Seeing one of her sons struggle to breathe is an all too familiar sight for Natalie Sua of Fresno. Three of her six children have been diagnosed with asthma, a chronic disease in which the airways swell and produce extra mucus.
In the past, when one of the three, who are all boys, had a severe asthma attack, Sua would rush him to the emergency room. But, now, thanks to Fresno’s Asthma Impact Model, she has learned how to reduce asthma triggers in her home and largely keep her sons’ asthma under control.
“We used to visit the ER three to four times a year, or more, when one of the children had a bad asthma attack,” Sua said. “In the past year, we’ve only had to go once or twice.
Launched in 2013, the Asthma Impact Model, focuses on helping low-income families in the Central Valley better manage their children’s asthma, thus avoiding ER visits. The program was designed by the Central California Asthma Collaborative and Clinica Sierra Vista, a Fresno health clinic.
Highest asthma rates in California
What started as a two-year pilot program, funded by a $1.1 million grant from the California Endowment, has continued with funding from a Social Impact Bond, created by the nonprofit group, Social Finance, and the Connecticut-based social enterprise group, Collective Health.
The funding is essential for the program because insurers — including the state’s low-income health program, Medi-Cal — often decline to pay for home visits or assessments done by health outreach workers, even though program administrators say such strategies have been proven to minimize the risk of asthma attacks. The Asthma Impact Model is offered free to low-income families in Fresno who are either referred by a physician or self-referred.
Stephani Pineda, a program coordinator for the Central California Asthma Collaborative, said the continued funding from Social Finance, Kaiser Permanente and others have allowed the Asthma Impact Model to expand to more families. The need is great in the Central Valley, an area with the highest rates of ER visits for childhood asthma in the state.
One in 6 children in the San Joaquin Valley have asthma, the highest level in the state. The American Lung Association’s State of the Air report for 2016 reports that the counties in San Joaquin Valley have the highest asthma rate for children in the nation. Over 550,000 Valley residents have asthma, and of those 105,000 are children.
Once families are in the intervention program, they meet with a care coordinator who visits the family to conduct an initial home assessment. When she visits houses, Pineda recommends strategies for reducing indoor environmental triggers, such as pet dander, dust, air fresheners and mold, which can cause asthma attacks. She also offers tips on using natural cleaning products and how to remove mold.
Pineda, who has a public health degree and has undergone extensive training on reducing asthma triggers, also reviews any medications family members are taking to make sure they are being used properly. Oftentimes, for example, families confuse inhaler types, Pineda said.
Pineda follows up with families every three months. Parents can also call her if they have any questions or concerns about managing their child’s asthma triggers.
Keeping children out of the ER
While much of the asthma burden in the Central Valley can be attributed to outdoor air pollutants, such as car exhaust and factory fumes, Pineda said addressing indoor air quality is also critical.
“Studies show children spend 70 to 90 percent of their days indoors,” she said.
According to several recent studies, indoor pollution often has more of an effect than outdoor pollution, because people spend more time indoors. Indoor pollutants include cooking residue, fungal spores, smoke, paint, varnishes and other household contaminants.
At Sua’s rental home in Fresno, Pineda asked about the type of cleaning products the family used. When Sua admitted she often used bleach, Pineda explained how harsh chemicals can actually trigger asthma symptoms and recommended mixing baking soda with water to create a natural cleaner that doesn’t irritate airways.
Moving on to the children’s bedrooms, Pineda suggested washing bedding once a week in hot water and using dust-mite covers on pillow cases, which she gave to Hua. Stuffed animals should move from beds to shelves, since the dust they collect can trigger an asthma attack, Pineda added. She also recommended throwing stuffed animals in the dryer once a week to remove dust mites.
When she visits a home, Pineda also looks for signs of mold, animal dander and cockroach droppings, which can all trigger asthma symptoms. If needed, she shows families how to use shampoos that neutralize animal dander, limit pet’s access to bedrooms, safely remove mold and curb exposure to cockroaches. In cases where this involves fixing leaky pipes or sealing cracks in walls or floors, Pineda can help facilitate conversations with landlords.
During her visits, Pineda offers hypoallergenic pillow cases, a machine to monitor indoor humidity and other supplies that she feels might help families to help keep irritants at bay.
Since connecting with the Asthma Impact Model two years ago, Sua has seen a big difference in the health of her sons, who are 7, 10 and 11.
One of Sua’s sons has even been able to play flag football for the entire season, “something he was never able to do in the past,” she said.