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Roughly 25 million people in the U.S. have active asthma. For most, it can be controlled with the right medications and by avoiding environmental triggers.
And yet nearly half of all adults and 40 percent of children have uncontrolled asthma, which can lead to expensive medical interventions. Total annual costs for the disease are estimated at $60 billion.
Today is World Asthma Day, which makes it a good moment for this report by special correspondent Cat Wise about a California program that's drawing attention for its way of keeping kids healthy.
Three-year-old Jesus Cresto has been to the emergency room twice in the past 12 months for asthma attacks. His mom, Angelica, says she isn't getting much sleep these days.
ANGELICA CRESTO, Mother:
I will just be checking on him. Is he OK? It's really hard, because they change your life. I just want to take care of my kids better.
The Cresto family lives in East Oakland, a predominately low-income community in Alameda County, which has some of the highest rates of asthma in California.
Children with uncontrolled asthma, especially those from low-income families, who often have government-funded health care insurance, account for a disproportionate number of costly E.R. visits and hospital stays.
So, keeping Jesus and the more than one million other kids with asthma in California healthy is a big priority. And Alameda County has been leading an effort to do just that, focusing on the place where kids spend the most time, their home.
On a recent morning, a team of cleaners specializing in asthma trigger remediation, arrive at the Cresto home. They cleaned up pest droppings behind the fridge, removed mold spots on a bedroom window, and put a dust mite cover on a mattress.
The cleaning visit was arranged by Sandra Rodriguez, a community outreach worker from the county's Healthy Homes Department. She is part of a unique collaboration between housing and public health agencies.
SANDRA RODRIGUEZ, Alameda County Healthy Homes Department:
Where does Jesus spend a lot of the time?
He usually likes to be on the floor. So, how I clean the house, I use Clorox a lot.
Because I think I want to keep the floors clean.
Using harsh chemicals like Clorox can really exacerbate a child's asthma. And so we recommend that you try natural products, just soap and water, soap and water, and one of the additional is baking soda.
The program, which began in 2001 and was among the first of its kind in the country, is open to all children in the county who have been diagnosed with asthma. Allergen-reducing products like HEPA filter vacuums are offered to families who can't afford them, and the program will even pay for minor home repairs.
BRENDA RUEDA-YAMASHITA, Alameda County Public Health Department:
We saw these very high rates in our county, and we didn't want to have residents who were dealing with issues like that.
Brenda Rueda-Yamashita manages the Public Health Department's side of the program called Asthma Start. She says the up-front costs, which average about $2,500 per family, depending on the needs, are worth spending to prevent the back-end costs.
It's around $23,000 for a child to have an asthma hospitalization, and around $3,500 for an E.R. visit, so that's the highest impact, mom losing money, dad losing money, because they have to stay home with a child or take the child to the E.R., and their employer doesn't pay for sick time. There's a cost to cities and/or counties for their fire, because fire departments show up to 911 calls.
The other key priority for the program is educating families about the importance of taking prescribed asthma medications.
That's where medical social worker Amy Sholinbeck comes in. On this day, she is back for a second visit with 2-year-old Romani Webb and his mom, Artency.
Romani has had several hospital stays for asthma attacks, but after an initial two-hour visit a month ago, the family has been on top of his medications.
AMY SHOLINBECK, Alameda County Public Health Department:
Have you noticed that he's been having less symptoms since you have been doing this?
ARTENCY WEBB, Mother:
At the nighttime, definitely. He sleeps a lot better too.
Oh, I'm so happy to hear that. It's all about his health. We want to keep you out of the hospital, baby.
Sometimes, the family ends up confusing the inhalers, or it wasn't explained to them in enough detail. So, we're in a calm environment in their home, and we take a lot of time to make sure they understand what the medications do in the body. And we have special stickers we put on the medicines, and we just make sure they really get it.
I just want to give you an update on our numbers.
The program has served about 250 families each year. It's been funded through a combination of sources, including grants, taxes, tobacco settlement money, and a local Medicaid managed-care program.
A data review by that organization in 2012 found health care costs for pediatric patients ages 0 to 5 were cut in half during the 12 months after they went through the program. Those results and the program's long track record are generating new interest in Alameda County's preventative approach.
LINDA NEUHAUSER, University of California, Berkeley: I have studied a lot of programs, but when I got introduced to this program, what I saw was a very seasoned, careful intervention that draws on the best practices that we get from research to date.
U.C., Berkeley, Professor Linda Neuhauser is leading an in-depth study of the program. Her research is ongoing, but she believes policy-makers around the country should pay attention.
It's hard to estimate the cost savings, but I think, in Alameda County alone, we might be able to save as much as $16 million a year just on hospitalizations of children. This is an amazing saving of health care costs.
Eight-year-old Mihlen Michael is one of those children who is happy to be out of the hospital. A year ago, she was in intensive care after an especially bad asthma attack. Her mom, Nebiyat Hagos, says some big changes have happened since the asthma teams visited their home.
NEBIYAT HAGOS, Mother:
Now she's doing a lot better. She hasn't been to the E.R. in a year. They made a great difference. We were living close to a freeway, and they mentioned to me how that affects asthma. So, we moved away from the freeway now, and that also helped.
Hagos is now working for the program, and using the training she received to help other families with asthma.
The home-based asthma program recently got a temporary boost in funding from a national nonprofit and the Alameda County Board of Supervisors. That money is being used in part to help an additional 250 families this year.
For the PBS NewsHour, I'm Cat Wise in Alameda County, California.
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