Program spots asthma in preschoolers
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A pilot program of The New York Academy of Medicine identifies 2-year-olds with probable asthma and facilitates treatment. The initiative has significantly curbed asthma symptoms among children in subsidized preschool and Head Start programs in East Harlem and the Lower East Side.
In East Harlem, which has been the epicenter of the asthma epidemic in NYC, asthma is “kind of off their radar” in participating preschools, Dr. Sebastian Bonner, staff asthma expert at the Academy told Reuters Health. “They are really dealing with other things like diabetes, obesity and issues that are harder to address.”
Although preschools routinely screen for hearing and vision problems, “until now there hasn’t been a tool to identify kids with probable asthma at this age,” Bonner explained.
He developed a 4-item questionnaire to be administered as part of routine preschool enrollment and re-enrollment. It asks: Has a nurse or a doctor ever told you that your child has asthma? Has your child ever been prescribed medicine for asthma? Has your child ever been to the ER for asthma or respiratory problems? Has your child ever been hospitalized for asthma or respiratory problems?
This has turned out to be “a really good test in the sense that in 97 percent of the kids that get sent to the doctor, the doctor is in fact going to diagnose asthma,” Bonner said, and, hopefully, complete an “Asthma Action Plan” - a form developed by the NYC health department that helps parents prevent and treat asthma symptoms in their child.
The problem, said Bonner, is that “there is not much uptake with this form, either with kids and parents or with doctors.”
To facilitate greater use of the form, the preschool provides the “probable asthmatic” child’s parent with a cover letter and blank Asthma Action Plan to take the doctor.
The Union Settlement Association - the largest provider of subsidized preschool childcare in East Harlem - has adopted an institutional policy that parents cannot register their asthmatic child in preschool unless a doctor fills out an Asthma Action Plan.
Based on the early success of the program, the NYC health department and City Council are funding expansion of the program to 90 subsidized preschools and Head Start centers in East Harlem, the South Bronx, Brooklyn, and Queens, with a reach of over 9,000 children.
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