In-home intervention program helps keep asthmatic children out of Fresno County hospitals


Studies show children are exposed to indoor air pollutants.


Nearly one in five children in Fresno County has been diagnosed with asthma.


Substituting baking soda and vinegar for bleach when cleaning is one way to reduce asthma attacks.


Emilio Camarena hopped onto his bed, reached high and grabbed a stuffed bear from a pile of plush toys on a shelf.

The toys used to be scattered across his bed in easy reach, but for the past year, they’ve been shelved. Emilio, 9, has asthma. Stuffed toys can harbor dust mites, which can trigger asthma attacks.

Emilio’s mother, Berta Camarena, banished Emilio’s zoo of plush animals at the urging of Stephani Pineda, a program coordinator at the Central California Asthma Collaborative.

It’s Pineda’s job to walk through homes of asthmatic children in Fresno County looking for dust and other lung irritants and recommend ways to eliminate or reduce them. The children are enrolled in Asthma Impact Model for Fresno, a two-year pilot program for low-income children at risk of asthma emergencies. The California Endowment, a private health foundation, is providing $1.1 million in funding.

The in-home intervention program fits a need: Asthma is one of the top chronic diseases among children, affecting nearly one in five in Fresno County.

It may seem odd in the polluted San Joaquin Valley to concentrate on reducing indoor air pollutants, but Pineda said it makes sense. “Studies show children spend 70% to 90% of their days indoors,” she said. “People kind of fail to recognize how important it is to regulate those indoor triggers.”

Children in the program are followed for a year. Coordinators make five home visits and speak with parents at least once a month by telephone. A family can get a vacuum cleaner with a high-efficiency filter, hypoallergenic pillow cases, a machine to monitor indoor humidity and other supplies to help keep irritants at bay.

The coordinators often make simple suggestions that make a difference, such as replacing bleach and other chemical cleaners with baking soda and vinegar. Strong chemical odors are common asthma triggers.

Program coordinator Nunu Sixay encouraged Dalia Mondragon to change how she cleans her southwest Fresno home, and it’s helped her four children who have asthma. “I’m not buying bleaches to clean my house,” Mondragon said. “I used to buy a lot of the liquids.”

Some of Sixay’s recommendations have been harder to accomplish. Sixay recommended the carpet be removed, but the family rents the house and the landlord declined to replace the carpet with other flooring. As an alternative, Mondragon has covered the carpet with a heavy plastic tarp that she mops daily.

The goal of the asthma project is to keep children out of hospital emergency rooms. Children in the program are on Medi-Cal, the state-federal insurance for low-income families. A Kaiser Permanente-Fresno grant covers some uninsured children.

The Fresno project is a test case for how a social-health program can show financial benefit, said Nirav Shah, director of Social Finance Inc., a Boston nonprofit organization. If successful, the Fresno project could attract investors to a social-impact bond and allow the program to expand, he said. “The ultimate goal is to scale up to reach many more at-risk children with asthma.”

So far, parents report the intervention program has lowered the number of health-care visits, Shah said.

Families have reported that asthma-related hospitalizations dropped by approximately 70%, while emergency department visits fell by about 80%, he said. But an evaluation using Medi-Cal claims data won’t be done until next year. The Fresno program will be the first to use claims data to look at the effect of an in-home asthma program on health utilization and costs, Shah said.

Emilio’s intervention is an example of the potential for cost savings. Before enrolling in the program, he had been taken to emergency several times. The bill for one of the hospital visits was more than $2,000, Camarena said. Medi-Cal paid, but not before she got a look at the bill.

Part of Emilio’s improvement has been achieved through better medication management. He had been taking asthma medicines incorrectly — confusing a quick relief medicine for one prescribed for daily use. A doctor had showed Camarena how to use the drugs, but she said: “The doctor visit is very fast, and they don’t teach you that much.”

Pineda taught Camarena and Emilio how to properly take the drugs for best effect. Children in the program are educated along with their parents on medication use and asthma triggers.

Emilio’s asthma is under control now, and he plays soccer without having to stop every few minutes to catch his breath. And he plays clarinet. When his asthma was out of control, he had an incessant cough and his mother had discouraged him from playing a wind instrument.

Uncontrolled asthma is a leading cause of school absences statewide.

Jennifer Martinez, a Fresno second grader, missed 15 days of school last year. Her teachers said she was behind in her schoolwork and might have to repeat first grade. Since enrolling in the asthma program, she “hasn’t been getting sick” and is now at grade level, her mother, Rosa Aguilar, said in Spanish.

Aguilar has removed the carpet in her northwest Fresno home and now uses “green” cleaning supplies. The family wipes their feet on a door mat that captures dust inside the front door, and Sixay has helped find a handyman to take out wallboard in the bathroom to get rid of mold that no amount of scrubbing had killed.

Jennifer has been learning about reducing asthma triggers alongside her mother. She was shy to participate at first, but she relaxed after Sixay brought her “Hello Kitty” stickers.

“We’re not just an educator,” Sixay said. “We’re a friend who’s here to help them.”

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