Breathing Easier (continued)

Quality of Life

Children's respiratory therapist, Jeanne Daddato

tests Briana's lung function during an appointment.

TJ and his sister Briana now visit third-year pulmonary fellow Terri Laguna, MD, at Children’s Asthma Clinic every three months to keep their asthma under control.

“I try to emphasize to patients and families that asthma can be controlled, and our goal is to give them the best quality of life they can have,” Dr. Laguna said. “If that means someone wants to be an elite marathon runner, then that’s what they want to be. If they just want to be able to walk up and down the stairs, or sleep at night, whatever it is, that’s our goal to make them symptom-free and give them whatever quality of life they want.”

Ann Marina said, “We’re a sports family. Now TJ can do whatever he wants – play baseball, basketball, and run around with his sisters.”

Basketball is Briana’s sport of choice, but before she was treated at Children’s, coughing and wheezing interfered with her ability to play.

She and TJ have learned to take their inhaled steroids every day and to use their Albuterol inhalers before exercise to prevent symptoms from occurring.

“I emphasize that it’s a process,” Dr. Laguna said. “We evaluate them, start them on medication, see them back and see what happens. If they’re having more symptoms, we’ll add something or change something. If they’re doing great, we’ll leave them where they are.”

Dr. Kerby said, “The large majority of patients’ symptoms can be well-controlled. Our whole goal is for them to have normal lives. No one should assume they can’t play sports and be involved in all the other activities and do everything other children do because they have asthma. It’s the onus of the provider to treat them appropriately so they can participate in everything all the other children are doing.”

Because of his young age, most of TJ’s clinic visits are spent simply “hanging out” with Dr. Laguna, who observes him running around the exam room to determine if he is limited by coughing or wheezing. Dr. Laguna also talks to TJ’s parents about how much Albuterol he’s been taking and whether he’s been sick. She listens to TJ’s lungs and asks him how he feels, and whether it’s difficult for him to take deep breaths.

Briana’s appointments are similar, but also include spirometry, in which she blows out “candles” on a computer screen to measure her lung volumes and flows. This is normally done with patients older than 5. At a recent clinic visit, Briana also received a “Zoey Kit,” an educational tool geared toward asthma patients ages 5 to 10. It features a booklet about a car named Zoey who has asthma, and is designed to help children manage their asthma by determining whether they are in the “green zone, yellow zone or red zone,” and how to treat those symptoms.

“Both TJ and Briana have had pretty impressive responses to their medications,” Dr. Laguna said. “It’s great to get to know TJ and Briana, and it’s nice to see when children go from not knowing what’s going on and being very affected by symptoms to being put on the right medications and seeing them do so well afterward.”

Ann Marina brought her two older sons, Sean and Dominic, to a clinic appointment so they could ask questions about TJ and Briana’s asthma.

“Children’s makes it a family thing, not an individual thing,” she said. “Everybody is involved in understanding that asthma is a life-changing thing. Sean and Dominic are responsible for their brother and sister when mom’s busy, so they have questions too. Children’s was really open to answering all of their questions.”

‘So Happy Now’

TJ, Briana and their family continue to learn to live with asthma, a disease that Dr. Kerby says has increased over the last 10 to 20 years.

“There’s always been a question of, is there really more asthma or are we diagnosing it more?” Dr. Kerby said. “I think there may be a little bit of both. I do think it’s becoming more recognized. A lot of people would call it other things when it was asthma causing chronic problems.

“Asthma can be diagnosed at any age. It can vary in severity at any point. It is based on genetics and environment. Some studies have shown there are different types of asthma. Children who have more allergies are more likely to continue to have asthma into their school years, whereas some children have asthma that may only be associated with viral illnesses and may outgrow it over time.”

Time will tell the role that asthma continues to play in TJ and Briana’s lives. For now, Ann Marina relishes the fact that neither child has been in the hospital since getting proper diagnoses and treatments.

TJ and Briana understand how to use their medications, and monitor their lung functions at home using a peak-flow meter.

“I feel like I’m free,” Ann Marina said. “It was so hard before, and I’m so happy now.” And so, she says, is TJ.

“TJ has opened up a lot now that he’s feeling better,” Ann Marina said. “Before he kept to himself and didn’t want to play with other kids. He’s a different kid now, so energetic and always wants to go, go, go – and the best part about it is now he can!”

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