At just a few months old, Diana Wickman's daughter often had trouble breathing.
Wickman took her baby, Brianna, to Claremont Pediatrics Specialty Clinic at UCSF Benioff Children's Hospital Oakland, where they were referred to the hospital's asthma clinic. Wickman had developed adult-onset asthma herself but didn't know much about the condition when her daughter was also diagnosed in 2010.
"When your child can't breathe, it is scary," Wickman said. "There were times when I would watch her sleep to make sure she was breathing okay."
The team at the UCSF Benioff Oakland asthma clinic taught Wickman when and how to administer medications to Brianna and how to manage any asthma attacks so they could avoid emergency room visits.
"The asthma team provided skills and knowledge that I can use for the rest of my life, for Brianna and myself both. I am so grateful for them," Wickman said.
She and Brianna returned to the asthma clinic regularly for years to check on Brianna as she grew and adjust her care to manage any triggers, such as seasonal, outdoor allergies. Wickman said she and Brianna, who is now 14, have gained the knowledge and confidence to successfully control their asthma, along with a care plan developed by the clinic to meet Brianna's individual needs.
The asthma clinic is hosted on Wednesdays year-round through the Federally Qualified Health Center (FQHC) for low-income families. Patients of the Oakland FQHC are referred to the clinic by their primary care provider.
Disproportionate health impacts
Asthma is one of the leading chronic diseases in children in the United States, with about 1 in 10 likely to have it. It is more prevalent in underserved communities and rates are higher among families with incomes below the poverty line, according to 2018 data from the American Lung Association.
Asthma is also more prevalent among certain demographic groups. Non-Hispanic African Americans are 30% more likely to have asthma than non-Hispanic whites, according to the Centers for Disease Control and Prevention. Non-Hispanic Black children are also 4.5 times more likely to be admitted to the hospital for asthma compared to non-Hispanic white children.
What makes the Oakland asthma clinic different from a standard doctor's visit is the time spent on education and preventive care. A typical clinic visit starts with the patient and their family meeting an asthma educator like Robert Mok, who is a licensed vocational nurse.
"The more they know about asthma, the more they will be prepared to deal with it," Mok said. "We concentrate on having them recognize asthma symptoms, what to do in those situations and how to use the medication. All of this may help them reduce the number of ER visits they have and avoid being hospitalized."
Asthma educators worked with Brianna's family to gather current and past experiences with asthma. They conducted a spirometry test to assess her lung function. And they collected Brianna's history, including her family history, symptoms, triggers and hospitalizations as well as a list of medications. They then worked with Brianna's family on ways to manage asthma to fit her lifestyle by considering any sports, activities and family challenges to improving asthma outcomes.
"We create a plan with the family and see what works. It is not a one-size-fits-all," said Cherri Harris, an asthma educator and licensed vocational nurse.
"Asthma education is really important because it literally can be a life-or-death situation depending on the severity of asthma," Harris added. "We do things like bring out a lung model, and we demonstrate how to use a spacer with an inhaler. Even if someone is from a family with a history of asthma, they usually leave the clinic having learned something."
The patient and their family also meet with a care provider like Lourdes Juarez, CPNP-PC, MSN, a pediatric nurse practitioner at the asthma clinic. The asthma clinic team focuses on forming an ongoing relationship with patients and their families, Juarez said.
"Asthma is something that no one should feel fearful or afraid of," she said. "Asthma is something that is controllable."