Five-year-old Tyvion Scott has been in and out of the hospital with breathing problems since he was four months old. His mom, Chiquita Coles, said Tyvion was hospitalized three times before his second birthday, including twice in the pediatric intensive care unit, and estimates he’s been to the emergency room more than a dozen times. Diagnosed with asthma as an infant, Tyvion was referred to a pulmonologist at Children’s Hospital of Richmond at VCU (CHoR) when he was a year old. His asthma flares up most often in the fall and winter, and a simple cold can make symptoms worse.

A kindergartener at Woodville Elementary School, Tyvion loves to run, play games, and do cartwheels and flips. His brown eyes lit up at the chance to smile for the camera and blow bubbles during a recent visit to CHoR’s Children’s Pavilion. But when his asthma flares up, Chiquita said Tyvion has no energy or appetite, coughs and wheezes a lot, and asks to go to the doctor.

“When he doesn’t want to eat, I know something is wrong,” Chiquita said. “His big eyes look so sad.”

Learning to Breathe Easy

The most common chronic childhood disease, asthma is an inflammation or irritation of the airway caused by colds, exercise or exposure to allergens or strong smells and characterized by wheezing, coughing, shortness of breath and other breathing difficulties. It is one of the most common causes of hospitalization in children and is the top reason for missed school days among children ages 5-17, according to the Asthma and Allergy Foundation. Asthma runs in families, and although it doesn’t have a cure, it can be managed with proper prevention and treatment.

Asthma prevention and education is what led to the creation of the You Can Control Asthma Now (UCAN) community asthma program at CHoR. Funded with a $422,514 grant from Children’s Hospital Foundation in 2015, the program has enrolled nearly 500 children since its inception and contributed to an almost 50 percent reduction in emergency room use, hospitalizations and missed school and work days for patients and families, said Michael Schechter, MD, MPH, Professor and Chief, Pulmonary Medicine; Director, Cystic Fibrosis Center; and Director, UCAN program, CHoR. The program was recently recognized by the U.S. Environmental Protection Agency with the National Environmental Leadership Award in Asthma Management. The Foundation also renewed its support with an additional $496,883 pledged over the next two fiscal years.

Children are identified for the UCAN program through hospitalizations, emergency room and clinic visits at CHoR, referrals from primary care physicians, and community inquiries. Working with a nurse program manager and a social worker, Dr. Schechter said the team develops relationships with families, which is important for building trust and improving communication between families and health care providers.

“Asthma is a particularly important problem in minorities, especially urban children,” said Dr. Schechter, referencing studies that connect ethnic differences in asthma with poverty, city air quality, indoor allergens, and quality of patient education and health care. “The UCAN program allows us to teach patients and families about asthma care, how to reduce exposure to asthma triggers, and the need to regularly take medications.”

For the last five years, the Asthma and Allergy Foundation of America’s Asthma Capitals report has listed Richmond as one of the worst cities to live in with asthma, citing Richmond’s higher than average emergency room visits and death rates in children with asthma. In addition to patient and family education, the UCAN program works to change this ranking through partnerships with community resources like school nurses and health departments and coalitions with area healthcare systems.

 

Changing at CHoR

Tyvion currently takes asthma control medicine twice a day and often tells his mom he can take it on his own – “it’s two pumps, right?” he confirms. Although he also has rescue medication for his asthma flare ups, Chiquita said he hasn’t needed to use it “in a while.” He hasn’t been hospitalized since March 2016 and hasn’t been to the emergency room in more than six months.

Tyvion visits CHoR every three to six months to follow up with his physician, H. Joel Schmidt, MD, one of CHoR’s six pulmonary medicine specialists. Chiquita said she likes how Dr. Schmidt makes Tyvion feel comfortable by doing things like allowing Tyvion to check his doctor’s ears after Dr. Schmidt checks Tyvion’s. She is also grateful for the attention they give her and Tyvion

“I didn’t know much about asthma until I came to Children’s Hospital,” Chiquita said. “The staff has always been there for me. They monitor Tyvion’s medication and always call and check to see if I need anything, especially after we go to the ER. The little stuff like that I really appreciate.”