Merck Childhood Asthma Network - Floyd J. Malveaux, MD, PhD · 2014-03-31 · When you’re two years old, it’s natural to look to your grandmother for help when you’re not feeling

Floyd J. Malveaux, MD, PhD

Floyd J. Malveaux, MD, PhD is Executive Vice President and Executive Director of the Merck Childhood Asthma Network, Inc. (MCAN). Dr. Malveaux is a nationally recognized expert on asthma and allergic diseases and is Emeritus Dean of the College of Medicine and Professor of Microbiology and Medicine at Howard University. Dr. Malveaux's research career has spanned from basic bench research on the regulation of IgE receptor density on human basophils to initiatives to identify and address risk factors that contribute to increased asthma morbidity among inner-city children and the development of evidence-based interventions to reduce and prevent asthma among at-risk populations. A native of Louisiana, Dr. Malveaux received a B.S. degree from Creighton University in Omaha, Nebraska, and a M.S. degree from Loyola University in New Orleans. He earned a Ph.D. degree in Microbiology and Public Health from Michigan State University and the Doctor of Medicine degree, with honors, from Howard University College of Medicine. Dr. Malveaux received specialty training in Internal Medicine at the Washington Hospital Center in the District of Columbia and subspecialty training in Allergy and Clinical Immunology at the John Hopkins University in Baltimore. He became Dean in 1995 of the Howard University College of Medicine. Later he served as Vice Provost for Health Affairs and Dean of the College of Medicine. He remained Dean of the College of Medicine and Professor of Microbiology and Medicine at Howard University until July 2005. Dr. Malveaux is a fellow of the American College of Physicians and the American Academy of Allergy, Asthma and Immunology. He is a member of Alpha Omega Alpha Honor Medical Society and was elected to the Institute of Medicine of the National Academies. He has served as a member of the Board of Directors of the American Lung Association; the National Allergy and Infectious Diseases Advisory Council of the NIH; chairman of the Committee of Underrepresented Minorities, American Academy of Allergy, Asthma and Immunology; the Board of Trustees of the Asthma and Allergy Foundation of America, and on the first expert panel of the NAEPP of the National Heart, Lung and Blood Institute of the NIH.; He has held a number of positions with the National Medical Association including member of the Board of Trustees and was first chair of the Allergy/Immunology Section. As executive vice president and executive director of the Merck Childhood Asthma Network, Inc, Dr. Malveaux manages a portfolio that supports enhanced quality of healthcare for children with asthma through translational research and implementation of science-based initiatives into routine medical practice in the continental United States and Puerto Rico. One major initiative supported by his non-profit network is the H.EA.L. (Head off Environmental Asthma in New Orleans) project in partnership with the National Institutes of Health to address the mounting childhood asthma problems following the flooding of New Orleans after Hurricane Katrina.

Merck Childhood Asthma Network (MCAN)

The

Merck

Childhood

Asthma

Network,

Inc.,

(MCAN),

is

a

non‐profit,

501(c)(3)

organization

established to address the complex and growing problem of pediatric asthma. MCAN is funded

by the Merck Company Foundation, and is located in Washington DC. Led by Floyd Malveaux,

MD, PhD, a nationally recognized expert in asthma and allergic diseases and former dean of the

Howard University College of Medicine, the mission of the Merck Childhood Asthma Network,

Inc. is to enhance the quality of life for children with asthma and their families and to reduce the

burden of the disease on them and society.

MCAN seeks to be a respected authority, effective catalyst, and influential advocate for children

with asthma by focusing on three goals:

Goal 1: Improve access

to and quality

of asthma healthcare for children, especially the

vulnerable and medically underserved

Goal 2: Advocate for policies

that expedite implementation, dissemination, and

sustainability of science‐based asthma care

Goal 3: Increase awareness

and knowledge

of asthma and quality asthma care

MCAN

programs

involve

tailored

asthma

case

management

and

reduction

of

environmental

risk

factors/triggers

in

the

home

and

are

implemented

in

several

different

settings:

community

health

centers,

school

systems,

community‐based

organizations,

public

housing

and

primary

care centers.

Additionally,

MCAN

funds

the

American

Academy

of

Pediatrics

to

support

education

for

pediatricians

to

implement

the

latest

asthma

diagnosis

and

management

guidelines,

and

the

National

Education

Association

to

train

educators

to

recognize

asthma

symptoms

and

manage

acute

episodes. MCAN

advocates

for

policies

that

support

science‐based

asthma

care

by

working

with

partners

such

as

the

George

Washington

University

School

of

Public

Health

and

Health

Services,

US

Environmental

Protection

Agency,

the

Centers

for

Disease

Control

and

Prevention, and the NIH.

Merck Childhood Asthma Network, 1400 K Street NW, Suite 750, Washington DC 20005Phone: (202) 326.5200 Fax: (202) 326.5201 www.mcanonline.org

When you’re two years old, it’s natural to look to your grandmother for help when you’re not feeling well. But for Melba Miles who lives south of downtown Chicago in Englewood, a neighborhood where half of all children live in poverty, it’s not easy to know where to look when trying to managing your grandson’s childhood asthma. Stress runs high in this African American neighborhood and most caregivers focus their time on keeping a roof over their heads and food on the table, leaving little time to focus on health.

Asthma deaths in Illinois are the highest among African Americans in the United States. Within Chicago, the Englewood neighborhood carries more than its share, with asthma-related hospitalizations that are double the city’s average.When an entire community is shouldering such a heavy burden of a complex, chronic disease like asthma, it takes more than educating individual families about asthma – it must be a collaborative effort. In Englewood, community leaders and residents had recognized asthma as one of its most pressing health priorities, but lacked the resources to address the complex condition. It was going to require residents like Melba, proud grandmother to 2-year-old Jamal, to be given a voice that would help improve the community’s health. Addressing Asthma in Englewood, funded by the Merck Childhood Asthma Network, Inc., is giving Melba that opportunity.

Melba spent many months standing by as her grandson suffered asthma attacks, one after another. Melba had lost a nephew to SIDS, so she was often afraid to sleep at night while caring for Jamal. Melba was checking on six- month-old Jamal one night when she realized he was barely breathing because his asthma had become so severe. She rushed him to the local emergency room at the children’s hospital. Jamal stayed in intensive care for five days.

After the attack, Melba became involved in the Addressing Asthma in Englewood program which provided her with tools and resources she needed to keep Jamal’s asthma under control. Jamal, now a curious toddler who loves music, has not been back to the hospital because of his asthma.

Jamal’s improvement alone is cause for celebration. But that isn’t the end of the story. Thanks to a neighborhood advisory board of community leaders and caregivers created by Addressing Asthma in Englewood, community-wide changes are being made to improve asthma control across Englewood. At one advisory board meeting, Melba expressed her concerns about the effects pesticide spraying was having on residents’ asthma. The city’s policy was to spray vacant lots in Chicago, the majority being in Englewood, without any warning to people living nearby. Melba reported that after nearby lots were sprayed, Jamal and other with asthma experienced breathing troubles.

Leaders of the asthma program took action. Working with city officials, they created new spraying policies that would limit exposure to the pesticides. Now, residents in Englewood and across Chicago can be put on a “do not spray” list or request to be notified before their neighborhood is sprayed so they can close the doors and windows or stay indoors while the spraying occurs.

The Addressing Asthma in Englewood program has given Melba a voice in improving the health of her grandson and her community. She now knows how to manage her grandson’s asthma and she is a tireless neighborhood educator about the disease. Empowered by the Addressing Asthma in Englewood program, she is dedicated to keeping on top of community health issues that can improve the quality of life for Jamal and others like him.

“The Addressing Asthma in Englewood program has given Melba a voice inimproving the health of her grandson and her community.”

“She now knows how to manage her grandson’s asthma and is a tireless neighborhood educator about asthma.”

Childhood Asthma – A Costly, Life Threatening Chronic DiseaseIt affects 10.2 million American children1; sends millions of parents racing to the hospital each year with their children2; and new government estimates say it costs our health care system $8 billion annually3, more than almost any other childhood condition, and our nation another $10 billion of indirect costs including school absenteeism and lost wages4. What is it? Believe it or not, it’s childhood asthma.

Most people think they know asthma, but they have no idea just how costly and life threatening it can be – especially when it comes to children.

It Doesn’t Have to Be This WayDecades of U.S.-led research has shown us what it takes to manage childhood asthma. It is not the common cold, a minor irritant that occurs every now and then. Asthma is a chronic disease that requires sustained and appropriate management to keep costs down and children and families healthy. But today, too many parents are watching their children – especially those families living in African American, Hispanic and poor neighborhoods – suffer needlessly because of limited access to care or poor management of their condition.

So, while we don’t know everything about childhood asthma, we know enough to change our approach. Too many kids still live one breath away from another urgent visit to the ER.

1 Bloom B, Cohen RA, Freeman G. Summary Health Statistics for US Children: National Health Interview Survey, 2008. Vital Health Stat.10(244). 2009.2 Akinbami, L. J., Moorman, J. E., Garbe, P. L. & Sondik, E. J. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009; 123:S131-S145.3 Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 20064 American Lung Association. Asthma and Children Fact Sheet. 5 The Illinois Department of Health, The Burden of Asthma in Illinois 2000 – 2007, April 2009.6 Respiratory Health Association of Metropolitan Chicago Asthma Fact Sheet. http://www.lungchicago.org/site/files/487/23938/89067/321794/Chicago_Asthma_8.07.pdf, Accessed on December 1, 2009.

What MCAN Is Doing The Merck Childhood Asthma Network, Inc. (MCAN), is the only national nonprofit, 501(c)(3) organization focused on addressing the complex and growing problem of pediatric asthma. The Los Angeles Unified School District Comprehensive Asthma Program described here is one of five program sites MCAN has funded across the country to put proven childhood asthma management strategies to work – and improve the health and lives of children and their families. Additionally, MCAN is partnering with the George Washington School of Public Health and Health Services, Department of Health Policy and the RCHN community health foundation, to identify and overcome the policy barriers that many families face when trying to control their children’s asthma.

MCAN is funded by the Merck Company Foundation, the philanthropic arm of Merck & Co., Inc., and works with governmental, private sector, foundation, community and quality organization leaders to bring proven, evidence-based strategies to communities that need them.

Learn more at www.mcanonline.org.

A Snapshot of Childhood Asthma

in Illinois

• In Illinois approximately 14 percent of households have a child diagnosed with asthma; two-thirds of these children still have asthma. Within Illinois blacks have at least a four- fold rate of asthma mortality.

• Children younger than 4 years of age had the highest asthma hospitalization rate with 27.4 hospitalizations per 10,000.

• The average asthma hospital length of stay was 3.3 days with a direct cost of $15,155; fifty-seven percent of all asthma hospitalizations were paid by Medicaid or Medicare.5

Chicago

• The asthma hospitalization rate in Chicago is nearly double the national average.6

For most third graders, PE class is fun. For nine-year-old Alicia Arrington, it was a lifesaver.

Alicia is a playful, bright third grader attending Windsor Hills elementary school in Los Angeles. So when she was sidelined in PE class with a dry hacking cough and trouble breathing, her PE teacher took notice and sent her to the school nurse.

Alicia’s teacher is part of a large collaborative team within the Los Angeles Unified School District (LAUSD) – the second largest school district in the United States with nearly 688,000 students and 63,000 students with asthma – that works to identify children with asthma and get them the help they need. This program provides children with asthma and their families, teachers and caregivers with the knowledge and resources they need to help manage the condition and to become effective advocates for asthma-friendly policies.

Alicia had a history of asthma and allergies, starting when she was two years old. Her hacking cough had triggered multiple asthma attacks that had sent Alicia and her aunt – Ms. Arrington, Alicia’s main caregiver – rushing to the emergency room six times over a 12 month period. These hospital runs meant many missed classes and school days; Alicia was falling behind.

This particular visit to the nurse’s office was a turning point for Alicia and her aunt. Hearing about the multiple hospital trips and their uncertainty about how to effectively manage Alicia's asthma, the school nurse referred the family to the LAUSD Comprehensive Asthma Program. Funded by the Merck Childhood Asthma Network., Inc., the program

aims to improve children’s asthma so they can stay in school, ready to learn.

Once involved, Alicia and Ms. Arrington received a home visit from Nurse Van Buren, a case manager who spent two hours with the family providing the building blocks to self management – educating them about asthma “triggers” and creating an asthma action plan to improve management. Then Nurse Van Buren took a hands-on approach, demonstrating how to use a peak flow meter to monitor Alicia’s asthma and helping them remove triggers in the home such as the many furry stuffed animals piled on top of Alicia’s bed.

Nurse Van Buren also referred the family to the Breathmobile, a mobile clinic based at the school that would provide access to continuous medical and educational support. The clinic offered Ms. Arrington and Alicia access to board-certified allergists, nurses and respiratory therapists who were able to monitor Alicia’s asthma. The clinic team also continued their education about the skills needed to manage asthma. The Breathmobile provides updates to Nurse Van Buren and the school nurse on Alicia’s progress so they can continue to work together as a team to keep this student on track to effectively manage Alicia’s asthma.

The LAUSD Asthma Program has armed Alicia and Ms. Arrington with the skills and confidence they need to gain and keep control of Alicia’s asthma. With her asthma in check, Alicia is now a healthy and active girl who has been able to jump back into playing basketball and double-dutch. Most importantly, Alicia is back in class, able to stay and learn each and every day.

“The LAUSD Comprehensive Asthma Program has armed Alicia and Ms. Arrington with the skills andconfidence they need to gain and keep control of Alicia’s asthma.”

“Alicia is now back in class, able to stay and learn each and every day.”





1 Bloom B, Cohen RA, Freeman G. Summary Health Statistics for US Children: National Health Interview Survey, 2008. Vital Health Stat.10(244). 2009.2 Akinbami, L. J., Moorman, J. E., Garbe, P. L. & Sondik, E. J. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009; 123:S131-S145.3 Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 20064 American Lung Association. Asthma and Children Fact Sheet. 5 California Department of Health Services, The Burden of Asthma in California: A Surveillance Report, June 2007.





in California

• 1.7 million children in California have been diagnosed with asthma at some point in their lifetime.

• There are approximately 145,000 emergency department visits from patients with asthma and 36,000 hospitalizations, including about 5,000 repeat hospitalizations every year.

• There are approximately 4.8 asthma hospitalizations for every 1,000 Medi-Cal (California’s Medicaid program) members with asthma.

• Rates of asthma-related ED visits are two times higher among children under age 19 than among adults. Rates of asthma-related hospitalizations are 1.6 times higher among children under age 15 than among people over age 15.

• Total charges for asthma hospitalizations in 2005 in California were $763 million. 5

Maria Tavarez’ cell phone rang while she was at work, a 45-minute commute from where her 4-year old son Juan was under the care of her sister-in-law. On the other end of the line was an EMT who reported that Juan had been admitted to the hospital after being revived with CPR following a life-threatening asthma attack.

On that January day, Juan’s asthma was triggered by a bitter cold New York morning; the winter air was freezing and Juan began having trouble breathing. The strained gasps for air scared his aunt, who took off with Juan to the local clinic for help – and not a moment too soon. By the time they arrived, Juan’s skin color had turned a shade of purple and the clinic staff immediately rushed him to the ER. It wasn’t the family’s first trip to the ER to treat a severe asthma attack – Juan had visited three times before – but it was the first without his mother or father.

While terrifying, the experience led Maria to the Washington Heights/Inwood Network (WIN) for Asthma Program that returned her “baby” from a child who often missed school, to the curious, playful boy who greets everyone on the street. Funded by the Merck Childhood Asthma Network, Inc., WIN for Asthma is a hospital-community partnership that takes a comprehensive approach to managing asthma, including home health assessments, education and goal setting.

Maria’s involvement in the program has provided her family with numerous opportunities to learn proper ways to manage Juan’s asthma – starting with the understanding that Juan’s asthma is not like thecommon cold that can be treated every and now and then. Prior to

becoming involved in the program, the family mostly treated Juan’s asthma with medication when he seemed to develop symptoms. They now understand that even through Juan may appear healthy, his asthma must be managed on a regular basis.

A WIN community health worker made a personal visit to the Tavarez home to help Maria learn easy ways to manage Juan’s asthma that can be worked into their daily family routine. They worked together to create an asthma action plan and identify possible triggers around the house that could contribute to an asthma attack, like dust, peeling paint and other allergens. Maria now works to eliminate asthma triggers in the home by frequently cleaning areas that gather dust, like her ceiling fan, and taking out the garbage daily. She also stopped applying perfume at home.

In addition, Maria attends monthly WIN asthma education courses and talks with the network of people available through the program – from community health workers to a pediatrician – that have helped the family recognize asthma symptoms and reduce Juan’s asthma episodes.

Today, the whole Tavarez family is part of Juan’s asthma management team. Maria has used the knowledge she has gained to teach Juan and his caregivers how to better maintain control over his asthma. She even shares what she knows with other families in her community.

WIN for Asthma has been a lifeline for Maria and her husband who no longer feel alone. And the best news? Juan hasn’t been back to the hospital since.

“WIN for Asthma has been a lifeline forMaria and her husband who no longer feel alone.

And the best news? Juan hasn’t been back to the hospital since.”





1 Bloom B, Cohen RA, Freeman G. Summary Health Statistics for US Children: National Health Interview Survey, 2008. Vital Health Stat.10(244). 2009.2 Akinbami, L. J., Moorman, J. E., Garbe, P. L. & Sondik, E. J. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009; 123:S131-S145.3 Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 20064 American Lung Association. Asthma and Children Fact Sheet. 5 CDC/NCHS:NationalHealthInterviewSurvey.6 National Asthma Survey - New York State Summary Report (Public Health Information Group Center for Community Health, New York State Department of Health), October 2007





in New York

• In New York State, asthma currently affects about 10.5 percent of children (0-17 years old)5

• Current asthma prevalence varies by race. Black children had the highest prevalence at 10.0 percent compared to White (7.2 percent) and Asian (4.3 percent) children.6

• Nearly 15,000 children aged 0-17 were hospitalized for asthma each year.

• Children aged 0- 4 years had the highest emergency department visit rate (181.4/10,000) compared to all other ages.

• The average cost per asthma hospitalization increased 110 percent from $6,044 in 1996 to $12,699 in 2005. The average adjusted asthma hospitalization cost increased 48 percent over this time period.

• Total Medicaid health care expenditures for enrollees with asthma in New York exceeded $1 billion in fiscal year 2005, inclusive of asthma related and unrelated medical services.

Ask Erica Bates of Philadelphia how she felt when her oldest son was first diagnosed with asthma and she’ll say simply, “I had no idea what to do…I was scared to death.”

And it’s no wonder. Following a diagnosis of allergies and a year or so of trial-and-error treatments to address her son’s chronic coughing and sneezing, Eric wound up in the hospital. Connected to breathing tubes and struggling for air, Eric, then about 4 years old, was diagnosed with asthma.

Today, Eric is 14 and his little sister Ebony is nine. While both have asthma that is being successfully managed, mother Erica recalls the nearly decade- long period she spent looking for answers that would keep her children’s asthma attacks at bay. She shuttled them back and forth to multiple doctors, followed their orders and tried multiple treatment regimens. Yet, asthma flare-ups were frequent. And even though one out of four children in Philadelphia suffers from asthma, Erica often felt alone, overwhelmed and filled with unanswered questions.

Families like the Bates needed better access to proper care, more education and information about ways to manage their children’s asthma inside the home and out. That’s where the Philadelphia MCAN Project, a program funded by the Merck Childhood Asthma Network, Inc., stepped in. The program connects families to care coordinators and creates action plans that help families keep asthma managed wherever their children are – at home, at school or outside.

Erica says her involvement in the Philadelphia MCAN program made her feel as if she had a constant partner in her children’s care, largely due to

a woman named Barbara Washington. Barbara, a care coordinator in the program’s Child Asthma LinkLine, calls Erica each month to monitor the Bates childrens’ asthma and answer any questions Erica may have.

Over the course of a year, Barbara and Erica had many conversations about ways to improve Eric’s and Ebony’s asthma. They talked about dealing with seasonal weather changes and planning vacations that would not trigger asthma episodes. Barbara provided referrals to doctors who were conveniently located and had hours that worked for the family. LinkLine has counseled other families on how to talk with their landlords about changes that could reduce or eliminate asthma triggers at home.

The Bates family also received home visits from Carmen Perez, a community health worker who helped Erica learn about hidden “triggers” that were unknowingly exacerbating her children’s asthma. Carmen helped the family to create an asthma-friendly living environment by replacing carpets that gathered dust with tile, and using dust mite impermeable mattress and pillow covers. Carmen involved the children by educating them about the disease and environmental triggers through fun exercises including an asthma education coloring book. Visits like the ones to the Bates’ home are provided to hundreds of Philadelphia-area families and have been shown to reduce asthma symptoms, emergency room visits and hospitalizations.

The Philadelphia MCAN program provided Erica with the information and tools needed to finally feel in control of her children’s asthma. Erica no longer feels alone and the children are doing well. “I don’t remember the last time they had an attack,” Erica says. With a pledge to stick to their plan, Erica, Eric and Ebony are working to keep it that way.

“The Philadelphia MCAN program provided Ericawith the information and tools she needed to finally feel in control of her children’s asthma.”

“I don’t remember the last time they had an attack,” Erica says.





1 Bloom B, Cohen RA, Freeman G. Summary Health Statistics for US Children: National Health Interview Survey, 2008. Vital Health Stat.10(244). 2009.2 Akinbami, L. J., Moorman, J. E., Garbe, P. L. & Sondik, E. J. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009; 123:S131-S145.3 Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 20064 American Lung Association. Asthma and Children Fact Sheet. 5 Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2006 6Akinbami, L. J., Moorman, J. E., Garbe, P. L. & Sondik, E. J. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009; 123:S131-S145





in Philadelphia

• In Pennsylvania, asthma affects about 10.1 percent of children (0- 17 years old).5

• In the 2006/2007 school year, approximately 215,000 students in kindergarten through grade 12 in Pennsylvania schools had been diagnosed with asthma.

• The prevalence of persistent asthma among people with asthma in the Medicaid program increased 36 percent over four years from 16,000 in 2004 to nearly 23,000 in 2007.

• Each year, 17 of every 10,000 Pennsylvanians are hospitalized due to asthma. The average hospital stay is three days in length and costs an average of $15,139.

• Asthma-related mortality rates in Philadelphia show that African Americans in Philadelphia are three times more likely to die from asthma than Caucasians.6

Warm weather, open spaces for playing and lots of relatives and friends nearby. What more can a seven year-old ask for? Unfortunately for David Diaz, the outdoor life in Puerto Rico was mostly out of reach due to his asthma. Instead of countless hours playing outside, David rarely counted seven days between hospital visits for his asthma.

The frequent visits – often in the middle of the school and work day – took their toll on David and his mother, Iris. Fear and stress were high. Without a personal car, Iris had to take David on the bus while he was having trouble breathing. Once at the urgent care site, David had to wait, sometimes for hours, a challenge for any 7-year-old. And even after all of those visits, Iris usually left the hospital feeling uncertain about how to control David’s chronic and severe disease on her own.

Iris is not alone in her struggle to manage her son’s asthma. Puerto Rico has the highest asthma prevalence rates in the United States. Many parents and caregivers watch helplessly as their children suffer due to limited access to care or insufficient knowledge about how to manage the disease.

In fact, in Iris’ San Juan community - the Manuel A. Pérez Housing Project – and the neighboring Luis Lloréns Torres, a staggering 41 to 46 percent of children are reported by their parents to have asthma. A survey conducted by La Red de Asma Infantil de Puerto Rico (the Puerto Rico Childhood Asthma Network), a program funded by the Merck Childhood Asthma Network, Inc., of neighborhood children with asthma found that only about 30 percent had a regular health care provider to treat their asthma; between 71 to 80 percent had had an asthma attack in the last year; and more than half had visited the emergency department because of their asthma. La Red created two clinics at the center of the housing communities that use evidence-based interventions to improve childhood asthma.

Once referred to the program, Iris met professionals who gave her something that no one had ever provided before – an answer to what was “triggering” David’s asthma. David received a skin test that discovered he was allergic to dust mites, a major asthma trigger. A community health worker then personally visited the Diaz home. Room by room, she identified changes that could reduce David’s exposure to dust and other elements that might aggravate David’s asthma. The family received dust covers for David’s bed and pillows and they removed stuffed animals from his room. The program also connected Iris to a doctor located at one of the neighborhood clinics, making it infinitely easier to monitor David’s asthma each month and learn the best ways to manage his asthma at home.

Iris calls her experience with La Red, “encantada en la vida” or “the joy of her life.” It’s a far cry from the frightening, frequent bus rides to the urgent care center. She is confident about knowing how to control David’s asthma and feels like an enormous weight has been lifted off her shoulders. David now spends his days working hard in school, where his grades have greatly improved, and his afternoons outside, riding his bike or playing with friends and family.

One child and family at a time, La Red is enhancing access to quality care for childhood asthma in Puerto Rico, and the quality of life of affected children and their families. Since it’s inception the program has reduced asthma-related emergency department (ED) visits and hospitalizations by more that one half, from 93 percent to 35 percent for ED use and 27 percent to 9 percent for hospitalizations.. Building on years of community-partnership and demonstrated success, the San Juan Department of Health is committed to sustaining the program in the pilot communities and extending it to other clinics in the city.

Iris calls her experience with La Red, “encantada en la vida” or “the joy of her life.” A far cryfrom frightening, frequent bus rides she made to the urgent care center, because of her son’s asthma.

David now spends his days working hard in school, and his afternoons outside, riding his bike or playing with friends and family.





1 Bloom B, Cohen RA, Freeman G. Summary Health Statistics for US Children: National Health Interview Survey, 2008. Vital Health Stat.10(244). 2009.2 Akinbami, L. J., Moorman, J. E., Garbe, P. L. & Sondik, E. J. Status of childhood asthma in the United States, 1980-2007. Pediatrics. 2009; 123:S131-S145.3 Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 20064 American Lung Association. Asthma and Children Fact Sheet. 5 Lara M, Ramos G, Gonzalez J, Arabia C, Morales B, Chinman M. Reducing Inequities among Children with Asthma in the Island of Puerto Rico: Experiences of a Community-Based Trans-Sectoral Effort. J Health Care Poor Underserved Nov 20096 Loyo-Berríos NI, Orengo JC, Serrano-Rodríguez RA. Childhood asthma prevalencein northern Puerto Rico, the Rio Grande, and Loíza experience. J Asthma. 2006 Oct;43(8):619–24.7 University of Puerto Rico, Asthma in Puerto Rico. Accessed on December 1, 2009. http://www.rcm.upr.edu/PublicHealth/diabetes/Asthma_Statistical_Report_Vol1.pdf. I believe this is the same reference as: Perez-Perdomo R, Perez-Cardona C, Disdier-Flores O, et al. Prevalence and correlates of asthma in the Puerto Rican population: Behavioral Risk Factor Surveillance System, 2000. J Asthma. 2003;40(5):465–74.8 Lara M, Akinbami L, Flores G, and Morgenstern H. Heterogeneity of Childhood Asthma among Hispanics: Puerto Ricans Bear a Disproportionate Burden. Pediatrics 2006;117(1):43-539. Bartolomei-Díaz J. Epidemiological profile of asthma in Puerto Rico. San Juan, PR:Puerto Rico Department of Health, 2008. Available at: http://www.salud.gov.pr/OficEpidemiologia/Documents/AsthmaEpiProfile.pdf.

What MCAN Is DoingThe Merck Childhood Asthma Network, Inc. (MCAN), is the only national nonprofit, 501(c)(3) organization focused on addressing the complex and growing problem of pediatric asthma. The Los Angeles Unified School District Comprehensive Asthma Program described here is one of five program sites MCAN has funded across the country to put proven childhood asthma management strategies to work – and improve the health and lives of children and their families. Additionally, MCAN is partnering with the George Washington School of Public Health and Health Services, Department of Health Policy and the RCHN community health foundation, to identify and overcome the policy barriers that many families face when trying to control their children’s asthma.




in Puerto Rico

• Puerto Rican children have the highest asthma prevalence rate in the United States and among one of the highest prevalence rates in the world. 5,6

• Nearly 30 percent of children living in Puerto Rica have been diagnosed with asthma.7 Island- born Puerto Rican children are 2.5 times more likely to be diagnosed with asthma than non-Hispanic white children.8

• Overall, children 0-14 years of age had higher emergency room visits than any other age group in Puerto Rico.9

• Twenty percent of parents whose child had asthma reported that their child had been hospitalized for the disease. 7

http://www.rcm.upr.edu/PublicHealth/diabetes/Asthma_Statistical_Report_Vol1.pdf