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Quick! To the Breathmobile!

August 16, 2006 -- Today WYPR, the Baltimore National Public Radio affiliate, had a very good report by Taunya English about the Breathmobile. The Breathmobile is a nurse-staffed "asthma and allergy clinic on wheels" that visits the city's elementary schools. The piece relies on audio quotes from two nurses. It explains how valuable the program is in keeping asthmatic kids in school and out of the ED. The report might have briefly explored the relation of the Breathmobile to school nurses. To what extent could school nurses help these kids manage their asthma if they weren't so short-staffed? But the piece does bring out important specifics about the clinic nurses' holistic care. We commend Ms. English and WYPR.

The report begins by noting that asthma is a major reason children miss school in Baltimore, and that more than 20% of school-age kids there have "chronic lung disease"--more than twice the national average. It stresses that asthma is a chronic condition that can make it very hard to breathe, and it has to be managed at home every day. So the Breathmobile, which is staffed by the University of Maryland Medical Center, goes from school to school to help kids and their families do that. On the 34-foot bus, kids get free ear, nose, and throat exams, pulmonary function testing, education on preventing attacks, and links to other helpful services.

The piece is built around quotes from two nurses that reveal the clinic's broad health focus. Registered nurse Michelle Foster stresses that the Breathmobile works to help kids have a normal life, be able to play with their friends, and stay out of the ER. She explains that the pulmonary function testing measures how well the family is doing with its asthma maintenance, and as part of this, we hear her asking a child to "pretend you're blowing out all your candles at your next birthday." Later, Foster says that sometimes a key to good care is helping parents get broader health services for their kids, and resolve other problems that may distract them from their kids' care, including public assistance with food and utilities: "I'm a certified case manager, so I can help with other things that can help [a mother] focus on getting her children medical care."

We also hear nurse practitioner Melissa Streett interacting with a patient, encouraging him to monitor symptoms and avoid triggers. English suggests that Streett "conspires with her kids," and we hear Streett bantering with one, amid much laughter: "This boy is allergic to everything, foods, chocolate, dairy, dust, grass, lemons, egg shell powder, oat... He's a walking booger. Did I miss anything, what else are you allergic to? Your brother?" The piece also quotes Streett on the importance of "maintenance medication," as opposed to the "rescue drugs" that offer a "quick fix" during an acute attack: "The controller is the everyday medication and that is to prevent asthma and asthma attacks." English mentions the "tricks" Streett uses to help her patients remember the medication, like keeping it next to the toothbrush. Streett also notes that sometimes "getting to a doctor's appointment can be a problem. So what's great about the Breathmobile is that one barrier to care, which is transportation, can be eliminated. We come to the children." (This reference to a "doctor's appointment" is somewhat ironic, coming from a nurse practitioner.)

To its credit, the piece explains the specific ways the nurses help patients. These range from addressing larger issues in the kids' lives that may be having unseen effects on their health, to offering seemingly small "tricks" that allow the kids to stay healthy and avoid costly emergency interventions. This kind of holistic, preventative care receives little attention in the mass media, particularly television. But it confers a huge, cost-effective benefit on society.

In this regard, the piece might have explored the extent to which need for the Breathmobile is driven by the acute shortage of school nurses that afflicts Baltimore and other areas. School nurses can be important partners in the health maintenance and school attendance on which this report focuses. But it appears that short-sighted cost-cutting has threatened the school nurses' work. Of course, the cost of ED care for these children can be significant--but it does not come out of school budgets. The piece does not explain how the Breathmobile is funded.

We thank Taunya English and WYPR for this fine report. Listen to the article here.

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