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School of Allied Health Sciences
An in-house asthma management study gives patients room to breathe
by Amanda Gallagher
It beats the common cold, the flu and those debilitating stomach viruses: Asthma is the number one reason children miss school. The chronic lung disease accounts for more than 10 million sick days each school year. Jennifer Sikkema remembers those days well. "As a child, I had frequent asthma attacks. I took medicine every day and I missed a lot of class," Sikkema said.
The 22-year-old is one of 15 million people in the United States diagnosed with asthma. The disease is characterized by chronic inflammation of the airways. Irritants such as dust, pollen and cigarette smoke can cause the airway to further constrict, leaving an asthmatic desperately short of breath. "It feels like you are suffocating, starving for air. You are in a total panic," Sikkema said.
With carefully managed treatment, asthma patients can avoid serious attacks. But thats the trouble many patients say they arent even sure how their medication works. "The doctors just handed me the medicine. I didnt know what it did or which medication to take. I was taking the wrong medication at the wrong time," Sikkema said. "I ended up in the emergency room three times."
Sikkema constantly battled her illness until she entered a Health Science Center study run by Terry S. LeGrand, Ph.D., an assistant professor in the department of respiratory care. "Theoretically, an asthma patient will go to a doctor for medications and the doctor will explain how to take those medications," Dr. LeGrand said. "But we have found discrepancies in what doctors are telling the patients and what the patients are hearing."
In 1999, Dr. LeGrand launched a study to evaluate the role of an in-home asthma disease management program delivered by respiratory therapists. The study compares three different asthma management strategies. One group of participants receives traditional treatment from a doctor. The second group receives five home visits from a nurse. The third group receives five home visits from a respiratory therapist (RT), who teaches patients to use medications, monitor symptoms and put an asthma plan into action if their symptoms worsen.
Research assistants track participants for the next six months, monitoring quality of life, pulmonary function, pulse oximetry, emergency room visits and hospitalizations. More than 180 participants have completed the trial to date.
"So far, it appears that subjects in the respiratory therapy group went back to the emergency room or the hospital fewer times," Dr. LeGrand said. "These are very preliminary numbers, but it looks like that is the trend."
Perhaps thats not suprising. Respiratory therapists are trained specifically to diagnose, treat and manage patients with chronic lung ailments like asthma and chronic bronchitis. The in-home evaluations enable them to provide personalized care in a familiar environment.
The Health Science Center study is one of the first to evaluate home intervention for asthma treatment delivered by respiratory therapists. The final results are expected in March 2003. They could have a major impact on the way patients learn to manage their disease in the future. Already, the trial has made a huge difference in Sikkemas life. "Before I got into the study, I had a lot of trouble with my asthma," Sikkema said. "But the RTs gave me the right equipment and explained how and when to take the medications."
Now she only uses a "quick acting" inhaler prior to exercise and hasnt been back to the hospital.
Sikkema will complete requirements for the B.S. degree in respiratory care in August. The program at the Health Science Center is one of the best in the country, with an excellent job placement rate and a near 100 percent pass rate on the national board exams. Like all of her classmates, Sikkema is already employed as an RT, and breathing quite a sigh of relief about the future.