Focus On Pediatrics-Phoenix 'Breathmobile' educates at schools

Mobile asthma unit reaches inner-city kids

The Breathmobile doesn't look much like the Batmobile driven by the Batman, but it probably has the potential to save more lives than this comic book hero ever has. That's because it reaches inner-city kids who suffer from asthma, providing the clinical support and education they need to manage their disease.

Every six to eight weeks, the mobile unit, which is staffed with clinicians from Phoenix (AZ) Children's Hospital, rolls into a school on a cyclical schedule. "Our primary purpose is to serve children in their schools. There are a lot of barriers to care in inner-city Phoenix. It is medically underserved, underinsured, and primarily an indigent population," says Judy Harris, MS, RN, CPNP, program director for the Breathmobile and a pulmonary nurse practitioner at Phoenix Children's Hospital.

The program, which is aimed at grades K-8, is patterned after a mobile program in Los Angeles. The mobile asthma clinic is a custom-designed recreational vehicle. Phoenix Children's Hospital started the asthma outreach program in the fall of 1999, while the mobile unit was still on order.

They worked out of the school nurse's office until the Breathmobile could be implemented. Wal-Mart has committed $300,000 a year for three years to help fund the Phoenix Breathmobile project. It was implemented by the Arizona Asthma Coalition, of which Phoenix Children's Hospital is a part.

When a new school joins the program, staff from the Breathmobile educate the teachers, school nurses, and principal about asthma and the program's interventions. They also explain how to recognize asthma symptoms in children. The teachers are asked to send questionnaires home with the kids for the parents to fill out and send back. These questionnaires are designed to discover children who may have asthma but have never been diagnosed, and those who have been diagnosed but aren't managing their asthma well.

The response rate from parents has been very good, says Harris. This is due in part to the relationship the Breathmobile team builds with the community before bringing the program into a school. Both parents and children from the community are invited to sit on the advisory board to discuss how the community can best use the Breathmobile.

School board members, principals, and community organizations also are involved in the planning process. "It takes a large amount of energy to identify these children and get them into services they need; there are a lot of barriers. If we would have just come rolling down the street in our RV, we probably wouldn't be very successful," says Harris.

Education designed to meet goals

The program has two primary goals. The first is to identify children with asthma and help them control it so they will be able to enjoy normal activities without visits to the emergency department, being admitted to the hospital, or missing school. The second goal is to identify children who don't have insurance and get them into primary health care. "If they are not getting general health care, it will be very hard to manage their asthma," says Harris.

To accomplish these goals, Breathmobile staff review the questionnaires that are returned, looking for children who might need an evaluation. If they have questions about the answers on the survey, they call the parents. If it appears a child would benefit from a further evaluation, an appointment is set up for the parent and child. Parents come to the school for the clinic appointment and the child is pulled out of class.

The visit begins with a screening for insurance eligibility. If possible, children are placed in a federal or state-funded insurance program so they can gain access to primary health care. After the screening, the parent and child see a clinician for an asthma history and physical.

When diagnosed with asthma, the children undergo a pulmonary function test and are educated on methods for self-management. The program also includes 24-hour follow-up and case management so parents can call any time to ask for guidance.

During the education session, parents and children learn to look for signs and symptoms that indicate asthma-related problems. They also learn how to identify asthma triggers, when and how to use medications, and to use peak flow meters and inhalers properly to help monitor and control asthma. "There are a lot of issues that go into helping families manage asthma in the home. Often, they are used to waiting until the last minute and going to the emergency department if they need to," says Harris.

With 24-hour case management available, the parents can call for advice before episodes escalate. At these times, education takes place over the phone. For example, parents learn how to determine what has triggered the asthma episode so the child can avoid these triggers.

After the initial visit to the Breathmobile, children are scheduled on a regular basis so their asthma can be monitored. Parents are asked to be present at each appointment as well. During subsequent visits, staff try to determine if the child's asthma symptoms have improved and if self-management fits into the family's lifestyle. Also, medication is adjusted and further education takes place as needed.

"We want children to learn the importance of taking care of themselves at a young age. Impro perly controlled asthma can actually lead to permanent lung damage as an adult," says Harris.

For more information on the Breathmobile asthma program, contact:

Judy Harris, MS, RN, CPNP, Program Director, Breathmobile, Phoenix Children's Hospital, 909 East Brill St., Phoenix, AZ 89006. Telephone: (602) 239-5778. Fax: (602) 239-2469. E-mail: jharris@phxchildrens.com.