Most people don't think much about breathing—the most basic, yet most essential, aspect of life. For people with asthma, each breath is a gift. Most have experienced the flip side of effortless breathing—the suffocating gasp for every precious breath that characterizes an asthma attack.

Asthma is bad enough for adults to bear, but for children, it can be utterly terrifying. The fear is only slightly less for parents, who can do little to help their children during an attack. The key, they learn soon after their child is diagnosed, is to prevent an attack from starting in the first place.

There is much to learn about asthma as it relates to medicines, inhalers, lifestyle and environmental triggers. It can be an overwhelming task to take all this in, especially for families with limited resources and those who are unfamiliar with navigating the health care system.

The South Bay Asthma Advocacy Program, an award-winning service of Paradise Valley Hospital (PVH) in the San Diego suburb of National City, Calif., addresses the asthma information and education gap head on and has scored tremendous victories within its predominantly low-income, immigrant community in its nearly four years of existence.

One-on-one, in-home communication is the basis of PVH’s Asthma Advocacy Program. Specially trained medical professionals—primarily licensed respiratory therapists—who speak the language of their clients and understand their culture provide the services.

During the first visit, the educator/advocate introduces the program and teaches clients the basics of asthma treatment. He or she also visually inspects the home and later prepares a list of suggestions about how to make the home environment healthier for the asthma patient. During the initial visit, the educator/advocate also discusses any immediate need the family has for community resources.

On the second visit, the educator/advocate offers suggestions for changes to the home environment. This is often the time when families are connected to resources in the community for home repair and renovation, landlord/tenant advocacy, legal assistance and so forth.

On subsequent visits, the family and the educator/advocate solidify a plan of action to remedy any environmental changes that are needed and review and reinforce teaching regarding the use of inhalers and medications.

The program is self-supporting, funded by reimbursement by Community Health Group, a local insurance plan that covers asthma education for its subscribers. PVH is seeking contracts with additional insurance companies, although many have yet to cover asthma prevention efforts like this.

Building a Future of Health

Just a few months ago, Michelle Santos faced a dilemma. All three of her daughters — 3-year-old Queannah (pronounced “kee-AH-nah”) and 8-year-old twins Jennifer and Caroline — had been diagnosed with asthma. Santos herself was asthmatic, and along with raising her children as a single mother, she added the responsibility of caring for her own mother, who suffered a stroke in March 2006.

Then another cloud — this one bearing a silver lining — came into Santos’s life. Caroline suffered an asthma attack, and Santos rushed her to the Emergency Department at PVH. A few days after Caroline returned home, Santos received a call from Ayda Parra-Sendt, an educator with PVH’s Asthma Advocacy Program.

Following the format of the program, Parra-Sendt offered to visit Santos and her girls in their home, and Santos agreed. From the beginning, Parra-Sendt’s impact on the girls was astounding.

“The twins didn’t care about their asthma before Ayda came,” Santos said. “I had to yell at them, ‘You have to use your inhaler,’ and they would say, ‘No, I don’t want to use it.’ But after Ayda came and explained to them what will happen to their health if they don’t do the right thing, that made the difference.”

Now the girls are enthusiastic about taking care of themselves and are begging Santos to let them attend asthma camp. Not to be outdone by her older sisters, Queannah is learning about controlling her asthma, too, and is keen on reminding her sisters to take their medicine and use their inhalers.

“They know that if they skip it just one time a day, their asthma will get bad,” Santos said, adding that none of the girls has had an asthma attack since their education with Parra-Sendt began.

Success Multiplied

The success reported by Santos has been repeated over and over since the Asthma Advocacy Program started in October 2002. During that time, educators have worked with nearly 800 children, and 300 have formally graduated from the six-month program.

In a study completed in May 2005 among children who had participated in the program, Emergency Department visits had decreased 77 percent, and unscheduled doctor’s visits had dropped 68 percent. These decreases amounted to an estimated savings of $66,750 and $27,000, respectively, in medical bills for the affected families.

In addition, missed days of school were down 73 percent, and hospital admissions had dropped 75 percent.

Recognition for an Outstanding Program

With success like this, it is no wonder that the South Bay Asthma Advocacy Program has attracted national attention. Earlier this year, the program took second place and a $28,000 award in the 14th annual Monroe E. Trout Premier Cares Award, which honors exemplary efforts by not-for-profit organizations to improve access to health care for under-served members of their community.

While the in-home education and training components of the program are certainly important and effective, said Mike Collins, director of respiratory services at PVH, the efforts of the educator/advocates to help patients access community resources make the program stand out among similar services around the country.

“I think the advocacy portion of the program is really significant,” he said. “Some of our clients have moved into new apartments; others have had carpets replaced, received new appliances or had new windowpanes installed. This has been a way for PVH to help people improve their lives above and beyond medical intervention.”