Breathing easier

Aug. 8, 2011

Wheezing, coughing, chest tightness and shortness of breath. This is asthma, and its symptoms were first recorded nearly 5,000 years ago.

Today, it is still the most common chronic illness of childhood with about 6.5 million children under the age of 18 diagnosed with asthma in the United States. It is still the leading cause of disability in children.

Through her research, Dr. Sharon Horner is working to improve the health of children with asthma, particularly those who live in rural areas. She will become associate dean for research at the School of Nursing on Sept. 1.

It is a life-long condition, and there is no cure.

Two University of Texas at Austin School of Nursing faculty researchers are conducting asthma self-management education studies with the goal of decreasing severity of attacks and improving the quality of life for children with the disease.

Through their community and school-based education programs, Drs. Sharon Horner and Eileen Kintner are teaching children how to accept their condition, manage symptoms, use appropriate medications and reduce environmental risk factors.

They are working with the children and family members, caregivers, friends, neighbors, coaches, teachers and other school personnel.

The disease, which inflames and narrows the airways (tubes that carry air into and out of your lungs) in the lungs, most often starts during childhood. During acute episodes, bronchial constriction, swelling of the airway wall and excessive mucus production decrease the ability to take in and breathe out air.

“Perhaps the best definition is how some children with asthma describe their condition: ‘I’m not able to do things other kids do,’” said Kintner.

According to the Centers for Disease Control and Prevention, asthma has increased among persons of all ages. In 2009, 24.6 million persons had asthma compared to 20.3 million persons with asthma in 2001.

Children in Dr. Eileen Kintner’s asthma education classes learn about what causes asthma and practice how to tell someone when they are having an episode.

It is more prevalent among children than adults, women than men and blacks than whites. Most persons with asthma can be symptom-free if they receive appropriate medical care, use inhaled corticosteroids when prescribed and modify their environment to reduce or eliminate exposure to allergens and irritants.

“Asthma has increased significantly among children 5-14 years of age,” said Horner, whose health education program is aimed primarily at helping rural school-aged children with the condition. “While asthma affects the child, the work to manage the disease can impact the entire family and also those in school and other community settings.”

Away from home, children need to be able to recognize early asthma warning signs, get help from other adults like teachers and coaches when they are having asthma symptoms and become more aware of asthma triggers and ways to avoid triggers, she said.

“Knowing who to tell, what to say, when to share and how to present asthma information can help other people better respond to meet your needs,” said Kintner.

Childhood asthma carries a heavy price tag for families in terms of health care costs, disruptions in family routines, lost wages, loss of learning time and even premature death, the researchers pointed out.

Horner is particularly interested in asthma education for rural families because there is a greater prevalence of chronic illnesses, lower education levels and poverty in these areas. Those living in the country also may be exposed to more allergens.

“Most of the information on childhood asthma has come from studies conducted in urban centers,” said Horner. “Yet, the lack of available, qualified health care providers and lack of urgent care services are extreme in rural areas.

These families travel a fair distance to receive good health care and when a child has worsening asthma symptoms, how far a family has to travel for medical help just increases the risk of a negative outcome.”

During their school lunch breaks, children in Horner’s treatment group learned how to deal with exacerbating situations, such as caring for animals or hard play outside. They practiced using teaching inhalers (which contained no medicine) and peak flow meters, simple devices that help measure airflow in the lungs.

Home visits also were incorporated into the treatment study. Families were given a peak flow meter and were taught how to use it and interpret the scores.

At the beginning of the study, Horner found some of the children had no prescribed medications for asthma and 42 percent of the children had their medication only at home. Only 19 percent of the children had a peak flow meter to use.

Having asthma doesn’t mean a child has to totally limit activities, the researchers said.

Elementary school children expressed their feelings about asthma through drawings.

Some people who have asthma will have symptoms, such as coughing and wheezing, even when they are not active. Other people have asthma that is caused only by exercise. In both cases, symptoms of asthma can almost always be prevented.

“Some people avoid the symptoms by keeping their asthma under control using long-term controller medications,” said Kintner. “For other people, taking quick-relief medicine before they exercise helps them prevent symptoms.”

Kintner’s asthma education program is primarily for medically underserved children in urban areas. The students participate in 10 academic and counseling sessions during school hours.

During these sessions, they work on spelling words, math problems, reading assignments and other learning activities — including drawing pictures and writing poems or songs — to describe what it’s like to live with asthma. They also practice how to tell someone when they’re having an asthma episode.

Kintner’s project monitors children as they transition from elementary school into middle school at sixth and seventh grades.

“Because children are moving toward more personal responsibility, it is a perfect time to learn about managing their own health conditions,” Kintner said. “We teach the children that they have a personal choice for how they want to manage their asthma. When a person has accepted their asthma, they feel empowered, responsible and prepared to manage and control their symptoms. They are able to set their own personal goals for control of their condition.”

Horner and Kintner pointed out that each child has different stimuli that cause asthma symptoms. These include food allergies, weather changes and outdoor air quality, dust mites, animal or mold allergies, environmental conditions, heartburn, strong smells, odors and sprays, colds and infections laughing or talking loudly and exercise.

The children in their programs are taught ways to avoid or control each one of these stimuli and are encouraged to keep written records of their activities. The research is funded by the National Institutes of Health.

The researchers have found positive results from their educational programs, including improved asthma self-management skills, reduced asthma symptom frequency and severity, and lower hospitalization and use of healthcare services. The children also missed less school after participating in the programs.

“The reduction in absences is significant — an improvement that benefits the child, parents and the schools,” said Horner. “Not only were the children better able to care for their asthma, but they can now do so in situations where adults are not around.”

*The children’s quotes and drawings are from participants in Dr. Eileen Kintner’s asthma education program.

For more information, contact: Nancy Neff;
Photos of Drs. Sharon Horner and Eileen Kintner: Marsha Miller