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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

Today in Your Health, two stories about the E.R. An emergency doctor looks back at a patient he wouldn't give up on, but whose family did. And our reporter talks about treating asthma to keep kids out of the E.R.

Three to four million American children have persistent wheezing, coughing and shortness of breath. Doctors say if they were treated for their allergies, their asthma might improve, as well. NPR's Joanne Silberner reports from Atlanta.

JOANNE SILBERNER: It's a spring day in Atlanta - sunny, breezy and full of pollen. Carla Denham has driven her daughter Abbie three-and-a-half hours from their home in South Georgia.

Unidentified Woman: Abbie for Dr. DeMuth.

SILBERNER: They've come to an allergy clinic at Emory University.

Unidentified Woman: Hey, Ms. Abbie. How are you doing today?

SILBERNER: Four-year-old Abbie bounces in on her pink-and-white sneakers.

Unidentified Woman: I'm going to be taking your blood pressure and your temperature today. OK?

SILBERNER: Before going into the exam room to see Abbie, her doctor, Karen DeMuth, talks about something that bothers her to no end, that even though studies show 90 percent of children with asthma also have allergies, many doctors don't look for allergies in asthmatic kids.

Dr. KAREN DEMUTH (Pediatrics, Allergy and Immunology): All they can see is somebody who coughs and wheezes. The reason they cough and wheeze can be very hard to figure out.

SILBERNER: Before Abbie first saw Dr. DeMuth, she had drugs for asthma flare-ups and medicine for her skin allergy, eczema. But no one had even diagnosed her respiratory allergies. Karen DeMuth did allergy tests. She reviews the results.

Dr. DEMUTH: These are dust mites up here. These ones with the strange names, those are molds - house dust mites, cat, dog, cockroach, tree pollens, grass pollens and weed pollens.

SILBERNER: And then she goes in to see how Abbie's been doing.

(Soundbite of laughter)

Abbie giggles as her mom tells Dr. DeMuth that she's thrilled with how things are going. Abbie now runs and plays without getting winded. And no more nightly coughing.

Ms. CARLA DENHAM: Even the way that she looked, you can see a difference in her face. And her eyes look so much brighter.

SILBERNER: Her mom's been working to keep Abbie away from dogs and cats and anything else she's allergic to. Dr. DeMuth has her on nasal sprays for her allergy symptoms and inhalers for her asthma. Now there's much less risk than before of a flare-up getting so bad that it would mean a trip to the emergency room.

According to one asthma expert, studies show that allergies are a very important factor in E.R. visits, and that at least a third of U.S. kids with asthma are not evaluated for their allergies. Stephen Teach of Children's National Medical Center in Washington, D.C. says it's worse at his hospital.

Dr. STEPHEN TEACH (Children's National Medical Center): The vast majority of inner city children have not had a comprehensive evaluation for allergies.

SILBERNER: And that's just the first of many obstacles. Allergies can be difficult to diagnose. Allergy tests aren't always accurate, and doctors need to take a full history to learn what the child is exposed to. And if allergies are found, there's the question of how to treat. Allergy shots take several years and don't always work.

One clear solution: teaching families how to avoid the things that cause the allergy. But Teach says that's hard to deliver, especially because most insurance doesn't pay for extensive counseling or home visits.

Dr. TEACH: And, you know, primary care doctors have a limited amount of time to spend with families. And we estimate that it takes probably about 60 to 90 minutes to provide the kind of comprehensive education that families require to really develop a sophisticated understanding of the disease.

SILBERNER: The good news is that education does make a difference. In one major study, researchers worked closely with several hundred families to allergy-proof their homes, getting rid of allergens like dust and cockroaches and getting tobacco smoke out, too. That cut 21 days off of each kid's annual total of wheezy days.

And best of all, a study where parents were taught to protect their kids from allergens and tobacco smoke reduced the number of emergency room visits by 30 percent.

Dr. DeMuth is proud of the hard work Abbie and her mom are doing on her allergy and asthma. She's had no asthma flare-ups and no E.R. visits.

Dr. DEMUTH: We'll see you in three months. You guys have done awesome together.

SILBERNER: Joanne Silberner, NPR News, Atlanta.

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