Asthma among youth in California has spread so widely it is now an epidemic, according to ‘Yes We Can,’ an intervention program that aims to prevent and manage the sometimes fatal respiratory disease.

Community Health Works, a collaboration created by SF State and City College of San Francisco, began in 1997 and is based out of San Francisco General Hospital. The program aims to empower low-income families with asthmatic children to handle the disease at home through education, clinical referrals and insurance enrollment.

Asthma most often first strikes in childhood, but adults can also be striken. Brendan Barton is a cinema studies senior who uses no medication but relys on an inhaler that he needs only before strenuous activity such as his softball class. His biggest concern is his insurance, covered under his mother's policy, a Kaiser employee. His coverage expires this year since he is twenty-five.

"A couple of years ago I had a really bad cold that went on for two weeks," said Barton. "I was short of breath but it didn't cause the asthma but probably brought it on, according to the doctor."

Statistics from Community Health Works show 13 percent of California’s children have asthma. The rate is 25 percent among inner-city children.

Asthma can be a problem for some at SF State but it is not an epidemic.

Carol Brewer, administrative analyst at SF State's Student Health Service, said there were 9,381 patient visits to the Health Service this semester. Of those, 397 were diagnosed with respiratory problems, she said, but there were only 140 diagnosed cases of asthma.

Mary Beth Love is founder of ‘Yes We Can’ and the chair of SF State’s Health Education Department.
Love said Medi-Cal (the statewide health insurance provider for low-income families) allocates too little funding for asthma prevention.

“The U.S. health care system is geared toward acute care,” said Love. “If you break a leg or have a heart attack we do a good job.

“But we need prevention orientation for asthma management. We’ve proven we can avoid 90 percent of hospitalizations."

Most children are prescribed rescue medication - drugs that clear blocked respiratory systems to help alleviate asthma attacks, Love said. But they should instead be using preventative medication that stops asthma attacks in the first place, she added.

Low-income families need a lot of support because decrepit housing conditions can breed asthma triggers, Love said. These include mold, poor ventilation, bad plumbing or building maintenance, and toxic hazards in the neighborhood.

“We use heavy education to empower families,” said Love. “It helps their children manage asthma better.

“Our model involves community health workers who are culturally and linguistically aligned with the communities in which they work.”

Workers from neighborhood clinics make home visits and inform families of how to reduce asthma triggers, said Love. Families can reduce such triggers by using mattress covers to discourage dust mites, keeping pets out of the bedroom, and asking adults who smoke to go outdoors, she added.

“If it’s treated right, a kid can have asthma and not get sick,” said Love.
Vicki Legion, a faculty member of the Health Science Department at City College and director of

Community Health Works, said researchers don’t know what causes people to initially contract asthma, but have catalogued many different causes of asthma attacks.

Some people have genes more susceptible to an attack and inherit genetic traits that weaken their ability to cope with the disease. But the quality of health care can be a deciding factor in the severity of attacks, she added.

“Doctors in poor communities have way too great a patient case load,” said Legion. “Poor kids are
routinely prescribed the wrong medicine.

“There’s been lots of scientific progress treating asthma. But many doctors are practicing medicine from 15 years ago. And Medi-Cal is shortchanging doctors.”

According to a study by Community Health Works, Medi-Cal is now spending $1,200 per child per year for rescue care. Asthma preventative care would require another $1,950 per year for the first year, with minimal costs for sustained monitoring, the study found.

The study also showed the average cost for an asthma-related hospital stay is $9,231. But for that same amount, preventative care could keep five children healthy.
Assemblywoman Wilma Chan, D-Oakland, has focused much of her attention on patient advocacy. Her chief of staff is Rachel Richmond.

"I don't have the details (of claims that) Medi-Cal is shortchanging doctors in treating asthma," said Richmond. "We do know that Medi-Cal rates are so low that many doctors lose money providing services to Medi-Cal patients. It creates a disincentive."

May 3 was designated as World Asthma Day and commemorated at SF City Hall by honoring Natasha Madaris, a Muni bus driver who lost her 4-year-old son, Armani, to an asthma attack three years ago.

Madaris maintained that Armani didn’t need to lose his life if paraprofessionals at her son’s preschool had been trained in asthma protocols: recognizing the asthma symptoms (discoloration in the face) and alerting the proper authorities.

“Take this disease seriously,” said Madaris. “If a child has a cold, it could be symptoms of asthma.
“Take him to a doctor and get him diagnosed. Make sure school records are up to date so they can monitor him. I don’t want parents to experience what I had experienced.”
San Francisco schools are now supplied with ‘tools for schools’ charts listing asthma symptoms.