Thousands of Akron’s children are registered as ‘high risk’ asthma patients
words by Noor Hindi, illustration by Chris Harvey
Dwight Slater describes his 13-year-old son’s asthma attack as one of the most terrifying moments of his life. In the middle of the night, Dwight could hear Mikhail gasping for breath, later turning blue as Dwight rushed to dial 911. For about 30 seconds, Mikhail stopped breathing.
“It was the longest 30 seconds of my life,” Dwight says. “[Mikhail] was really scared.”
Mikhail spent three days in the hospital, and that wasn’t the first time his life was interrupted as a consequence of his severe asthma attacks. In November 2018, Mikhail had an asthma attack at school and spent the day in the hospital after being transported by an ambulance.
After this incident, Mikhail was placed on Akron Children’s Hospital asthma registry list, which includes 30,000 other children between the ages of 2 and 18 from Summit County and beyond. Of those 30,000 kids, about half are considered high risk, including Mikhail.
The Asthma and Allergy Foundation of America (AAFA) has named 20 U.S. cities “asthma capitals,” or particularly challenging places to live if you have asthma. Five Ohio cities are on the list: Akron, Dayton, Cleveland, Cincinnati and Columbus. Akron is ranked 14 out of 20.
On par with national averages, Black residents of Akron are twice as likely to die from asthma as white residents, and in Ohio, Black children are more likely to have asthma than white children. This is due to poor social determinants of health, like living next to a freeway or other pollution source, living in an older home, or not having health insurance.
Sam Rubens, Summit County Public Health’s manager of air quality and solid waste, says living next to a highway, which contributes to so much air pollution, is a big reason why Ohio’s numbers are so high.
Dr. Cooper White, director of the Locust Pediatric Care Group at Akron Children’s Hospital, says respiratory viruses like the flu during Ohio’s winters cause an asthma burden for many kids.
“We always see huge bumps in our asthma frequency [during the winter],” he says. “There are socioeconomic factors, too. If you live in poverty and in inner-city areas, you’re much more likely to have asthma. These factors tend to be relevant in cities like ours.”
Rubens argues that the numbers in Ohio are especially high because our cities have “really good hospital systems,” making people more likely to utilize them, which drives up numbers simply because Ohio would have more data than states with inferior hospital systems.
Statistics from the AAFA support Rubens’ argument. All five Ohio cities on the list are ranked worse than average for ER visits for asthma but are average for the number of deaths and estimated asthma prevalence. No Ohio cities are ranked better than average in any marking.
Asthma causes school absences, limited social activity
For the majority of kids living with asthma, Dr. White says their asthma does not severely impact their lives, and dying from asthma is rare. For example, according to the Centers for Disease Control and Prevention, in 2007, of the roughly 250,000 children with asthma in the U.S., 10 of them died.
This is not to underscore the severity of living with asthma.
“You can go weeks without eating. You can go days without drinking. But try and hold your breath for more than two minutes and it’s all over,” Rubens says.
Dr. White also says most kids have mild, intermittent asthma that requires occasional use of an inhaler. But for some kids, it can negatively affect their lives in big ways, causing an inability to interact with friends and attend school.
“For the ones that are more affected with persistent asthma that’s not well controlled, oftentimes they have a chronic cough. There’s always that feeling in your lungs that you’re not well,” Dr. White says. “And nighttime cough, in particular, is a problem because it interferes with sleep. The ability to participate fully in life can also be impaired. These are the kids who tire easily on the soccer field. And they have to take breaks and recover to fully participate.”
Kent State University student Allison Erin Cooper grew up with severe asthma. While it was mostly exercise-induced, it was especially triggered in the winter months and hindered her ability to play sports.
“I played soccer but I was a goalie because I couldn’t run, so that kind of sucked. I played softball but that really doesn’t include a lot of running. I was mostly in the outfield,” she says. “I couldn’t keep up with my friends. I couldn’t run around with my cousins or else I’d start wheezing.”
For Allison, her asthma attacks were often coupled with anxiety attacks, worsening symptoms.
“It happens so fast,” she says. “Everything closes up and you’re just gasping. It kind of feels like you’re drowning. Your chest gets tight and it hurts, and you start crying and then you start freaking out.”
School absenteeism is a big issue for children with asthma. According to the CDC, low-income populations, minorities and children living in inner-city areas are more likely to be hospitalized due to asthma, interrupting their learning.
Additionally, a study published by the American Journal of Preventive Medicine finds that asthma is associated with more than 10 milled missed school days annually. The study links this data with “lower academic performance, especially among urban minority youth.”
Michele Wilmoth, director of nursing for the school health programs at Akron Children’s Hospital says during the 2018-2019 school year, school nurses had to use their emergency stock inhalers 50 times. The numbers grew to 74 times during the 2019-2020 school year.
The emergency stock inhaler program was implemented in 2017. Before this, EMS would immediately be called, and the child having an asthma attack would be taken to an emergency department. These numbers are taken from the roughly 300 schools Akron Children’s Hospital works with in Akron and neighboring cities.
The program has helped APS and Akron Children’s Hospital track high-risk asthma students, get them the help they need, and ensure the student stays in school.
“I always think of Maslow’s Hierarchy of Needs,” Wilmoth says. “If you’re hungry, if you need medical care, you can’t breathe adequately, you’re not going to be able to get your academic potential met.”
For each missed school day, parents are also impacted because they’re missing work to care for the child.
“If you can’t breathe, you can’t learn. You can’t learn to your fullest potential. And if your child has asthma, they’re not going to school, they’re going to the hospital. You’re not going to work, you’re going to the hospital,” Rubens says.
Asthma triggers lurk in Akron homes
Though doctors can prescribe medicine and reduce the risk of asthma, if at-home triggers aren’t removed, a child’s life can continue to be interrupted. These triggers can include smoking, pets, dust trapped in carpet, and mold.
In 2018, Summit County Public Health, Akron Children’s Hospital and Akron Metropolitan Housing Authority (AMHA) partnered and launched the Managing Asthma Triggers at Home (MATH) program. The three institutions work together to identify high-risk asthma patients who they define as a child who has been hospitalized for asthma twice in one year, visited an emergency department three times a year, or intubated for asthma, among other criteria.
Once identified, the program does an assessment of an enrolled family’s house to locate asthma triggers, then provides the household with a vacuum cleaner, asthma-friendly bed and pillow bags, a dehumidifier and a HEPA unit, which purifies the air. Each quarter, they do an asthma control test at the house to test air quality and mold. They also provide education to the family to help manage asthma triggers at home. For example, they show the family how to change their furnace filter to prevent dirt and dust from building up.
“There are things that are evidence-based interventions, but if you’re just moving through life and all of a sudden your kid has this really bad, easily triggered asthma, that’s not the first thing on your mind,” Rubens says.
The program is free and has a total of 80 families enrolled. It lasts for one year, and Dr. White says the program is saving the city money by reducing hospital utilization.
Many of the families in the program are housed through AMHA’s voucher program. AMHA director Brian Gage says they specifically chose families in the voucher program because AMHA houses already have a preventative maintenance program. They’re smoke-free, they regularly change air filters and they’ve removed carpeting.
Since being part of the program, Mikhail’s asthma has improved. In the past, Dwight says Mikhail’s asthma was a source of anxiety and fear. Mikhail was also missing about a week of school each year due to his asthma. Today, he doesn’t miss any school.
“He’s pretty much equipped with everything he needs to keep dust and pollen outside the home,” Dwight, his father, says. “He’s an honor roll, merit roll student. He doesn’t think about his asthma too much anymore.”
Noor Hindi is The Devil Strip’s Senior Reporter. Email her at firstname.lastname@example.org.