.”
Vicky Modica has initiated a campaign that people will be seeing throughout the country over the next few months called “Mikey’s Mom Didn’t Know Asthma Could Kill.” It’s a short dramatic story because her whole philosophy is, “It’s too late for Mikey, but I want other people to know that there are things that they can do to prevent asthma death.”
- Erin:
- Well, it sounds like kids with asthma can often be stoic and wait until the last minute for help, which is also a problem. I mean, here’s the kid in front of the computer. He doesn’t want to stop. And then he realized, “Oh, I need a breathing treatment.” [I'm] backing up a bit because I was thinking about your three children and how one is more severe than the others, and I wonder what warning signs do you look for in your child in terms of asthma? I understand it can go undiagnosed for quite some time in adults as well.
- Nancy:
- Well, when the asthma symptoms are severe, it’s pretty easy to diagnose. But, my son Dan, – we didn’t know that his chronic coughing, whenever he was exercising, was asthma. We just thought he just was overexerting himself, [that] he was this athlete with [a] gung-ho personality, and there was going to be nothing to stop him.
[When] he was a teenager, I would go to his basketball practices and see that he would stop about halfway through running across the court, and lean down and put his hands on his knees. He would lift his chin up like he was gasping for air. And so I recognized – I’d seen a picture in a book at that time, – that this was a stance that athletes will often take when they have asthma.
So, ironically, when I asked him, “Now, are you having trouble breathing?” he says, “You know, my chest makes funny sounds like Brooke’s when I’m exercising.” Sure enough, I took him to the doctor and right away [he was] diagnosed [with] asthma. So, he was able to treat his asthma before he exercised by using an inhaled bronchodilator, a medication to relax the airways so that they didn’t tense up when he was exercising.
- Erin:
- I would like you to give us some key messages to convey to parents and others, some sort of golden nuggets for our listeners.
- Nancy:
- Well, your instincts are better than you know. Always trust your instincts. That’s what God gave them to us for, and if you feel that something is not right with your child – whether you understand it or not – take the child to your doctor. If you don’t get the answers you need from that doctor, keep going until you find the answers. Whatever it is that you know is wrong – is wrong.
- Erin:
- Go for clinical trials I would imagine is on that list, if you can.
- Nancy:
- Well, participate in clinical trials whenever you qualify. Not only is the care usually free, but [so are] the medications. And you have clinical investigators, people who act like little private eyes, who are focused on your child or your asthma symptoms. Just make sure that these clinical trials are certified and that the certification information is provided to you, and check on that certification information before you participate. You know, talk to other doctors about it, too, to make sure that it is a good program.
- Erin:
- When your child goes to school, make sure your child has an asthma management plan, right?
- Nancy:
- Absolutely, and that you’ve gotten all the forms that you need to get from the school before the school year starts. Do not wait until after the school year starts. A lot of parents also will say, “Oh, I’m just going to tell my child to hide his inhaler. I’m not going to tell the school about it because I don’t want them treating him any differently.” That actually sets your child up for a possible disaster, and children do die of asthma at school. Children do sit on the sidelines at school and get bad grades because no one has ever explained to anyone that they have asthma.
- Erin:
- And then a nugget that I liked a lot was when you talked about defining goals for your child with asthma – and yourself too – in terms of the recovery, right?
- Nancy:
- Start out with your asthma wish list. Before you go into the doctor’s office for an appointment, set some goals. These are things that I want to achieve. And tell the doctor about these things. If your doctor seems like he or she is in a rush, ask when you can come back for an appointment that will address all of your needs, and they generally slow down. Joining our organization is very easy. Just make a donation of any amount. It doesn’t matter [how much], but your donation tells us that you’re serious about controlling asthma and allergies and you want all the help that you can get. We’re an award-winning organization. Our materials are resourced by physicians around the country, as well as by patients.
So when you contact us and join, you’ll get our newsletter or our magazine. You’ll get discounts on products that arrange for you and all kinds of good help by just picking up the phone and calling us.
You can reach us at 800-878-4403 and you can also order our catalog through our Web site, AANMA.org.
- Erin:
- Now, you’ve given us so much information about how to help others. Before we go, can you tell us how you found out you have asthma?
- Nancy:
- I found out the hard way. I was teaching aerobic classes, and I’ve always been highly energetic and very stoic, and I would find that my lungs were burning every I was teaching my classes. So, I went to a doctor, and the doctor says, “Oh, well, you have asthma.” And my daughter was two at the time, and I said, “Only little children have asthma.”
And he just gave me an inhaler and he said, “Use this when you feel like you need it.” The mistake was I was never taught how to use that inhaler. My daughter wasn’t using one. I didn’t know the first thing about using it. No one ever told me I could overuse it, and I was coughing so hard from an asthma attack that I broke a rib.
Yep. I wound up in the hospital for a week, and I had been using this inhaler that he gave me every 20 minutes. I know that sounds like a very stupid thing that I did, but I was following his instructions. He said, “Use this when you feel like you need it.” So I learned right then and there that I almost left my children without a mother, and that even though I wasn’t wheezing and making sounds like my daughter, that asthma is a very serious disease. Just this burning feeling in my lung and the coughing was enough to break my rib and keep me in the hospital for a week.
- Erin:
- So, how do you currently manage your asthma, Nancy?
- Nancy:
- I am so fortunate. My asthma is either exercise-induced or [triggered by] certain smells [and] fumes. So, I avoid any kind of fume that I can. And when I’m going to [exercise], I generally don’t need medication before I work out. But if I do, I just use that. My daughter uses an inhaled corticosteroid every single day. She also uses medication [and a] bronchodilator to relax the airways when she has those noisy symptoms. She needs to treat her asthma every single day. I just am very, very aware. And that’s what we can teach people.
Here’s another nugget. Pay attention to your total health. The way you live your life definitely has impact on your health, and if you have a chronic illness, you must be even better to your body than you should normally be. You know, get enough rest. Get enough food, like fresh vegetables and fresh fruit so that your body’s not trying to constantly remove preservatives out of your foods.
- Erin:
- I was thinking about medication schedules and management of it. You’ve got to incorporate that into your life and think about it.
- Nancy:
- Well, managing asthma often requires juggling several medications, and that’s why that written treatment plan is so important. For example, if you have an episode that lasts a couple of weeks, and you’re on your medication for a couple months and then your doctor says, “Okay, you can back off.” A couple months later if you have an episode again, what are you supposed to do? And nine times out of ten, you forget some aspect.
So having it written down means you can go back to it and say, “Aha. This is what I’m supposed to do” and get things on board faster. You can prevent the forest fire – like Smoky the Bear used to say – by putting out your match appropriately. That’s what you have to do with asthma. At the first sign of a flame, you must extinguish it. But you can prevent it as well along the way.
Your asthma can be controlled. Expect nothing less.
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