Two years ago, Ofelia Vidal was bringing her son Julian to the emergency room half a dozen times a month.
Anytime he coughed; anytime he started breathing heavily; anytime he appeared at all distressed, the worried mother rushed him to the hospital. She didn’t know what else to do.
But now, after participating in asthma programs through Yakima Valley Farm Workers Clinic over the past year, Vidal and her 6-year-old son have the education and the tools to confidently manage his asthma at home.
“He hasn’t gone to the emergency room since we started the program,” Vidal said. “Now, I feel more calm.”
With spring coming on fast, bringing more pollen in the air and more dust stirred up by agriculture, asthma is sure to kick into high gear for many in the Yakima Valley. But in a study Farm Workers is doing with the University of Washington, researchers and clinicians are looking for ways to minimize the effects of the respiratory condition in local children.
The community-based study, for “Home Air in Agriculture — Pediatric Intervention,” is aimed at children who live within 400 meters of crop production or dairy operations in the Yakima Valley. The five-year project is about halfway done, with 54 of the target 75 families already finished with their one-year trial or currently enrolled. Three to six new families are enrolled in the project every month through a rolling admission process.
“We’ve been lucky. We have a community that really cares about the population and the environment, and understanding what we’re trying to achieve here,” said Griselda Arias, Asthma Project coordinator with Farm Workers. “It’s always great for us when families are willing to participate.”
The study, paid for by a $2.5 million grant from the National Institute for Environmental Health Sciences, builds on work previously done by UW’s Dr. Catherine Karr, who has found that kids with asthma experienced higher asthma morbidity, or poor health, after days where poor air quality was recorded in the region.
In the new study, families receive six visits from Farm Workers “asthma educators” over a yearlong period, as well as two weeks of air-quality monitoring in their home at the beginning and end of the year. Half of the enrolled families, selected at random, also receive high-end air purifiers that have been found to help in urban areas with high pollution from traffic, and in homes with cigarette smokers. Karr hopes to learn if they can help reduce asthma irritants in a rural agricultural setting, as well.
“The main question of the study is, does it help to have an indoor air cleaner, above and beyond education and understanding how to take care of your disease — what you can do behaviorally around risk factors,” Karr said.
The six visits include measuring the kids’ air function and lung inflammation, using a “peak flow meter” or a spirometer that the child blows into as hard as he or she can. They also do urine samples to test for phthalates, chemicals commonly found in household cleaning products, after asking for the family’s cleaning routine the day before the urine sample was taken.
The urine sampling, data input and set-up of the air monitoring equipment is conducted by Radio KDNA, which partners with Farm Workers on the project.
The study also will examine the four weeks’ worth of air monitoring data collected at the beginning and end of the family’s enrollment period to measure the air pollution in the home.
The study has had strong retention among the children who’ve enrolled, Karr said.
By design, she said, “They have to be kids with asthma that’s not well-controlled that we think will benefit.”
Many of the families also are part of Farm Workers’ broader Asthma Project, which involves three visits in a three- or four-month period for asthma educators to come into the home and teach families about the risk factors and behaviors that contribute to asthma, such as carpets that hold in dust particles or cleaning products that can aggravate a child’s lungs.
In the Vidal home, carpets were one of the first things to go after joining the Farm Workers project. Vidal pulled up the carpet in the living room and in Julian’s bedroom, which seems to have made a big impact on his asthma. They haven’t used their wood-burning fireplace in two years.
The family was not selected to receive the air purifiers for the study but did receive a “green cleaning” kit from Farm Workers, so Vidal now uses vinegar to clean instead of harsher ammonia-based products. She also uses Murphy’s oil on the hardwood floors.
“I think most likely, it was the dust from the carpet” that really bothered Julian’s lungs, she said. “Ever since we got rid of it, I’ve noticed a big difference in his health.”
She and Julian have his medication routine down pat, knowing when he needs to take his pill at night, and that he needs to use his inhaler before running outside to play. He also keeps an inhaler at school to use before recess.
Before, Vidal said. “I was more ignorant about how things affected him.”
Since they were going to the hospital so much, she tried a few times to find other resources for how to manage her son’s asthma, but the attacks were so scary she always defaulted to the emergency room. When Julian was 5, he was hospitalized for more than a day with a particularly nasty attack.
But since starting the Farm Workers program, his attacks have subsided significantly. He had some trouble a few weeks ago, Vidal said, but “a little one — not like before.”
That’s the goal of the program, Arias says — helping kids and families understand their asthma so they can manage it all on their own, and know what to do when they encounter any number of external factors.
“Spring is definitely a trigger,” Arias said. “And for a lot of asthma patients, they’re fine all winter, so depending on how much education they have on understanding their condition,” they may think they’ve got it under control and no longer need their medication. “Spring, even though it happens every year, it seems to hit them out of nowhere and complicates things.”
Since they can’t control the outdoor environment, the program encourages families to do everything in their power to mitigate asthma triggers indoors.
“If everyone knows what to do with their medication, and they’re doing as much as they can to keep their indoor air as clean as possible, that helps,” Arias said.
And once the study is completed in 2019, Karr can begin to assess any positive impact of the air purifiers, and potentially help more kids with asthma get access to them.
“What I see something like this doing is showing the evidence that the use of an air cleaner improves asthma health outcomes, and as such could be a reimbursable part of asthma care,” Karr said. “As a pediatrician, I see myself writing a prescription for an air purifier in their home, if we have the evidence.”