Caring for the Youngest Asthma Patients
The landlord wasn’t happy.
He had received a letter from the doctors of the Pediatric Asthma Clinic (PAC), informing him that his building was contributing to their young patient’s breathing challenges. Further, the letter made it clear that he had a responsibility to do something about it.
The landlord wasn’t happy, and he wanted the doctors to know it. They were interfering where they had no business.
They told him that he had a legal responsibility to get rid of the mold and the cockroaches in the building anyway.
Another day, another round.
The fight to help young asthma patients live full, healthy lives takes many forms, and the doctors of EPFMC’s Pediatric Asthma Clinic are more than up to the tasks..
Meet Dr. Rebollo and Dr. Lopez
Dr. Yolanda Rebollo is one of the doctors who participates in the rotation schedule in the Pediatric Asthma Clinic. “We received a grant for the clinic, and this allowed us to put together a team focused on pediatric asthma care,” she explains.
Dr. Rebollo came to Eisner Pediatric & Family Medical Center in 2007. Previously, she had been part of a multigroup specialty practice. A graduate of the UCLA School of Medicine, Dr. Rebollo completed her residency at Harbor-UCLA Medical Center and Massachusetts General Hospital. She is board certified in Pediatrics.
Environmental factors play a huge role in children developing asthma, so it’s not unusual that a specialist in treating pediatric asthma would get involved in resolving triggers within the child’s home.
“Often, parents notice a problem when the weather changes or we enter allergy season. Children develop colds, and the coughing does not go away.
“The child is brought into our regular clinic and is seen by a pediatrician. If we diagnose asthma, or the child complains of breathing problems, we refer him or her to our Pediatric Asthma Clinic.”
The focus of the clinic is achieving better asthma control.
According to Dr. Rebollo, “We look at the symptoms, how persistent they are, whether there is a chronic cough. How frequently is the child using the medication? If we suspect an allergy is the trigger, we try to identify the source. Often, environmental factors in the home are the culprit. If there is mold or a pest control issue, there are organizations that we work with who can go in and do some remediation inside the home to eliminate the problem.”
Dr. Luis Lopez is the Director of Pediatric Services and also a member of the Pediatric Asthma Clinic rotation team. He is board certified in Pediatrics and is a graduate of Stony Brook University Health Sciences Center School of Medicine. He completed his residency and fellowship in Ambulatory Pediatrics at USC.
Dr. Lopez smiles and shakes his head as he recalls some of the “less than cooperative” responses the pediatric asthma team has received from landlords. Writing letters to landlords, urging them to take care of essential repairs for their tenants, is a critical part of protecting children sickened by their environment. He and Dr. Rebollo see this advocacy as essential to helping their young patients heal.
The Challenges of Diagnosing the Very Young
According to Dr. Lopez, the doctors need to be careful when diagnosing very young children as suffering from asthma. “We determine whether there is true asthma by using a spirometer to measure lung capacity and how air is flowing in and out of the lungs.” Younger children cannot cooperate with the test.
“So we are more likely to rely on their symptoms when assessing their condition. It’s one of the reasons we don’t like to diagnose children who are younger than 5 or 6 as definitely having asthma. A young child who wheezes may not have asthma since there are other conditions which can be causing their symptoms.”
Dr. Rebollo agrees, “It’s too easy to misdiagnose them at that age. We treat their symptoms and keep watch.”
To diagnose allergies, the doctors administer the IgE test, short for Immunoglobulin E. It measures the amount of IgE, or allergic antibody in the child’s body. A high IgE measurement indicates allergies as the likely reason behind the asthma.
“We correlate this with the child’s food history. We also look at sensitivity to dust mites, cockroaches, and other indoor factors that could be affecting the child’s breathing. Also a lot of children are exposed to smoking, another trigger, either in the home or around the neighborhood,” adds Dr. Rebollo.
By the time children are about 7 or 8, they are old enough to give reliable results using the spirometry test. The young patient breathes in deeply and then exhales as fast as possible. The spirometer measures how much air is being forced out over one minute which, in turn, lets the doctor know if there is obstruction to air flow.
Children have smaller bronchial passages than adults, so it takes less to affect them. In someone with asthma, it takes even less of a trigger to produce narrowing. If the spirometer indicates air flow obstruction, the child takes a dose of the bronchodilator, and the doctors measure with the spirometer again. This not only helps them diagnose whether the child has asthma but whether the child has another form of air flow obstruction.
Treating the Parent to Help the Child
Once there is a diagnosis of asthma, it’s essential that the child begins a treatment program. According to Dr. Lopez, “We work with the child and the parent to develop the asthma action plan and teach both how and when to take the medication. Then, we like to see the child every two to three months, more often if the asthma is moderate to severe, to make sure the disease is under control.”
The asthma action plan specifies what to give the child and when to give it to manage the disease and avoid attacks. It’s important to involve all adults who are significant in the child’s care, including babysitters and teachers.
Still, frightened parents can be an obstacle to gaining the child’s commitment to following the plan. Dr. Rebollo appreciates their feelings, “Parents are sometimes reluctant to begin the asthma treatment program for their children. They have a lot of fears about the medication their children will be taking. They may have family members who had asthma and died from it or suffered their entire lives.”
But here’s where the Pediatric Asthma Clinic makes a huge difference. “One of the things we can do in the Pediatric Asthma Clinic (PAC) is spend more time with the parents, getting to the bottom of their fears and then helping them understand that asthma can be controlled with the proper care.
“We help parents see that so much has changed. By learning their triggers, avoiding them, and taking their medication as prescribed, most children can live normal active healthy lives.”
PAC team members educate parents to recognize inflammation as the culprit behind the child’s coughing and wheezing and that it needs to be controlled to manage the asthma.
Parents’ eyes and ears are critical to managing the disease because, “What we prescribe depends on what the child is experiencing,” Dr. Lopez notes. PAC team members teach parents what to look for, “For example, we want to know, ‘Is your child experiencing daytime or nighttime symptoms? Does exercise bring on the symptoms or make them worse?’”
For children needing better control, the doctors often prescribe a steroid inhaler and/or Singulair. Teens are most likely to ask questions to gain clarification about proper use and how to avoid overuse of the medication.
For younger kids, the medicines can be dispensed in a nebulizer. It’s easier for them to use it properly and get the correct dosage into their lungs.
Time Away from the PAC
Drs. Rebollo and Lopez are committed to their time in the PAC rotations, despite their busy schedule seeing and treating other pediatric patients. Time away from EPFMC to relax is limited and prized. So how do these two busy professionals relax when they get some free time away from the clinic?
In addition to spending time with her family, Dr. Rebollo loves to travel, cook, and enjoy salsa music.
And Dr. Lopez? He spends time perfecting another passion: playing a mean bass.