Volunteers get young asthmatics in the swim

Low-cost way to reduce attacks, cut utilization

A swimming program run by volunteers helps young asthma patients at Boston Medical Center improve their physical condition and learn how to stay active. The program for inner-city children with moderate to severe asthma is a combination of asthma education and highly supervised swimming. It is designed to help children learn to manage their disease and increase their pulmonary function through exercise.

With current asthma therapy, almost all asthmatics have the chance to lead a normal live with minimal symptoms, "but many asthmatics and their families remain fearful and restrict activities," explains Suzanne Steinbach, MD, chair of the pediatric allergy/respiratory department at Boston Medical Center and co-founder of the asthma swimming program.

In setting up the program, Steinbach was looking for a way to help her young patients get involved in an exercise program and learn about their disease. Swimming is an ideal sport for children with asthma because it improves lung function and decreases the frequency of asthma attacks, Steinbach says. Exercising in a humid environment also is helpful. "We were looking for a way to get our patients into the water, not to just splash around but to build up their endurance and their skills," she says.

The program started this summer and continued in the fall after school. The children receive an hour of education and an hour of swimming twice a week.

Research shows swimming helps build cardiovascular fitness for patients with asthma, and that as they participate in a swimming program, their pulmonary function improves and the frequency of acute attacks declines, Steinbach says.

During the summer, none of the children in the program had an asthma attack. Those who have come back for fall checkups are showing better pulmonary function and fewer, less severe symptoms than when they were in the clinic last spring. "We are providing so much education that children are getting the message that taking their medication brings rewards — being able to swim and to be with their friends," she says.

Program volunteers are from project H.E.A.L.T.H. (Helping Empower and Lead Through Health), a Harvard University undergraduate group. "Without an ample supply of skilled volunteers, the program wouldn’t be possible," Steinbach says.

Community participation

A community recreation center allows the program exclusive use of its pool during peak hours, two days a week. "The community center has been extraordinary. We wanted the most desirable time of day because that’s when it’s easiest to get both volunteers and children, and the pool administration was willing to go along," she says.

The first hour of the program is devoted to an asthma education program that teaches the children about their condition and the necessity for monitoring their peak air flow and keeping up with medication. At the beginning of the second hour, the children check their peak flow and can get in the pool if their readings are within a normal range. Otherwise, they use their bronchodilators, then enter the water.

Volunteers coach the children in perfecting their swimming strokes, building endurance, and working on speed in the water.

"Many people believe that any type of exertion will lead to an asthma attack. This program helps relieve that anxiety," Steinbach explains.

The program is staffed entirely by volunteers, but it took a lot of coordination on the part of the hospital’s paid staff to set it up. "This is a low-cost program if you can find the necessary collaborators. But it does take a lot of coordination. The clinic director spent a lot of time on it doing outreach calls and reminder calls to make the program work," Steinbach says.

The hospital solicited donations from charitable foundations and pharmaceutical companies, so there is no cost to the families. The donated funds have been used to purchase a bathing suit for one child, to provide transportation to and from the community center, and to cover the cost of the educational materials.

Volunteers run the show

During the summer, about 20 children and 10 volunteers participated. Two of the volunteers developed an asthma education program with materials available through the hospital. They conduct the educational session, then get into the pool with the children. Usually, there are at least six volunteers in the pool. In addition, the community center’s lifeguards are on duty during the swimming sessions.

When Steinbach first proposed the program, the hospital attorneys developed a liability release form for parents to sign. The community center also has a release that parents must sign.

The hospital has an insurance policy that protects Steinbach from liability when she participates in activities that do not involve clinical care. "In any swimming program, there are risks, but with the high level of supervision and the low child-to-instructor ratio, we have limited the risks," she says.

The student volunteers have been educated about asthma in general, exercise and swimming for asthmatics, the role of a swim instructor in treating an acute asthma episode, and how to use inhalers and nebulizers.

The student volunteer who directs the program has been trained in assessment and administration of medications and is equipped with inhalers, a portable nebulizer, and asthma medication.

Some of the volunteer instructors have asthma themselves and understand what the children are going through, Steinbach says.

Editor’s note: For more information on the asthma swim program, contact Suzanne Steinbach, MD, at (617) 534-7417.