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Asthma: Coordinated care keeps children active and out of the hospital



Coordinated care means that Malik, 8, no longer makes twice-monthly visits to the emergency room.

Malik Wilkerson is an 8-year-old third-grader who has asthma. A dust mite, cigarette fumes or a chemical additive in scented soap can trigger a severe reaction in his nose, throat, windpipe or lungs. He starts to wheeze and gasp for breath.

Asthma attacks used to send Malik to the emergency room once or twice a month, says his mother, Maydean Wilkerson. "He'd get to the point where he couldn't breathe."

Today, that almost never happens. The primary care team at Portland's Northeast Health Center has helped Malik bring his asthma under control and drastically reduce his trips to the hospital. The new, coordinated approach involves reduced exposure to household asthma "triggers"; a home nebulizer to convert his medication into a quicker-acting mist; and a portable mini-inhaler to help him overcome wheezing attacks at school or on the playground.

Asthma is the most common chronic disease among children — and especially prevalent in low-income households. Although asthma can be well controlled by medication and preventive measures, Oregon children went to hospital emergency rooms 550 times for asthma attacks in 2006, according to the state Asthma Program. The average cost of a hospital visit for asthma was $12,000. The Oregon Health Plan paid more than $5.5 million in 2007 for hospital care of asthma.

Malik is an example of how coordinated care can reduce that expense while improving health.

His mom enrolled in Multnomah County's Healthy Homes program, which helps children with asthma get control over their disease through careful choice of medications and reduction of environmental hazards in the home.

Healthy Homes visited the Wilkerson home to search for asthma triggers and recommend preventive steps: Natural cleaning agents. Mold prevention. Non-allergenic bedding and pillow cases. A special vacuum cleaner that captures dust without releasing any into the air.

Since Malik started using the nebulizer and special bedding and since his mom substituted vinegar-based cleaners for scented detergents, he has made only two visits to the hospital for asthma. These lower-cost interventions are a  good deal for everyone, his mother says, including taxpayers.

"In the long run it saves money by keeping Malik out of the hospital."