By Adem Lewis / in , , , , , , , , , , /


>>HI. I’M STEPHEN JONES. AT ROBERT WOOD JOHNSON, WE BELIEVE CITIZENS NEED TO BE INFORMED ABOUT THE IMPORTANT HEALTHCARE ISSUES AFFECTING THEIR LIVES. THAT’S WHY WE’RE PROUD TO SUPPORT THE HEALTHCARE PROGRAMMING PRODUCED BY THE CAUCUS EDUCATIONAL CORPORATION.>>CHILD ASTHMA, NEXT ON “CAUCUS: NEW JERSEY.”>>FUNDING FOR THIS EDITION OF “CAUCUS: NEW JERSEY” HAS BEEN PROVIDED BY… ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, THE HEART OF ACADEMIC MEDICINE… HEALTHFIRST NEW JERSEY… MD ADVANTAGE INSURANCE COMPANY OF NEW JERSEY… AND BY ROCHE.>>WELCOME TO “CAUCUS: NEW JERSEY.” I’M STEVE ADUBATO. ASTHMA IS THE MOST COMMON CHRONIC DISEASE OF CHILDHOOD, YET MANY PARENTS KNOW LITTLE ABOUT IT. JOINING US HERE IN THE STUDIO TO EXPLORE THE TOPIC OF CHILDHOOD ASTHMA ARE DR. NIEL MIELE, WHO IS THE ASSISTANT DIRECTOR OF PEDIATRIC EMERGENCY DEPARTMENT AT THE ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, DR. NELSON TURCIOS, WHO IS A PEDIATRIC PULMONOLOGIST AND DIRECTOR OF THE PEDIATRIC ASTHMA INSTITUTE, DR. JENNIFER WARREN, ASSISTANT PROFESSOR OF HEALTH COMMUNICATION AT RUTGERS UNIVERSITY, AND FINALLY, ALLISON INSERRO, WHO IS LEADER OF THE ALLERGY AND ASTHMA SUPPORT GROUP OF CENTRAL NEW JERSEY, AND YOUR SON COLIN HAS ASTHMA.>>HE DOES.>>I WANT TO THANK ALL OF YOU FOR JOINING US. DR. MIELE, LET ME ASK YOU. THIS ISSUE OF ASTHMA–PEOPLE CONFUSED ABOUT IT, DON’T UNDERSTAND IT. WHAT IS IT? WHAT IS THE ISSUE WE’RE TALKING ABOUT HERE?>>ASTHMA IS A CHRONIC CONDITION. IT’S SOMETHING, FIRST OF ALL, THAT HAPPENS OVER AND OVER AGAIN. PEOPLE KNOW ABOUT WHEEZING, WHICH IS ONLY ONE MANIFESTATION OF ASTHMA. WE’VE CHANGED THE TERMINOLOGY. WE CALL IT NOW REACTIVE AIRWAY DISEASE.>>WHY?>>IT BRINGS OUT OR TRIES TO GET ACROSS THE MESSAGE THAT YOUR LUNGS ARE REACTING TO SOMETHING, AND FOR DIFFERENT PEOPLE, THAT SOMETHING COULD BE DIFFERENT THINGS. IT COULD BE DUST. IT COULD BE CIGARETTE SMOKE. IT COULD BE PETS. IT COULD BE EXERCISE. IT COULD BE COLD. VARIOUS THINGS– INFECTIONS CAN SET OFF A WHEEZING EPISODE. SO WHAT HAPPENS IS THE SMALL AIRWAYS IN THE LUNGS KIND OF GO INTO A SPASM, AND AS AIR MOVES IN AND OUT OF THE LUNGS, THAT’S WHAT CAUSES WHAT WE KNOW AS WHEEZING. I TELL PARENTS IT’S LIKE HAVING A MILLION LITTLE WHISTLES IN YOUR CHEST. BUT THERE ARE OTHER COMPONENTS TO ASTHMA. WE ALSO GET INFLAMMATION OF THE LUNGS, SO NOT ONLY ARE THE AIRWAYS SPASMING, BUT THEY’RE ALSO KIND OF SWELLING UP. THE THIRD COMPONENT IS YOU END UP MAKING MORE MUCUS IN YOUR LUNGS, AND BECAUSE OF THE SPASMING OF THE AIRWAYS AND BECAUSE OF THE INFLAMMATION OF THE AIRWAYS, IT’S HARD TO COUGH THAT STUFF UP, RESULTING IN A PATIENT WHO IS HAVING DIFFICULTY BREATHING.>>DOCTOR, TALK TO US. SOME OF THE RISK FACTORS THAT WE NEED TO UNDERSTAND.>>THE IDENTIFICATION OF THE PRIMARY CAUSES OF ASTHMA, AS WELL AS THE POTENTIAL RISK FOR ASTHMA, THERE HAVE BEEN REALLY NONE IDENTIFIED. THERE ARE SOME RISK FACTORS THAT WE CAN INCLUDE. FOR EXAMPLE, THE PRESENCE OF A CHILD WITH A CHRONIC MANIFESTATION OF AIRWAY OBSTRUCTION.>>AIRWAY OBSTRUCTION. BRONCHIAL OBSTRUCTION.>>OK.>>SPECIFICALLY, WHEEZING, COUGHING, AND A SHORTNESS BREATH. IN THE PRESENCE OF THOSE SYMPTOMS, SOMEONE WHO HAS A STRONG FAMILY HISTORY OF ASTHMA OR THE PRESENCE OF ATOPIC DISEASES, LIKE ECZEMA AND HAY FEVER OR FOOD ALLERGIES, INCREASES THE LIKELIHOOD THAT THOSE SYMPTOMS ARE DUE TO ASTHMA.>>HOLD ON A SECOND. IF A PARENT IS A SMOKER AND HAS ASTHMA, GETS ASTHMA BECAUSE OF THEIR SMOKING, DOES IT INCREASE THE LIKELIHOOD THAT THE CHILD WILL GET ASTHMA?>>I DON’T KNOW IF THERE’S A CONNECTION BETWEEN THE PARENT SMOKING HAVING ASTHMA AND THE CHILD GETTING ASTHMA, BUT THERE’S SOMETHING ABOUT THE ENVIRONMENTAL TOBACCO SMOKE THAT OCCURS WHEN A PARENT SMOKES. SO ONCE A PERSON COMBUSTS A CIGARETTE–COMBUSTS MEANING LIGHTS THE CIGARETTE– TOXIC CHEMICALS ARE RELEASED INTO THE AIR, AND THESE CHEMICALS, MANY OF THEM ARE DEADLY, AND THERE’S OVER 4,000 CHEMICALS, 99 OF WHICH HAVE BEEN DETERMINED AS HUMAN CARCINOGENS. AND THIS IMPACTS A CHILD’S BREATHING, AND THE YOUNGER THE CHILD, THE MORE IT IMPACTS BECAUSE THE CHILD IS BREATHING FASTER, THEY METABOLIZE THINGS FASTER, AND THEY’RE CLOSER TO THE GROUND, WHICH MAKES THEM MORE EXPOSED TO SOMETHING CALLED THIRD-HAND SMOKE, WHICH INDEED IS–>>THIRD-HAND?>>YES. WE HAVE THE SMOKE THAT COMES OFF THE CIGARETTE, AND THEN THERE ARE PARTICULATE MATTER THAT FALLS ONTO FURNITURE, RUGS, IN CARS, AND CHILDREN INHALE THESE. IF YOU HAVE A CHILD CRAWLING ON THE FLOOR INHALING THIS PARTICULATE MATTER, IT’S GOING TO IMPACT THEIR HEALTH. I DON’T KNOW IF SMOKING DIRECTLY CAUSES ASTHMA, BUT IT CAN EXACERBATE ISSUES RELATED TO ASTHMA, AND IT CAN CAUSE ALLERGY-LIKE SYMPTOMS THAT CAN MIMIC ASTHMA. SO, YES.>>ASTHMA IS LITTLE UNDERSTOOD BY MANY, MANY PEOPLE. BY THE WAY, LOG ON TO OUR WEBSITE. WE’LL HOOK YOU UP WITH NONPROFIT ORGANIZATIONS AROUND THE STATE, BUT PARTICULARLY OUR COLLEAGUES AND FRIENDS AT ROBERT WOOD JOHNSON, WHO HAVE BEEN DOING IMPORTANT WORK HERE. LET ME ASK YOU SOMETHING ELSE. YOUR SON COLIN GOT DIAGNOSED WITH ASTHMA WHEN?>>BETWEEN THE AGES OF ONE AND TWO, BUT AS DR. TURCIOS MENTIONED, AS A BABY HE HAD WHAT WE NOW CALL THE ATOPIC MARCH.>>SAY IT AGAIN.>>THE ATOPIC MARCH.>>WHAT DOES THAT MEAN?>>HE HAD A CONSTELLATION OF THINGS. HE STARTED OUT WITH ECZEMA AS AN INFANT. AHEM. EXCUSE ME. HE WAS DIAGNOSED WITH MULTIPLE FOOD ALLERGIES AT 10 MONTHS, AND THEN AROUND AGE ONE, HE HAD A REALLY BAD CASE OF THE CROUP, AND THEN AFTER THAT, EVERY TIME HE WAS AROUND CATS, RUNNING AROUND IN THE COLD AIR, POLLEN DURING THE SPRING ALLERGY SEASON, HE WOULD START WHEEZING AND COUGHING, SO HE WAS PRESCRIBED ALBUTEROL, WHICH IS A RESCUE MEDICATION, AND A NEBULIZER. AND I THINK RIGHT AFTER AGE TWO, HE WAS PUT ON A CONTROLLER MEDICATION TO CONTROL THE SYMPTOMS AND REDUCE THE INFLAMMATION AND MAKE IT LESS LIKELY THAT YOU WOULD NEED TO USE YOUR RESCUE MEDICATION.>>WHAT WAS HAPPENING FOR YOU DURING THIS?>>IT WAS PRETTY STRESSFUL. I WAS DEALING WITH A LOT OF THINGS–THE FOOD ALLERGIES, THE ASTHMA. THEY’RE ALL RELATED. I OFTEN SAY THAT MY SON’S GENERATION IS PART OF GENERATION ALLERGY. YOU KNOW, THESE KIDS WHO ARE NOW IN PRESCHOOL, EARLY ELEMENTARY AGES, THEY’RE SUFFERING FROM A LOT OF THINGS RIGHT NOW, AND AS HE SAID, WE DON’T REALLY KNOW WHY. IT’S REALLY FRUSTRATING TO HAVE TO LEAVE A PARTY OR TO HAVE TO LEAVE A PARK IN THE SPRING AND FALL, WHEN THE RAGWEED SEASON IS HIGH–SAY, IN AUGUST– BECAUSE HE FEELS SICK.>>HOW OLD IS HE NOW?>>HE’S 8.>>HOW IS HE DOING?>>HE’S GREAT. HE’S VERY FUNNY. FORTUNATELY, HE’S NOT TOO INTO SPORTS, WHICH MAYBE IS A GOOD THING. HE LIKES TO SAY HE’S A LEGO GUY AND AN ART GUY, SO HOPEFULLY–BUT PEOPLE WITH ASTHMA CAN PARTICIPATE IN SPORTS AND DO EVERYTHING THAT PEOPLE WITHOUT ASTHMA CAN DO. IT SHOULDN’T IMPEDE–>>HOW DOES IT AFFECT HIM?>>WHEEZING AND COUGHING, PRIMARILY.>>HOW OFTEN DO YOU SEE THIS, DOCTOR?>>PRETTY OFTEN. STUDIES, DEPENDING ON WHICH BOOK YOU READ, BETWEEN 5% AND 10% OF KIDS HAVE ASTHMA, AND THERE’S PROBABLY A NUMBER MORE THAT DON’T EVEN CARRY THE DIAGNOSIS YET THAT MIGHT HAVE SOME MILD SYMPTOMS, AND SOME–>>BECOMING MORE COMMON?>>WE THINK IT IS.>>OR JUST GETTING DIAGNOSED MORE? I NEVER KNOW THAT.>>I THINK IT’S A COMBINATION. OVERALL, I THINK IT’S A COMBINATION. I THINK WE ARE SEEING MORE ASTHMA. I THINK THERE’S JUST POSSIBLY, AS ALLISON WAS REFERRING TO, THERE MAY BE MORE THINGS THAT ARE OUT THERE THAT OUR KIDS ARE GETTING EXPOSED TO AND VARIOUS TRIGGERS. SO WE ARE SEEING IT MORE.>>DOCTOR, LET ME ASK YOU– I’LL COME BACK TO YOU–BUT LET ME ASK YOU SOMETHING. HOW MUCH OF THE ISSUE OF CHILDHOOD ASTHMA, FROM YOUR EXPERIENCE, FROM YOUR EXPERTISE, IS TIED TO SOCIOECONOMIC CONDITIONS AND ALSO WHERE CHILDREN GROW UP, WHAT THEIR ENVIRONMENT IS, WHO THEY’RE AROUND, WHAT THEY’RE AROUND, AND WHAT THEY HAVE ACCESS TO IN TERMS OF HEALTHCARE, ET CETERA? HOW MUCH OF IT IS ABOUT THAT? SIMPLY PUT, POORER KIDS, ARE THEY MORE LIKELY TO GET ASTHMA?>>BEFORE I ADDRESS YOUR QUESTION, ESTABLISHING THE DIAGNOSIS OF ASTHMA IN YOUNG CHILDREN IS VERY DIFFICULT.>>THE DIAGNOSIS ITSELF? WHY?>>A STUDY HAS DEMONSTRATED THAT THE BULK OF THE CHILDREN WITH ASTHMA, THEY DO PRESENT WITH SYMPTOMS–50-80% OF THE CHILDREN PRESENT WITH SYMPTOMS BEFORE 5 YEARS OF AGE. THEN THE DIAGNOSIS IS COMPLICATED BY THE FACT THAT WE’RE UNABLE TO DO BREATHING TESTS IN THAT AGE GROUP.>>BREATHING TESTS?>>IN THAT AGE GROUP.>>WHY CAN’T YOU DO IT?>>FOR PRACTICAL PURPOSES, BECAUSE YOU NEED TWO COMPONENTS THERE. YOU NEED THE COOPERATION FROM THE CHILD AND A GOOD TECHNICIAN.>>YOU HAVE TO BE COORDINATED.>>HOLD ON. LET ME GET THIS STRAIGHT. TIME OUT. WELL, KIDS DON’T COOPERATE. YOU’RE SAYING IT’S HARD TO GET A GOOD READ.>>ABSOLUTELY. IT’S DIFFICULT TO DO A BREATHING TEST IN THE CHILD, WHICH IDEALLY, YOU KNOW, YOU SHOULD BE MAKING THE DIAGNOSIS OF ASTHMA IN THE CONTEXT OF THE CLINICAL SYMPTOMS PLUS SUBJECTIVE EVIDENCE THAT THERE IS AN AIRWAY OBSTRUCTION THERE. SO THIS HAS TWO IMPORTANT IMPLICATIONS. NUMBER ONE, BECAUSE THEY’RE WRONG LABELS, INAPPROPRIATE LABELS. THERE ARE A LOT OF CHILDREN THAT ARE WALKING AROUND WITH A DIAGNOSIS OF REACTIVE AIRWAY DISEASE, CHRONIC BRONCHITIS, ASTHMATIC BRONCHITIS, CHEST DISCHARGE, RECURRING PNEUMONIA–YOU NAME IT. WHAT IS THE IMPLICATION OF THIS? THE WRONG TREATMENT. ALSO, ON THE OTHER HAND, THERE IS ANOTHER GROUP OF CHILDREN THAT WE NEED TO UNDERSTAND THE FOLLOWING–THEY KNOW WHEEZES AND COUGHING IS CAUSED BY ASTHMA. THERE IS A GROUP, ALTHOUGH LESS COMMON THAN ASTHMA, THAT MAY PRESENT IN THE FASHION THAT COMPOUNDS TO MAKE THE DIAGNOSIS OF ASTHMA. CYSTIC FIBROSIS, CONGENITAL HEART DISEASE, PRIMARY IMMUNODEFICIENCY, JUST TO NAME A FEW–THEY BEHAVE IN THE SAME WAY LIKE A CHILDHOOD ASTHMA.>>HOLD ON. SO YOU’RE SAYING THAT THERE’S A LOT OF MISDIAGNOSIS GOING ON.>>ABSOLUTELY. ABSOLUTELY.>>IS THERE A DIFFERENCE BETWEEN ASTHMA–I WANT TO UNDERSTAND SOMETHING. CHILDHOOD SERIOUS ALLERGY AND ASTHMA. NOT THE SAME THING.>>THEY’RE PROBABLY ON THE SAME CONTINUUM.>>THEY ARE.>>THEY ARE ON THE SAME CONTINUUM, BUT ARE THEY ABSOLUTELY THE SAME THING? DOES EVERYONE WHO HAVE FOOD ALLERGY HAVE ASTHMA? NOT NECESSARILY.>>BUT IF YOU HAVE SERIOUS ALLERGIES, ARE YOU MORE INCLINED TO GET ASTHMA?>>YES.>>OK. DO YOU AGREE WITH THE DOCTOR’S ASSESSMENT OF SOME OF THESE MISDIAGNOSES GOING ON?>>I THINK, AGAIN, WHAT DR. TURCIOS IS SAYING IS THAT IT’S HARD TO MAKE THE DIAGNOSIS. YOU CAN’T GET A TWO-YEAR-OLD TO PUT A TUBE IN HIS MOUTH, TAKE A DEEP BREATH ON COMMAND, BLOW OUT AS HARD AS HE CAN, THOSE KIND OF THINGS. SO WE OFTEN WILL MAKE THE DIAGNOSIS BASED ON HOW THE PATIENT IS DOING CLINICALLY AND GIVE THEM THIS LABEL OF BEING A CHILD WITH ASTHMA. SOME OF THOSE TIMES, IT’S ASTHMATIC SYMPTOMS THAT ARE COMPOUNDING SOME OTHER ILLNESS.>>REAL QUICK, DO ADULTS GET ASTHMA WHO HAVE NOT HAD ASTHMA AS CHILDREN?>>IT DOES HAPPEN.>>RARE?>>TO BE HONEST, I’M NOT SURE HOW RARE OR NOT IT IS.>>I HAVE GOOD QUESTIONS. I DON’T HAVE THE ANSWERS. DOCTOR, LET ME ASK YOU, YOU HAVE TOLD OUR PRODUCERS, AND YOU SAID PUBLICLY, THIS IS A SOCIAL JUSTICE ISSUE. WHAT DO YOU MEAN BY THAT?>>WELL, I THINK THAT IN MY RESEARCH AND WHAT I HAVE SEEN IN MY WORK IN NORTH MINNEAPOLIS, WHERE I PARTNERED WITH A CHILDCARE CENTER, A LOT OF THE CHILDREN THERE WERE AFRICAN AMERICANS, AND THEY WERE DISPROPORTIONATELY, BASED ON THE STATISTICS OF THAT CITY, AFRICAN-AMERICAN CHILDREN AGED ZERO TO 5 WERE–NOT ZERO, BUT 6 WEEKS TO 5, WERE DISPROPORTIONATELY IMPACTED BY ASTHMA OR ASTHMA-LIKE SYMPTOMS. AND UNFORTUNATELY, MANY OF THE CHILDREN AT THE CENTERS THAT I PARTNERED WITH– THESE CENTERS WERE FEDERALLY SUBSIDIZED, SO A LOT OF THE PEOPLE THAT WERE THERE WERE POVERTY LINE OR BELOW, AND UNFORTUNATELY THEY LIVED IN HOUSING, ATTACHED HOUSING, WHICH INDEED CAN CAUSE GREATER EXPOSURE OF ENVIRONMENTAL TOBACCO SMOKE–SHARING VENTILATION SYSTEMS, PEOPLE SMOKING OUTSIDE OF WINDOWS. MANY TIMES THERE COULD BE RODENT OR ROACH DUST, OR THE MATTER THAT’S LEFT BEHIND BY ROACHES CAN CAUSE ISSUES. SO I WAS JUST SPEAKING WITH A COLLEAGUE THE OTHER DAY. THEY ARE DOING THESE NEW PROJECTS IN THE BRONX, THESE NEW APARTMENTS, AND SHE WAS TELLING ME THAT HUD– AND MAYBE I SHOULDN’T SAY–>>HOUSING AND URBAN DEVELOPMENT. YOU MAYBE SHOULDN’T SAY IT? WHEN YOU SAY THAT TO ME, I SAY DEFINITELY SAY IT.>>HA HA! WELL, HUD, SHE WAS TELLING THEM ABOUT THE SHARING OF VENTILATION SYSTEMS, MEANING THAT IF SOMEONE IS SMOKING, IT’S GOING TO GO INTO OTHER APARTMENTS. SO HUD DID NOT CHOOSE TO TAKE THIS WOMAN’S ADVICE OR THE DESIGNER’S ADVICE BECAUSE IT WAS CHEAPER. SO YES, IT IS A SOCIAL JUSTICE ISSUE BECAUSE THE PEOPLE WHO CANNOT AFFORD TO HAVE HOUSES AND HOMES THAT CAN ALLOW THEM TO BE SMOKE-FREE–>>I’M SORRY FOR INTERRUPTING, DOCTOR. YOU JUST ANSWERED MY QUESTION. I SAID, ARE POORER CHILDREN MORE LIKELY… WELL, LISTEN, AGAIN, I DON’T KNOW WHAT THE RESEARCH SHOWS, BUT JUST ANECDOTALLY, BASED ON WHAT YOU JUST SAID, WHEN I ASKED THE QUESTION, ARE POORER CHILDREN MORE LIKELY TO BE EXPOSED TO CONDITIONS THAT WOULD ULTIMATELY MANIFEST THEMSELVES IN ASTHMA OR ASTHMA-LIKE SYMPTOMS, THE ANSWER IS–COME ON. LET’S NOT KID OURSELVES.>>YES.>>THERE IS A KNOWN BODY OF EVIDENCE THAT THERE ARE SOME POPULATIONS THAT REALLY ARE HIGH RISK OF DEVELOPING ASTHMA. THE BURDEN IS ON THAT POPULATION. LOW-INCOME POPULATION, AFRICAN-AMERICAN POPULATION, INNER CITIES. CHILDREN LIVING IN THE INNER CITY, THEY ARE THE HIGHEST RISK FOR DEVELOPING ASTHMA.>>AND ALSO LESS LIKELY TO GET THE CARE THAT THEY NEED TO BE TREATED, WHICH ONLY COMPOUNDS THE SITUATION.>>ABSOLUTELY.>>ABSOLUTELY.>>I WANT TO BRING YOU BACK IN HERE. YOUR ORGANIZATION– DESCRIBE IT.>>WE’RE A SUPPORT GROUP OF ABOUT 100 FAMILIES. WE’RE LINKED TO MANY OTHER SUPPORT GROUPS IN NEW JERSEY.>>SAY THE WEBSITE, BECAUSE WE’LL PUT IT UP AS YOU’RE TALKING.>>ALLERGYFRIENDSNJ.ORG.>>ALLERGYFRIENDS…>>NJ.ORG.>>WE LIKE .ORGs. THEY’RE NONPROFIT. NOBODY IS MAKING MONEY OFF THIS, RIGHT?>>NO.>>TELL US WHAT HAPPENS.>>A PARENT WILL JOIN THE GROUP, AND WE CAN PROVIDE TRAININGS TO SCHOOLS. WE DO PHONE CALLS AND MONTHLY MEETINGS AROUND ALLERGIES AND ASTHMA. ANOTHER GREAT RESOURCE THAT PARENTS SHOULD KNOW ABOUT FOR PARENT EDUCATION IS THE PEDIATRIC/ADULT ASTHMA COALITION OF NEW JERSEY, WHICH DR. TURCIOS IS ALSO INVOLVED IN. THAT HAS THOSE PARENT RESOURCES ONLINE FOR PARENT EDUCATION ABOUT HOW TO USE A NEBULIZER, HOW TO USE A SPACER, HOW TO USE A PEAK FLOW METER, HOW TO STAY ON TOP OF YOUR CHILD’S SYMPTOMS WHEN THINGS ARE STARTING TO GET OUT OF HAND, BECAUSE IF YOU CAN GET ON TOP OF IT EARLY ENOUGH, YOU CAN PREVENT A TRIP TO THE EMERGENCY ROOM.>>CAN I ADD SOMETHING?>>I WANT TO TALK ABOUT THE SO-CALLED PUFFER. GOING TO BACK TO YOU, DR. MIELE, RIGHT AFTER THIS.>>ANOTHER RISK FACTOR, TOO, IS THE HEALTH LITERACY LEVEL OF THE PARENTS.>>THE HEALTH LITERACY LEVEL. HOW MUCH THEY KNOW ABOUT HEALTH.>>YES, AND HOW MUCH DO THEY KNOW ABOUT THE CHRONIC ILLNESS OR DISEASE OF ASTHMA AND HOW TO TAKE CARE OF IT? MANY PARENTS BELIEVE THAT THEY’RE DOING THE BEST THING THAT THEY CAN, BUT AT THE SAME TIME, THEY’RE RELYING ON SOME OLD-FASHIONED METHODS, LIKE THEY DON’T HAVE ACCESS TO CARE, SO THEY USE HOMEMADE METHODS, OR THEY THEMSELVES JUST DON’T UNDERSTAND ABOUT PERSONAL HEALTH PROMOTION, AND THAT IMPACTS THEIR OWN CHILD.>>EDUCATION, HUGE. EDUCATION IS HUGE HERE.>>IT’S ABSOLUTELY PERTINENT.>>DR. MIELE, ONE SECOND. WHAT’S A PUFFER?>>WELL, THE USUAL THING WE USE IS ALBUTEROL. SOME PEOPLE REFER TO IT AS A RESCUE INHALER. IT’S A MEDICATION THAT STOPS OR SHOULD CAUSE YOUR AIRWAYS TO STOP SPASMING, THAT FIRST COMPONENT OF ASTHMA THAT WE TALKED ABOUT.>>CAN IT BE MISUSED?>>IT ABSOLUTELY CAN BE MISUSED.>>TALK ABOUT IT.>>TYPICALLY, AND EVERYONE KNOWS–I’M SORRY I DON’T HAVE ONE WITH ME, BUT IT’S KIND OF THIS “L”-SHAPED THING. YOU’RE SUPPOSED TO PUFF INHALE– THE RIGHT WAY TO USE IT, SHAKE THAT UP FIRST, TAKE A DEEP BREATH OUT, AND THEN PUFF AS YOU START TO INHALE IN. A LOT OF PEOPLE CAN’T DO THAT, PARTICULARLY KIDS. JUST CAN’T COORDINATE THAT ALL. WE VERY OFTEN SUGGEST USING A SPACER DEVICE.>>SPACER?>>A LITTLE PLASTIC CONTAINER. THERE ARE VARIOUS FORMS THAT THEY CAN USE, BUT BASICALLY, YOU PUFF YOUR MEDICATION INTO THIS CONTAINER, AND THEN, WITH A MASK, BREATH IN THROUGH THE MASK SO YOU’RE NOT LOSING IT. I’VE SEEN MANY KIDS OVER THE YEARS, AND THEY’LL SAY, “MY PUFFER DOESN’T WORK.” I’LL SAY, “SHOW ME HOW YOU’RE USING IT,” AND YOU’LL SEE THEM GO… [EXHALES] AND YOU’LL SEE THEM BLOW THE MEDICATION RIGHT OUT AS YOU’RE WATCHING THEM. SO THERE’S CERTAINLY THE ASPECT THAT FIRST, IT’S NOT EASY FOR A CHILD TO USE, PARTICULARLY ALL BY HIMSELF.>>WE NEED TO TEACH KIDS? DO YOU TEACH?>>YEAH.>>AND THE PARENTS NEED TO KNOW SO THAT THEY CAN TEACH, RIGHT?>>YES. TYPICALLY IN THE EMERGENCY ROOM, WHEN WE HAVE A CHILD THAT’S NEVER USED THIS BEFORE, OR EVEN IF THEY HAVE USED IT BEFORE, WHO’S RUN OUT OF MEDICATION, WE’LL USUALLY SUPPLY THEM WITH A PUFFER AND A SPACER. THE NURSE WILL SHOW THEM HOW TO USE IT AS THE CHILD GETS DISCHARGED.>>ONE MORE QUICKIE HERE BEFORE YOU COME BACK. YOU ALSO SAID THAT YOU’RE CONCERNED ABOUT US BECOMING TOO COMPLACENT ABOUT ASTHMA, WHICH IS WHY I’M GLAD WE’RE DOING THIS PROGRAM.>>YES. I THINK AS OUR MEDICATIONS HAVE GOTTEN BETTER AND BETTER OVER THE YEARS– 20 YEARS AGO, THE TREATMENT FOR ASTHMA WAS YOU SHOWED UP IN THE EMERGENCY ROOM, AND YOU GOT UP TO 3 SHOTS OF EPINEPHRINE 15 MINUTES APART. WE DIDN’T HAVE ALL THESE WONDERFUL EASY BREATHING TREATMENTS AND NEBULIZERS AND THINGS THAT YOU COULD USE AT HOME. AS WE’VE GOTTEN BETTER AND BETTER MEDICATIONS, THE DEATH RATE FROM ASTHMA HAS ACTUALLY INCREASED OVERALL.>>WHY?>>THERE’S DIFFERENT THEORIES AS TO WHY THAT’S HAPPENED. WHAT I LIKE TO THINK–NO ONE HAS BEEN ABLE TO PROVE IT ENTIRELY, BUT ANECDOTALLY, SOME PATIENTS WILL USE THEIR PUFFER, AND TYPICALLY WE SAY IF YOU’RE USING IT MORE THAN EVERY 4 HOURS, YOU PROBABLY NEED SOME HELP, YOU KNOW? WHETHER THAT IS TALK TO YOUR DOCTOR ABOUT A DIFFERENT MEDICATION, MAYBE COME TO THE EMERGENCY ROOM OR WHATEVER, BUT SOME PEOPLE WILL GIVE THEMSELVES A PUFF–“OK. IT LASTED ME HALF AN HOUR. LET’S TAKE ANOTHER PUFF.” IT LASTS ANOTHER HALF-HOUR. IF YOU’RE IN THAT MUCH TROUBLE, THAT PUFFER IS NOT ENOUGH.>>JUMP IN, DOCTOR.>>ALLOW ME TO EXPAND A LITTLE BIT ABOUT THE TREATMENT OF ASTHMA. I STRONGLY BELIEVE EDUCATION IS THE SINGLE MOST IMPORTANT COMPONENT. THOSE PARENTS AND PATIENTS, WHEN THE AGE ALLOWS, THEY ARE FAMILIAR WITH THE DISEASE, THEY ARE THE ONES THAT ARE BETTER EQUIPPED NOT ONLY TO COPE WITH ANY EMERGENCY, BUT ALSO TO HELP ME FORMULATE A GOOD TREATMENT PLAN. THE EDUCATION, YOU HAVE TWO IMPORTANT PARTS TO. NUMBER ONE, REVIEW THE BASICS, YOU KNOW. EVERY TIME, EVERY OPPORTUNITY, THE BASICS OF ASTHMA, THE USE OF THE INHALERS, THE ENVIRONMENTAL CONTROL MEASURES, ET CETERA, AND ALWAYS TO PROVIDE THE PATIENT WITH A WRITTEN ACTION PLAN. THE WRITTEN ACTION PLAN SHOULD CONTAIN TWO COMPONENTS. NUMBER ONE IS THE DAILY MANAGEMENT, AND NUMBER TWO, HOW TO HANDLE AND RECOGNIZE A SYMPTOM EPISODE. WHAT ARE THE IMPLICATIONS OF A POOR EDUCATION? NUMBER ONE IS PATIENT HEALTH.>>SO LET’S TALK ABOUT, WHAT HAPPENS IF YOU DON’T HAVE THOSE THINGS, IF YOU DON’T HAVE THE SYMPTOMS TO LOOK FOR, THE SIGNS TO LOOK FOR, IF YOU DON’T HAVE THE DAILY PROTOCOL? NOW TELL US WHAT THE RISK IS IF YOU DON’T HAVE IT.>>THE RISKS ARE VERY CLEAR. THIS PATIENT MAY END UP IN AN EMERGENCY ROOM, AN UNSCHEDULED OFFICE VISIT, HOSPITALIZED, OR EVEN, YOU KNOW, ASTHMA CAN KILL.>>ASTHMA CAN KILL.>>ABSOLUTELY. THE RATE OF THE ASTHMA DEATHS ARE LOW, BUT STILL, YOU KNOW, FATALITIES OCCUR. AND THE ONES, AGAIN, AT HIGH RISK ARE THOSE POORLY EDUCATED.>>GOT IT. JUMP BACK IN HERE. IN THE SUPPORT GROUPS, WHAT KIND OF THINGS COME OUT?>>ISSUES WITH SCHOOLS, TRIGGERS IN SCHOOLS. DOES THE CHILD GOING TO SCHOOL HAVE AN ASTHMA ACTION PLAN, WHICH IS ACTUALLY REQUIRED BY NEW JERSEY STATE LAW?>>AN ASTHMA ACTION PLAN. BY THE WAY, WHAT IS THE STATE LAW RIGHT NOW?>>STUDENTS ARE SUPPOSED TO HAVE THEIR MEDICINE IN SCHOOL. THEY’RE SUPPOSED TO HAVE THEIR ACTION PLANS IN SCHOOL. SCHOOL NURSES ARE SUPPOSED TO BE PROVIDING TRAINING TO THE STAFF ON RECOGNIZING SYMPTOMS. THE ORGANIZATION I MENTIONED, THE PEDIATRIC/ADULT ASTHMA COALITION OF NEW JERSEY, THEY HAVE AN ASTHMA FRIENDLY SCHOOL AWARD THAT NEARLY 600 SCHOOLS IN NEW JERSEY HAVE RECEIVED, AND MOST OF THAT AWARD IS ACTUALLY, THEY TOLD ME, COVERED BY STATE STATUTE.>>BY THE WAY, DO CHILDREN WITH ASTHMA–IS THERE ANY RESEARCH THAT SHOWS HOW CHILDREN WITH ASTHMA ARE DOING IN SCHOOL?>>ACADEMICALLY?>>YES. IT’S GOT TO BE CHALLENGING.>>THAT’S AN INTERESTING QUESTION.>>IT’S GOT TO BE CHALLENGING.>>I KNOW FROM JUST–FOR ME, THE PREVENTION STARTS VERY EARLY ON, SO IF WE’RE LOOKING AT CHILDREN WHO ARE IN DAYCARE SETTINGS AND THEY HAVE ASTHMA OR ALLERGY-LIKE SYMPTOMS THAT ARE LIKE ASTHMA, THEY TEND TO MISS SCHOOL MANY TIMES. THEY MISS OUT ON SOCIAL DEVELOPMENT THAT IS NECESSARY AT TIMES. AND THIS CAN BE POWERFUL BECAUSE IF A CHILD IS NOT LEARNING DEVELOPMENTALLY IN A WAY THAT’S NECESSARY FOR THEM TO MOVE ON– AGAIN, GOING BACK TO THAT SOCIAL JUSTICE ISSUE–WE COULD BE CYCLING THE POVERTY OVER AND OVER AGAIN. SO YES, IT COULD BE VERY PROBLEMATIC WITH KIDS NOT BEING ABLE TO GO TO SCHOOL.>>IN THE LIMITED TIME WE HAVE LEFT, I’M CURIOUS ABOUT THIS. DOCTOR, WE TALKED ABOUT THE COMPLACENCY ISSUE. FOR POLICYMAKERS, FOR ELECTED OFFICIALS, FOR PEOPLE OF INFLUENCE, HOW HIGH A PRIORITY IS THE ISSUE OF ASTHMA, FROM YOUR POINT OF VIEW?>>OH, BOY.>>A MINUTE LEFT. GO AHEAD.>>YEAH, OK.>>I HAVEN’T HEARD MUCH DISCUSSION ABOUT IT.>>I THINK IT’S IMPORTANT, AND BOY…>>I HAVEN’T HEARD MUCH.>>YEAH. NOT SURE THAT THERE HAS BEEN–>>NO DISRESPECT. I HAVE NOT HEARD MUCH FROM CONGRESS OR THE WHITE HOUSE OR THE STATE HOUSE. AM I MISSING IT?>>YOU’RE NOT MISSING IT. I DON’T REALLY THINK IT’S OUT THERE, OTHER THAN, FORTUNATELY IN NEW JERSEY, WE ACTUALLY HAVE SOME STATE LAWS REGARDING ACTION PLANS.>>AND IF IT WEREN’T FOR PARENTS WHO HAVE CHILDREN WHO ARE DEALING WITH IT AND WHO HAVE BECOME ADVOCATES…>>THERE ARE PHYSICIAN ORGANIZATIONS THAT ARE ADVOCATING FOR THIS. THE A.P. HAS THEIR RECOMMENDATIONS IN TERMS OF–>>BUT NOT OF A HIGH ENOUGH PRIORITY, RIGHT?>>UNFORTUNATELY NOT.>>LET’S DO THIS. I PROMISE YOU IT WILL NOT BE THE LAST PROGRAM WE DO, PARTICULARLY WITH SUPPORT OF IMPORTANT ORGANIZATIONS WHO PROVIDE THE DOLLARS TO MAKE IT HAPPEN. THAT’S WHY WE’RE HERE. AND MORE IMPORTANT, THAT’S WHY WE HAVE PEOPLE LIKE YOURSELVES. YOU PROVIDED A TREMENDOUS PUBLIC SERVICE. THANK YOU VERY MUCH.>>THANK YOU.>>THE PRECEDING PROGRAM HAS BEEN A PRODUCTION OF THE CAUCUS EDUCATIONAL CORPORATION, CELEBRATING OVER 20 YEARS OF BROADCAST EXCELLENCE, AND THIRTEEN FOR WNET, NJTV, AND WHYY. FUNDING FOR THIS EDITION OF “CAUCUS: NEW JERSEY” HAS BEEN PROVIDED BY… ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, THE HEART OF ACADEMIC MEDICINE… HEALTHFIRST NEW JERSEY… MD ADVANTAGE INSURANCE COMPANY OF NEW JERSEY… AND BY ROCHE. PROMOTIONAL SUPPORT PROVIDED BY “NJBIZ”–ALL BUSINESS, ALL NEW JERSEY– AND THE “STAR-LEDGER” AND NJ.COM–EVERYTHING JERSEY. TRANSPORTATION PROVIDED BY AIR BROOK LIMOUSINE, SERVING THE METROPOLITAN NEW YORK-NEW JERSEY AREA. “CAUCUS: NEW JERSEY” HAS BEEN PRODUCED IN PARTNERSHIP WITH TRISTAR STUDIOS.>>HI. I’M TERENCE BYRD. AT HEALTHFIRST NEW JERSEY, WE BELIEVE EVERYONE SHOULD BE INFORMED ABOUT THE IMPORTANT HEALTHCARE ISSUES THAT AFFECT THEM AND THEIR FAMILIES. THAT’S WHY HEALTHFIRST IS PROUD TO SUPPORT PROGRAMMING PRODUCED BY THE CAUCUS EDUCATIONAL CORPORATION.>>THIS IS “ONE ON ONE.”>>♪ I’M A FOOL FOR YOU, BABE ♪>>JOIN ME AS WE GET UP CLOSE AND PERSONAL WITH SOME OF TODAY’S MOST COMPELLING PERSONALITIES. THIS IS ONE YOU CAN’T AFFORD TO MISS.>>WEEKNIGHTS AT 7:00 AND 11:30 P.M. ON NJTV AND 12:30 A.M. ON THIRTEEN.


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