Asthma affects more than 27 million Americans, including 4.5 million children — and eastern North Carolina families feel that impact every day, from missed school and work to ER visits and hospital stays.
May is Asthma Awareness Month, and recent health data shows that eastern North Carolina has the state's highest rates of pediatric asthma-related emergency room visits. While numbers have stabilized elsewhere, local emergency visits climbed significantly to nearly one percent of children. “Eastern North Carolina still has a good prevalence of asthma,” said ECU Health Registered Respiratory Therapist Bailey Hattem Edwards. She added the highest risk is among children ages five to nine, with the heaviest spikes clustered in rural communities like Beaufort and Bertie counties. “Eastern North Carolina is very rural, meaning that we have patients who live very far with not a lot of access to healthcare options,” she said, “So, transportation is an issue. Just access to care in general can be an issue.”
Edwards runs ECU Health’s Regional Pediatric Asthma Program, and said, “We cover all 29 counties in eastern North Carolina. So, FeNO testing is portable. It's easy. We carry it with us. We partner with the school nurses. Of course, the parents are in on the treatment plan and they've given us permission to go to the schools and treat.” A FeNO – or Fractional Exhaled Nitric Oxide -- test measures the amount of nitric oxide in the breath. It is a quick, non-invasive way for doctors to check for airway inflammation— which is a key characteristic of asthma.
While the program initially focused on Pitt and Greene County Schools, Edwards said the most recent school-based expansions have specifically targeted highly rural, medically underserved districts – including Duplin and Jones County Public Schools. Edwards said they work with students, “Educating with them within a school really empowers them because they're on their own kind of. So, we teach them signs and symptoms of asthma. We complete FeNO testing and explain to them what that means on their terms. So, it really empowers them to speak up for themselves and let their teacher or their school nurse or an adult know what's going on with their lungs that day, and if they need help or intervention, they know how to speak up quickly.”
The students involved in the program learn the proper way to take their medications, and sometimes obtain the medicine in the first place – which Edwards said can keep them in the classroom and out of the hospital. She said, “If the medicine's not getting deep in the lungs where it's supposed to go, then we're not really treating their asthma. And then if they don't have the funds to get the spacer or the medication, we have resources to bridge those gaps for people so asthmatics are not going without because we don't want them in the hospitals. We don't want them in the ED or admitted to the ICU, stuff like that.”
Between 150 and 200 children under the age of 18 die from asthma each year in the United States – a fairly low percentage but they are deaths Edwards said are entirely avoidable with access to the proper care. “You can have childhood asthma that might be mild or it might be extreme. I mean, we've seen kids admitted to our hospital many times that are on extreme life support to help overcome their very sick lungs,” she said, “But that's the thing about asthma. It's a chronic lung disease, but it is very manageable and without resources and knowledge. You run the risk of having a bad exacerbation and really ending up in the hospital and we're hoping you come home. It's not always that dramatic, but it can be.”
Earlier this Spring, East Carolina University and ECU Health secured a $600,000 grant from The Duke Endowment to integrate pediatric asthma services into the Healthier Lives at School and Beyond telehealth network across region. It’s intended to help better manage high-risk cases, improve at-home care, and keep vulnerable children out of local emergency rooms.
