WHO CARES: Chronic Illness in America
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Kashaye GladdenThe Information Treatment

Kashaye Gladden's rough road to asthma management

The emergency room is no place to treat asthma, but for years that was the only option open to Kashaye Gladden.

The 13-year-old Washington, D.C. resident and basketball player aspires to play in the WNBA. At age 4, she was diagnosed with asthma and until relatively recently, like many children, Kashaye's treatment consisted mostly of pediatric emergency room visits during asthma attacks, which are usually triggered by colds and changes in weather.

Kashaye's mother, Kim Gladden, estimates that her daughter visited the E.R. about four to six times a year until she was 12 -- anywhere from 30 to 50 visits. It was a dangerous cycle that reflected a failure to meet a chronic condition, asthma, by focusing on an acute one. Kashaye's asthma wasn't being treated; her asthma attacks were. Kashaye was relying solely on a generic emergency inhaler without the benefit of preventive corticosteroids and other anti-inflammatories.

Because they lacked adequate health insurance coverage, Kim and Kashaye were not informed about medications or even routine habits such as the use of a peak flow meter. Asthma has been with the Gladden family for three generations, and the approach to treatment had always consisted of crisis management. Kim often missed work and even had to quit a job in order to care for Kashaye. She currently works two jobs.

One of the last E.R. visits came at a summer camp when Kashaye was 11. After swimming with friends, she went to the air-conditioned dining hall, and later, she started to wheeze. That night, Kashaye's grandfather carried her gasping for breath into D.C. General Hospital's now-familiar E.R. The 1999 incident was described in an article about asthma featuring Kashaye in the Washington Post Magazine.

After reading about Kashaye, Eleanor Thornton, director of Asthma Community Outreach at Howard University, contacted her family to offer them asthma counseling. Kashaye soon began taking the daily medications that now have her asthma under control. But Kashaye must constantly have her inhaler handy, and she must stick diligently to her routine, taking her medications and monitoring her breathing every day, or else she will again run the risk of an asthma attack.
Question and answer Kashaye's mother, Kimberly Gladden
A day in the life of Kashaye Gladden
Allies Against Asthma
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More than five million children in America have asthma.

Parents make nearly a million emergency room visits every year to treat their asthmatic children.

The Centers for Disease Control and Prevention estimates there were 17.3 million U.S. asthmatics in 1998, compared with 6.8 million in 1980.

Asthma appears to have socioeconomic roots. A 1999 study in New York City found that nearly half of the city's homeless children suffered from asthma. Another study found 223 ER visits for asthma for every 10,000 inhabitants in Spanish Harlem while in wealthier Manhattan districts, there were none.

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