Attack on asthma: Hospital helps kids fight for breath

The St. Louis Children's Hospital program demonstrates how coordinated, comprehensive strategies make breathing easier.

By Kathleen Phalen Tomaselli, AMNews correspondent. Nov. 17, 2003.

Being 6 brings with it lots of firsts. John Christian Hashagen, now 9, remembers that year as marking his first day of kindergarten and his first soccer game. It was also when he had his first respiratory arrest.

"All of a sudden I had a huge spiderweb in my throat," John Christian says.

It was right after a soccer practice. The day was warm and the pollen count high. John Christian had been coughing and had a runny nose, but so did his mom, due to allergies. But by the time he got home from practice, his condition was grim. "He said, 'Mommy, something is wrong with me,' " says Christi Hashagen, his mother, a registered nurse. "He let out a gasp, and that was it."

CPR, rescue breathing and four days on a ventilator saved him. Doctors said it was anaphylaxis caused by a food product. Exactly 14 days later, though, the respiratory distress started again. This time, the boy was airlifted to St. Louis Children's Hospital where he was diagnosed with fatality-prone asthma.

"I was terrified," Hashagen says. "I didn't even know there was such a thing."

Although fatality-prone asthma is rare, childhood asthma is not. Affecting more than 5.2 million school-age children, it's estimated that 4 million children have an attack each year. The No. 1 reason for school absenteeism, asthma accounts for 14 million lost school days. Its incidence has increased 150% in the past decade and is St. Louis Children's Hospital No. 1 reason for admittance.

That's why Robert Strunk, MD, an allergy and pulmonary medicine specialist there, seized an opportunity to develop a more consistent approach to handling it. About seven years ago, working with a team of nurse practitioners, he created an innovative program -- known as the Asthma Intervention Model or AIM. The effort involves an asthma protocol for every child admitted for an asthma-related illness, an after-hours answer line and community education. These elements offer ideas for other physicians to use in addressing this volatile disease.