Margarita Rabin’s asthma is so bad some days that she heads to the nurse’s office as soon as she arrives at Stewart Middle School in Norristown, Pa.
When the 12-year-old is in gym class or playing basketball, she often has trouble breathing after a few minutes of activity.
She is plagued by the attacks even though she takes asthma medicines.
“You can’t breathe and it makes your chest real tight,” Margarita said recently as she took part in an asthma screening program in the school auditorium.
Along with about 185 other students, she filled out an asthma checklist and took a breathing test for lung function — all part of an effort to pinpoint children whose asthma may be undiagnosed or inadequately treated.
The incidence of asthma has risen significantly among children in the United States in recent years and it is a leading reason for missing school.
The school nurse at Stewart, Cheryl Brumbaugh, decided to offer the screening because she sees the toll asthma takes: 71 of the school’s 626 students have reported to the school that they have asthma.
That’s one of every nine children.
Each day at scheduled times, more than 20 students come to her office to use their inhalers, which dispense a spray of medicine into their lungs to keep their airways clear.
Last September, Brumbaugh started an asthma club at the school so the students could share ideas on how to better take care of their disease.
“These kids miss a lot of school and it really affects their academics,” said Brumbaugh. Asthma also sidelines them in sports. “My goal is to get the kids under control so they feel they can compete in athletics.”
Principal Joe Howell, who has been at the school for 21 years, said that 10 years ago he knew of only about 10 children with asthma, but now he considers it a major health concern. He said schools need to pay attention to students’ health if “you want them here and you want them learning.”
The increase in asthma among Stewart Middle School students reflects a national trend, which has seen the number of people with asthma increase from 6.7 million in 1980 to 17.3 million in 1998, including 4.8 million children, according to the federal Centers for Disease Control and Prevention.
While public health experts say better diagnosis and growing awareness of the disease probably explains part of the increase, most agree the epidemic is real.
But what is causing it isn’t known. Researchers are focusing on environmental factors known to be asthma triggers, including dust mites and cockroach allergens, and prevention is aimed at avoiding them.
The thinking on asthma has also undergone a fundamental change. Once it was thought to be mostly an episodic problem that goes away when the lungs’ airways stop restricting and breathlessness subsides. Now, asthma is viewed as a chronic inflammatory disease.
For that reason, asthma experts recommend the regular use of anti-inflammatory drugs, such as inhaled steroids, to keep inflammation of the airways in check.
A recent screening — sponsored by the American College of Allergy, Asthma and Immunology and funded by the drug company AstraZeneca — used a child-friendly checklist. The check is based on the notion that children are good at identifying symptoms if asked the right questions.
Seventh-grader Lyndon Haley marked “yes” to several questions: When I walk or play hard with friends, I have trouble breathing or I cough; sometimes I wake up at night with coughing or trouble breathing; colds make me cough or wheeze.
Lyndon, 13, said his mother and older brother have asthma, and his doctor has told him that he might be at risk for the disease.
After filling out the checklist, he lined up to take a lung function test being given by nurses and a doctor from Allergy and Asthma Specialists, which runs six doctors’ offices around the area. He had to blow into a tube as hard and long as he could, and as he did he “blew out” birthday candles cake on a computer screen. The breathing machine measured his pulmonary function, indicating whether expelled air was getting trapped in his airways.
Lyndon did fine on the breathing test, but Brumbaugh plans to talk to his mother about the concerns he indicated on the questionnaire.
Stephen Redd, the chief of the CDC’s air pollution and respiratory health branch, said the CDC is funding a study to see if school-based asthma screening is useful.
The study, to be done by three universities, will measure whether children’s symptoms are reduced at schools that offer screenings and whether they miss less school.
By the end of the school day, the lung function test had turned up five students who were not on Brumbaugh’s asthma list and about 10 others whose asthma treatment may need adjustment. She will call their parents to suggest the children get further evaluation. She will also scan the questionnaires for other children with problems.
Even though Margarita’s lung function test was normal, Brumbaugh told the mother that she was worried that Margarita was so regularly feeling sick and suggested taking her to see an asthma specialist to possibly change her medicines. Now she gets her care at a state-run health clinic.
