ST. LOUIS — One in five children has asthma in some of the poorest areas of St. Louis city and county, where health officials are hoping closer attention to managing treatment and medication will save money and lives.
Nationwide, about 1 in 10 children has asthma, a lung disease that causes episodes of breathing difficulty. The St. Louis area statistics are even more alarming.
The St. Louis Post-Dispatch reported that four children died from asthma in the city and county in 2009 and 2010 and the ailment has become the leading chronic condition among children, with poor, inner-city minorities bearing the brunt.
"Many children are walking around very sick, but they don't know they don't have to be," said Lisa Meadows, a nurse who works on a mobile van that visits grade schools. "It's not unusual for me to see severe obstruction in children who think it's normal for them to have to stop running and playing in gym class."
A St. Louis Regional Health Commission study released this month shows that black children in St. Louis city and county are 7.5 times more likely than white children to visit an emergency room for asthma, and 6.6 times more likely to be hospitalized.
The high asthma rate is particularly alarming in light of improvements in care for other diseases such as heart disease, stroke, diabetes, cancer and infant mortality. Childhood lead poisoning has fallen by more than 80 percent.
"There have been so many positive changes in so many other health conditions, but childhood asthma still remains a huge challenge," said Jeanine Arrighi, a children's environmental health services manager with the St. Louis Health Department.
Advocates with the St. Louis chapter of the Asthma and Allergy Foundation of America traveled to Jefferson City in December to push for more services to be covered under Medicaid. They are asking for a case management approach to asthma that includes access to a primary care doctor, help with medication and home assessments.
"There are a lot of kids who need this, but the financial incentives aren't there," said Joy Krieger, director of the St. Louis chapter.
Asthma can be difficult to treat because children are often confused by the devices they have to use to take the medications and sometimes they use the equipment incorrectly. Some families buy cheaper emergency medicine and forgo medications used to help manage the disease. Some patients think they are better and stop using medicine altogether.
Karen Tobias, 46, of Pagedale, believes she is doing all she can to make sure her 9-year-old daughter gets good treatment, yet the child has been to the emergency room three times in recent weeks.
"Every time the weather changes, she gets sick," Tobias said. "I miss work, and she misses school."
Krieger believes that a case management approach would save money and lives. Advocates cite the results of efforts such as the St. Louis Children's Hospital's outreach into hard-hit schools with their mobile medical van.
The Healthy Kids Express van began visiting schools in 2009 in the Normandy School District and parts of the city, with a focus on schools with a high rate of poverty and asthma-related hospitalizations.
The van's health care team sees about 600 children a year and tests how well the children are controlling their asthma and taking their medications. The team works closely with parents and pediatricians, and helps train teachers and school nurses.
Children visited by the van are missing fewer days of school and reducing their hospital trips by 25 percent.
"Parents want to do the right thing for their children, but the system is so fragmented, and it's so complex," Meadows said. "If they can be guided and recognize what is most important and work on those goals first, we can make a dent."
The city health department, seeking to replicate the success that efforts to reduce lead poisoning have achieved, won a $533,000 grant from the Missouri Foundation for Health to target asthma. The money allowed the department to increase to 20 from two the number of staff involved in asthma education and reduction, and to begin a program that involves checking for asthma triggers inside homes.