Asthma Care On Wheels

Breathmobiles and Asthma Vans are improving access to healthcare in urban and rural areas. 

By Gary Fitzgerald 

BreathmobleHector Hernandez is going places. On foot, he’s passionate about running. “It keeps me fit and allows me to stretch my lungs,” the Anaheim, California teenager says.

Four years ago, as a freshman in high school, Hector was running up to four miles a day for the cross country team when he experienced breathing problems – coughing, wheezing, gasping for air. At first he thought he was just out of shape, but symptoms occurred even while stretching and cooling down.

Much to his surprise, Hector was diagnosed with asthma. For treatment, he turned to a Breathmobile – a 36-foot, RV-style asthma clinic on wheels.  It’s one of two affiliated with Children’s Hospital of Orange County (CHOC).

CHOC’s Breathmobile program, founded by pediatrician Stanley Galant, MD, visits 22 schools and community sites in Orange County. The allergists, pediatricians and nurse practitioners on board provide diagnosis, treatment and education for preschool and school-aged children with asthma, many of whom live in underserved, low-income areas.

“It’s really pretty cool, how all the medical equipment and technology fits inside, and then it moves on to different locations,” Hector says.

Breaking Down Barriers to Care

Mobile asthma clinics started trending in the mid-1990s. The first Breathmobile opened in Los Angeles in 1995, and the idea was soon replicated in cities across the country, including Baltimore, Chicago, Oakland, Phoenix, St Louis and Mobile, Alabama. CHOC’s Breathmobile opened in 2002.

Mobile asthma clinics were designed to help break down barriers for families unable to travel or pay for preventive asthma care. Thanks mostly to grants, donations, Medicaid funding and, for some, financial support from hospitals, services provided by mobile asthma clinics are free, including prescription medications if needed.

In addition, CHOC Breathmobile providers are bilingual, essential for the large Spanish-speaking population in Orange County.

“By reducing some of the common barriers to care, such as transportation, costs and language difficulties, we provide a much-needed service for children in both urban and rural areas,” says pediatrician Olga Guijon, MD, assistant medical director for CHOC Breathmobile and one of the doctors who treated Hector.

“The Breathmobile returns to the same site every 3-4 weeks, so we can provide continuity of care,” Dr. Guijon adds. “Families see the same provider each visit, which builds trust and adherence to the treatment program.”

‘It Can Change Their Life’

In Chicago, the nonprofit Mobile C.A.R.E. Foundation operates two Asthma Vans – one on the Northside and one on the Southside. Staffed by nurse practitioners, asthma educators and clinical assistants, the vans have served inner city public schools in areas with high asthma rates since 1999. They see 8-15 children per day; last year they treated 1,646 children.

In most of the communities, there is no asthma specialist close by. “If services aren’t provided by Asthma Vans, it’s likely they aren’t being provided at all,” says Matt Siemer, director of operations for Mobile C.A.R.E. Foundation. “For a lot of the children, the Asthma Van is the first time they have been seen by a specialist. It can change their life.”

Every child who arrives for an appointment at an Asthma Van is given a general health exam and then undergoes spirometry testing to measure lung function. Symptom triggers and correct inhaler technique are discussed and an Asthma Action Plan is developed and put on file at the school. Staff can also conduct allergy skin testing to detect allergies.

In recent years, some mobile asthma clinics are expanding to home interventions.

“If a patient tells us they are following their medication plan and their asthma is still not improving, then we can send a community health worker to their home to figure out if there’s something in the home setting off asthma,” Siemer says. “Maybe it’s mold, or pet dander. We can work with families to try to fix the problem.”

Running From Asthma

Now 18, Hector Hernandez is running without any breathing difficulties. He uses his albuterol inhaler 15 minutes before running, and if symptoms arise.

Last year, Hector was awarded the Allergy & Asthma Network Scholarship for 2015 based on his story of how asthma has impacted his life and his financial needs to accomplish his goals and dreams. He is studying graphic design and digital media at an Orange County community college.

“I’m grateful for the Breathmobile and what the doctors there have done for me,” Hector says. “There are days when I don’t even realize I have asthma. I feel confident managing it and now I’m able to achieve more.”

Reviewed by Tera Crisalida, PA-C