Don't Treat My Baby's Asthma Like It's a Zit on a Teenager

09/18/2009

Spend a morning in the ER of an average city hospital, and you'll likely see a lot of asthma. I sure did, recently, when I rushed my three-year old, T-Rex, to a local D.C. hospital for an acute asthma attack. He was wheezing and panting, and I couldn't drive there fast enough (yes, I made an illegal left on red).

By the time we got to the ER's intake tech, I was freaking out so much I was panting almost as much as T-Rex.

“HOLD up,” said the tech, typing languidly. She cast a sideways glance, sighed. “Let me guess. Asthma?”

“Yes, he was coughing all night and it just kept getting worse and…”

“HOLD up. I know I know. All day it’s been all asthma all the time around here.”

She wasn’t kidding. We were herded into the ER’s sizable asthma unit, where a nurse resembling Frau Blücher from Young Frankenstein strapped a mask onto T-Rex’s face, flipped the nebulizer switch, and marched off.

Over the next two hours, Frau Blücher dispatched a steady stream of hacking kids to similar treatment. Meanwhile, three doctors on the unit spent most of their time pecking on computers. Occasionally, one of them would scurry up, prod T-Rex, mumble something, and sprint back to the doc station for more typing.

It took cart-wheels and shrieking like Howard Dean, but I finally managed to flag down one of the doctors during his drive-by. In the nanosecond I knew I had, I asked if they were going to give T-Rex systemic steroids, which go into the bloodstream instead of just the lungs and had stopped a previous attack like this in its tracks.

He eyed me suspiciously and blathered something about checking with the other doctors. It was right about then that I realized we were on the ER asthma assembly line—a 24/7, mechanized operation—and weren’t supposed to break protocol.

 
Now, I could make a number of statements about what this automation says about our health-care system. I could lament the fact that doctors spend most of their time doing data entry for legal CYA, instead of treating patients like people. I could note that some nurses are so jaded by patients using the ER as primary care that they’ve forgotten their bedside manners. But. I’m not going to go there.

So, here’s where I’m going: It’s sad that asthma has become so common that ERs treat it like it’s no big thing—“all asthma, all the time, just give 'em the regular treatment.” Asthma rates have more than doubled in the past 25 years. And as incidence has grown, so has casualness. But the exact opposite should be happening.

 
First, we need more emphasis on stopping asthma before it starts. Studies show that urban kids are at higher risk for the disease because of more exposure to irritants like pollution, cockroaches, and indoor dust. But they also show that in neighborhoods with more trees, fewer kids have asthma. So let’s plant more trees and cut pollution (think walking, public transportation, and carbon caps)!

Second, when kids do have a serious asthma attack, let’s not treat it like it’s no big whoop. Actually it is. Too many people—5,000 each year—die from this disease. And kids who were preemies (like T-Rex) are at even higher risk for problems.
 

So if you’re a health-care professional, I don’t care if you’re seeing T-Rex on Jupiter or in an ER, please take the bleeping time to find out his medical history. And please don't treat his asthma attack like it’s a zit on a teenager.

Because, getting back to his story (and not to sound too vindicated here, but hey, why not), the systemic steroids I requested turned out to be exactly what he needed. It took several foot-stomping trips to the doc station to make sure they were ordered, and to then verify that they'd been given.

But, along with the hour-long nebulizer treatment with rescue meds, the steroids eased T-Rex's breathing after just two hours. Of course, we were kept in the ER another two hours, no doubt also for legal CYA. I tried to warn the staff that this was not a good idea because once T-Rex is bored, you are screwed.

 
They just ignored me; I don't think they got it. But they sure did later, when T-Rex began harassing other patients, using his chair as a trampoline, and swinging on his heart-monitor line. I didn’t do anything. I just waited.

"Do NOT jump off your chair," scolded Frau Blücher as she strode past.

What T-Rex did next was truly masterful. I really have to hand it to him.

He climbed right back on his chair, wound himself up for take-off, then yelled full-volume at the doc station as he jumped: "LET ME OUT OF HERE!  NOW!!!"

We were discharged with in five minutes, steroids refill in hand.

What Dirty Air Is Doing to Our—Cough—Lungs

05/20/2009

When I was a kid, my parents used to play a song from the ’60s that always stopped me short.  It was the Tom Lehrer number, “Pollution,” and it blew my most basic expectation that our air and water are clean.

Here’s a highlight:

“Just go out for a breath of air,
And you’ll be ready for Medicare.
The city streets are really quite a thrill.
If the hoods don’t get you, the monoxide will.

Pollution, pollution,
Wear a gas mask and a veil.
Then you can breathe, long as you don’t inhale.”

Sure enough, at age nine, during a family trip to Pittsburgh, I woke everyone at midnight with an explosive asthma attack. My father slammed shut the sliding door, uttering oaths about the cloud of stink that had permeated our hotel room. He seemed to take it as a personal affront. “This city’s air is so filthy, we’re being forced to freeze in the confounded air conditioning,” he muttered. “So much for the big effort to clean it up.”

This was the late ’70s, around the time Pittsburgh got tired of bad publicity about its lung-busting smog and started cracking down on polluters. Nationwide, regulators put controls on emissions from industrial plants and vehicles, and appeared to get results. By 1985, Pittsburgh had cleaned up its air enough to be rated America’s most livable city in Rand McNally's "Places Rated Almanac."

Fast forward to the present, and it’s déjà vu all over again—except in Washington, D.C. This spring rolls around, and my three-year-old son T-Rex gets hit with nonstop asthma attacks. We’ve no sooner turned off the lights, and he’s wheezing, coughing, and spluttering. It’s so bad that the urgent-care doctors have prescribed a combination of Pulmicort (the preventive med) and Albuterol (the “rescue” med) four times a day (for more on asthma and its treatment, check out this guide: http://health.discovery.com/centers/allergyasthma/asthma/guide/asthma-attack.html).

It’s a pathetic sight to behold—your three-year-old with a plastic mask strapped to his head, sucking air through plastic tubing like an emphysema patient who’s smoked his whole life.

Here’s the thing: I’d thought we’d cleaned up the air since Tom Lehrer recommended we wear masks and Pittsburgh was smog-ridden.

I was wrong. Yes, the country has better regulated emissions, and those who can afford them are driving Priuses (is that the plural?). But we’ve got more people than ever burning fossil fuels that generate greenhouse gases; the U.S. population alone has grown by over a 100 million people since the 1960s. As for the D.C. area, it’s got more cars than its roads can handle, besides which it’s a humid, swampy basin, so there’s poor air circulation. Factor in warm weather, and you get a blanket of brown smog that won’t budge.

And here’s the kicker: Right across the Potomac River is the coal-burning Mirant Plant, belching its fine-particle emissions into our air. Luckily, members of Congress literally just got the nearby Capitol Power Plant to convert to natural gas; here’s hoping they can do the same with Mirant.

The D.C. air is so bad, in fact, that the American Lung Association has consistently given it an “F” in its annual State of The Air report. The association cites and defines two major types of air pollution:

 

• Particle pollution: A mix of very tiny solid and liquid particles that are in the air we breathe…. Particle pollution can damage the body in ways similar to cigarette smoking. Short-term exposure to particle pollution can kill. Peaks or spikes in particle pollution can last for hours to days.
• Ozone: An extremely reactive gas molecule composed of three oxygen atoms. It is the primary ingredient of smog air pollution and is very harmful to breathe. Ozone attacks lung tissue by reacting chemically with it. Ozone is capable of causing inflammation in the lung at lower concentrations than any other gas. Breathing ozone…can alter the lungs’ ability to function.”

D.C. has problems with both pollution types, making top 20 lists of the country’s most ozone- and particle-polluted cities. And unfortunately, these pollutants put older people and young children like T-Rex at especially high risk for asthma and other respiratory problems.

The most dangerous time of the year for asthma sufferers is spring and summer, when heat and sunlight trap polluted air near the earth’s surface. Breathing that air is more irritating for children because their lungs are still growing and they’re more active than adults, according to the American Lung Association’s Web site. Throw pollen allergies into the mix, and it’s no wonder T-Rex has been having frequent attacks.

Other than medicating him, what can we do to help? Well, we could move to Billings, Montana, the least ozone-polluted city in the country. But job-wise, that isn’t an option. So, we’ll keep him inside and minimize his exercise on high air-pollution days. (I’ve signed up to get daily air-quality e-mail alerts from the Metropolitan Washington Council of Governments; you can sign up for air alerts for your area at http://airnow.gov/.)

But the real solution is up to society at large. It’s up to all of us to drive less, walk more, seek alternatives to fossil fuels, push for stricter emissions regulations, and take public transportation.

Because it’s obvious we have a lot of work to do. Pittsburgh, for example, just made the top spot of a very different list from livable cities—it has the country’s worst particle pollution, finds the State of the Air report. The city has, it appears, has lost the ground it once gained. Too bad. If only Tom Lehrer’s musical jab at our dirty air were no longer relevant. Instead, it still makes us laugh uncomfortably. Because it’s still all too true.

Links:
• Video of Tom Lehrer singing “Pollution”: http://www.youtube.com/watch?v=JPrAuF2f_oI
• The American Lung Association’s “State of the Air” report: http://www.stateoftheair.org/