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Asthma Epidemic Among Latino Kids

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With moderator Elianne Ramos, Vice-Chair of Communications and PR, LATISM; Chris Espinosa, National Director of Advocacy at the Hispanic Federation; Dr. Evelyn Montalvo, Pediatric Pulmonologist; and Steph's mom, Lydia Rojas.

Asthma is an issue of social justice. With 66 percent of Latinos in the United States living in areas that do not meet federal air quality standards, Latino children are 60 percent more at risk for asthma than white children. When these children grow into adults, they are three times as likely as whites to die from asthma. Particulate pollution emitted by power plants over poorer neighborhoods  – over school buildings and playgrounds were children spend their days – triggers and aggravates asthma, which translates into missed days of work and school, visits to the emergency room, and greater exposure to dangerous and expensive health issues. This blog radio discussion will look at the connection between coal pollution and asthma, the connection between asthma and race, differences in health care given to suffering children, and what parents can do.

About the Moms Clean Air Force

The Moms Clean Air Force is a growing community of moms, dads and others, from all walks of life, who are defending clean air for the sake of our children's health.


0:04 Elianne Ramos

Hello everyone. Welcome to this Blog Talk Radio program, The Asthma Epidemic Among Latino Kids, brought to you by Moms Clean Air Force, a community organization defending clean air for the sake of our children's health, in partnership with Latinos in Social Media, LATISM, the largest organization of Latinos engaged in social media. My name is Elianne Ramos, ergeekgoddess on Twitter, and I am the Vice-Chair of Communications and PR for LATISM. I will be your moderator today. A big part of LATISM mission is to enable our members to take action on the issues that affect their life and become agents for change. It is an honor for LATISM to join Moms Clean Air Force in this important campaign. Today, we will be talking about asthma, a chronic disease that affects the passages of the lungs causing difficulty to breathe. We'll be taking questions through the online chat and also through Twitter. We have a hashtag MCAF. At the end of the discussion, we'll have a Q and A so our experts can answer your question. So, let's talk a little bit about asthma. As our experts are telling, asthma is more than a disease. It's an issue of social justice. With 66% of Latinos in the United States living in areas that don't meet federal air quality standards, Latino children are 60% more at risk for asthma than white children. When these children grow into adults, they are three times more likely than whites to die from asthma. As you can see, this is a very troubling pattern and a huge issue for our community. In this discussion, we'll look at the connection between coal pollution and asthma, the connection between asthma and race, the differences in health care given to suffering children, and also we'll give you a very pointed advice into what parents can do to prevent the disease.

2:04 Elianne Ramos

So with us to discuss this issue is Chris Espinosa, the National Director of Advocacy for the Hispanic Federation. We also have Dr. Evelyn Montalvo, who is a pediatric pulmonologist, and we have Lydia Rojas, who is an activist trying to raise awareness about asthma. Her daughter, Steph, died at age 15 from an asthma attack so it's a really heartbreaking story. How's the rerun this afternoon?

2:34 Dr. Evelyn Montalvo

Good. Good. How are you?

2:35 Elianne Ramos

Good. Evelyn, bienvenida. Why don't you tell us a bit more about yourself? Where do you practice?

2:44 Dr. Evelyn Montalvo

Well, I'm a pediatric pulmonologist at UMDNJ-New Jersey Medical School in New Jersey, and I have a practice here as well in Nork as well as in Jersey City and my major focus is on pulmonary issues, of course, asthma being number one.

3:07 Elianne Ramos

Okay. Good. Well, very nice to have you here, Evelyn.

3:10 Dr. Evelyn Montalvo

Thank you.

3:13 Elianne Ramos

Chris, you as the Director of Advocacy for the Hispanic Federation. Why do you speak Hispanic Federation?

3:21 Chris Espinosa

Thanks, and thanks for allowing us to participate today. Hispanic Federation is a member service organization that seeks to empower the Hispanic community by supporting the institutions that work within those communities.

3:40 Elianne Ramos

Nice. Very nice. It's a great cause to be involved in. Now Lydia, how are you Lydia?

3:48 Lydia Rojas

Good. [Crosstalk]

3:50 Elianne Ramos

About where you're from and what got you interested in this cause to begin with.

3:58 Lydia Rojas

I'm an asthma sufferer and I have had asthma my entire life and I spent half of my childhood in and out of hospitals because of it, and I remember like the doctors telling my mom when I was little, "If you would have waited any longer, your daughter would have died." And I never took it serious. I never took it serious then, and even as an adult I was hospitalized with my asthma and then I had three children and they were asthmatics as well. And my thing is we've always -- they've been in hospital before too but I always brought them back home. They spent a week in the hospital breathing treatments and we always came back home and I though I was doing everything in my power to care for them, but you can just never be too prepared. I don't know. I don't know what else I could have done as far as preventing what had happened to us. I mean she was seeing an asthma specialist. She had all the forms that needed to be filled out at school, doctor's notes. She had inhalers in the office, inhaler in her backpack, and everybody said when she's sick that day and she left for school and I was like, "No. If she was sick, I would have kept her home. She was fine." It's just asthma is so unpredictable.

5:15 Elianne Ramos

Yeah. Yeah. Well, let me ask Evelyn this question because she might be well suited to answer this. Evelyn, are there triggers that particularly impact Latino kids? Is this like a cultural thing? Are there cultural factors like food or lifestyle that impact Latino kids?

5:40 Dr. Evelyn Montalvo

Well, I think that there are several things that sort of impact Latino children. We know that there are at least seven million children in the United States with asthma less than 17 years of age and the predominance of asthma is mostly in Latino populations, half-American populations, and if we look at the Latino population, Puerto Rican children are the most affected. But I think one of the things we look is what is causing them to have the asthma and there are many triggers. Usually, allergens, we're talking about tree pollen, grass pollen, weed pollen, colds, weather change, exercise, animals, so there are different factors that can cause a trigger for asthma, and remember asthma really involves inflammation inside the airway, chronic inflammation, chronic obstruction and if treated you can lead a normal lifestyle. But in children who live in inner city, it's very different and a lot of it not only involves the socioeconomic conditions but also the fact that there's a great language barrier in some of these children, in particular the parents because they don't speak English. Fortunate for those who are bilingual, it's even much better for them to understand an asthma treatment plan and how to manage a child's asthma. But there are other parents that don't have that -- fortunate to learn the English language. And so what we wind up finding is that a lot of family don't know about asthma, don't know how to manage the child and that don't know how to use the medications appropriately. And inner city kids, when we're talking also about poor air quality, that also is a trigger for asthma as well. An air quality makes a difference where children are living in the inner city and the ozone level is high, that's one of the major triggers that we see, a lot of the kids coming into the emergency room and getting hospitalized.

7:48 Dr. Evelyn Montalvo

I think it's a combination of things all together. It's multifactorial. It involves the socioeconomic conditions, genetic predisposition, and all integrated with what actually stimulates the immune system to make you predisposed to having asthma. So, Latino children are high up on the list and this is the problem that we're having right now. Especially where I am at right now in New Jersey, I see a lot of Latino children and where I was practicing we have a lot of hospitalizations and emergency room visits throughout the state of New Jersey and we were proactive in developing a children for a speed up education program which was actually designed to teach Latino families about asthma and educate them and providing them the assistance they need to learn more about asthma which I think is so important.

8:48 Elianne Ramos

And that is essential certainly, especially as you mentioned before, there are 66% of Latinos living in areas that don't meet the federal air quality standards. So that's a very big issue for our community.

9:03 Dr. Evelyn Montalvo


9:05 Elianne Ramos

Now Chris, your work is with the Hispanic Federation. Why is the Hispanic Federation concerned about asthma? Why is this considered the Latino issue?

9:16 Chris Espinosa

Well, for us, this was mentioned earlier, it really is a social justice issue. I think at its core, people have a right to live in a clean environment and to provide safety and health for their families, and you mentioned the 60% figure, but with Hispanics, that rated even higher. It's closer to 80% of Hispanics that live in areas that don't meet the air quality standards. So, right up there with education and immigration, the environment is a very important issue to the Latino community and it has impact on health as we're seeing in some of the stories that we're talking about today were people have multiple hospital visits, don't understand why this is happening to them and their families and just want to be able to where their kids to be healthy and safe. So that's why the Hispanic Federation takes this very seriously. And many of our partners that we work on national efforts these issues are critical to our community and I think we all feel that.

10:39 Elianne Ramos

Can you explain a little bit, Chris, what is environmental justice for those of our listeners who are not very familiar with the concept?

10:50 Chris Espinosa

Sure. I think environmental justice is about, particularly among the Latino community, is about creating equity and making sure that through environmental standards and environmental protection, our community is safe and healthy. So the environmental justice is about creating a movement of change from the community that amplifies that message. And our role as institution is really to support and encourage that work.

11:29 Elianne Ramos

Very, very important. Now Evelyn, I've heard people say that asthma is not just a medical problem, but a public health problem. And as Chris was explaining before, it is vital for parents to get involved. Could you explain why it is considered a public health problem beyond the Latino population?

11:53 Dr. Evelyn Montalvo

Well, I think that one of the things that we have to be aware of is that as children, or even adults, go to the emergency room and get hospitalized for an acute asthma attack, it's not a quality of life for a lot of these families and that becomes an issue, both for the parents who lose workdays and lose school days for the children. I mean in reality, if we look at the cost, we're talking about more than 20 billion dollars of healthcare cost just on asthma alone, and that's not even including the fact that we're talking about children that missed school days and parents that missed workdays, but importantly, I think that it also involves what's in our environment and what's going on in the inner city, in areas where pollution is very high. And I think that people need to recognize and learn about when there is a high ozone alert, what does that mean? What does that mean to a person who has pulmonary problems or asthma problems, especially for inner city hits, and so I think that people, we need to be aware of this. I don't think people understand that. I mean in those days that we've had a very hot weather and the ozone was very high in New Jersey, I would say like two or three weeks ago, our emergency room visits were enormously high. And people were not aware that when it's high like this, you should be indoors, in an air conditioning and taking proper hydration and taking their medication. It becomes a public issue when we don't have that control and people need to be educated about this. And that it's a serious problem that we have in hand.

13:50 Elianne Ramos

So you say that they're not being aware. What are some of the major challenges the Latino parent sees in caring for an asthmatic child?

14:01 Dr. Evelyn Montalvo

Well, I think that in my experience when I started working here at UMDNJ, I saw that language barrier was the major problem. You would have physicians giving prescriptions and giving instructions but they were not in Spanish, so they would get the medication and they don't know what to do with the medication. They don't know why they needed to use a medication, what were the instructions or if the patient got the medication and they got well, they would stop all medication, they figure oh, he's doing great, he doesn't need to take the pump. So that in itself was one issue right there. I think also importantly is the fact that many families don't have insurance. There are some families who cannot afford to buy medication and that was another issue. I mean it's not just going to the emergency getting a quick fix but what happens after that. And that was another issue that I was also seeing, and this sort of prompt me to say okay, wait a minute, I think we need to sort of educate our Latino families about asthma and their children as well. And that's why we came up with the speed up program, the children for a speed up program because I thought that we needed to intervene with these families, we needed to educate them, we needed to empower them and make them understand what asthma is all about. And we, so far, have recruited like 850 families in our program, we have like a thousand children, and we've been collecting data which was recently presented at the American Thoracic Society. Looking at the quality of life, doing --being part of this program and we saw a drop, a significant drop in emergency room visits, a significant drop in hospitalization, a change in behavioral pattern where some of these families were not afraid to call the pediatrician to say, hey, my kid is having a problem, I've tried this, I've tried that, what would I need to do.

16:01 Dr. Evelyn Montalvo

I mean I found a lot of Latino families are inhibited and they feel like they can't talk to their healthcare provider. So I think that making them more proactive and learning about the disease and learning about the medication has really empowered these families. And I think that we've really done that with our program which is for me has been very -- it's a passion of mine at this point and had provided the assistance that these families need.

16:31 Elianne Ramos

Alright. Very, very amazing campaign you're doing there. It's so vital that our families learn about this disease and I'm sure that Lydia can relate to a lot of the things that you're saying. Now, you have noticed that I left Lydia for last and it's because I want for her to have the time to tell us her story. Lydia, you are listed in the program as Steph's mom. Tell us a little a bit about Steph.

17:02 Lydia Rojas

Steph was 15 years old. It was two months before her 16th birthday and it's 4-1/2 years ago, a parent's worst nightmare became a reality. We received that one phone call that no parents should ever receive. I was told to get to the hospital and in the back of my mind I knew oh, she's having an asthma attack, she's having an asthma attack. And like before, she's going to be hospitalized, breathing treatments, we'll bring her, like other times, she's going to come back home. Not so -- I get there and I'm pulling into the parking a lot and the chaplain is calling me and he says, "Mrs Rojas," he's like, "Where are you?" and I said, "I'm right here, I'm into the hospital." And he was like, "You need to hurry because it's not looking good." And my friend was driving me, my friend was driving me and I jumped out of the car. She's still driving. I jumped out of the car and I ran there and I remember it was like slow motion. I see the school official there out front and I'm like, "This is not good." And I run inside and I told the lady, "I'm here, I'm Steph's mom," and she takes me into a private room and the first thing I see is my husband. He has his face in his hands and he's crying, and I've never seen him cry ever, and he was like, "She's gone." Stephanie died and I'm like, "No way!" Like. "How did that happened? How do you die from an asthma attack?" I know it can happen and I never took it serious but -- My asthma, I believe that my asthma was worse than hers. I was the one that always going to the doctor and getting my inhalers and we had hers under control. She was taking her Advair twice a day. She was seeing her asthma specialist. We did everything we were supposed to be doing. How did this happen? And still to this day, I still don't know how it happened. The only thing that people have said to us is maybe we should have -- it happened during P.E. class.

19:02 Lydia Rojas

And class was over and people said maybe we should have the chlorine level checked at school because maybe the chlorine was a trigger, I don't know. She was fine when she left for school that morning.

19:17 Elianne Ramos

Just telling your story and I'm here. I got goose bumps. I have a 16 year old myself so I could only imagine the pain that you're still going through and my God. Do you have any thoughts about how her death could have been prevented?

19:37 Lydia Rojas

I asked myself that everyday and I'm really beating myself off about it because there were times like she was taking Advair, she had to do it twice a day, and there were days like I would tell her, "Did you do your medicine today?" And she will go rolling her eyes like I was bothering her. And I'm like, "You need to do your medicine everyday, even if you're feeling well, you still need to keep doing it." And like Dr. Evelyn spoke earlier saying they think they're doing okay, they can stop the medication. Well, not so. And I would always tell her doctor, "You need to tell her because she thinks I'm nagging her." And the doctor would say, "Yes. Even though you're feeling good, you still need to keep taking your Advair." And there were times that I'd go checking her room and she'd missed a dose or two doses and then think into myself could have been those two doses that she missed that cause this? I mean I asked myself this all the time, I don't know, and I just kick myself all the time about it. I'm like I should have stayed on her but like I said, we -- she was seeing her asthma specialist. We were doing everything that we were supposed to be doing. I don't know how this happened. I don't know.

20:44 Elianne Ramos

Do you think that doctor could reach out to kids maybe so the kids -- or maybe at school, maybe some program can be implemented to make people aware it's important.

20:57 Lydia Rojas

Right. In all her friends, like when this was going on, the P.E. teacher was nowhere around, she was in her office when this happened, and it wasn't until she heard all the kids screaming for help when she finally came out to see what was going on. Three students were pulling my daughter out of the pool and at first they started saying was she a poor swimmer, did she drown, and she was a strong swimmer and I remember telling that the doctor know, she was a strong swimmer, she didn't drown. I knew in my heart, I knew it, and that's why we requested the autopsy and it came back she suffered an acute asthma episode and -- I don't know. I think maybe -- I'm not saying that the teacher was there but I'm thinking the schools need to be educated as well.

21:41 Dr. Evelyn Montalvo

I agree.

21:42 Lydia Rojas

It's just asthma. Let her use her inhaler or keep her inhaler. I told them no, she needs to carry her inhaler with her at all time. I made it a point that she has to carry and self-administer her own inhaler. She wasn't going to run, have time to run to the office whenever she was having an attack to go get her inhaler, so I made it a point. And even the paramedics told my husband she died in three minutes, I mean there was no way she would have had time to run to the office or somebody run to office for her to get her inhaler or for friends who scramblely they run to the locker room to go get her backpack because they all knew she had asthma.

22:24 Elianne Ramos

Wow. Now, Evelyn, can you tell us a little bit about what is it that your program doing in terms of preventing things like this, in terms of making people aware of how to prevent this kind of attacks?

22:43 Dr. Evelyn Montalvo

Well firstly, my condolences to Lydia. I can really emphasize and sympathize with you. It's horrible. I think that -- I can't comment to the situation but adolescence is one of the biggest, as a pediatrician, it is a challenge because they think they know it all and it's very hard to really make them understand what the underlying issues are. I think that one of the things that we try to do is to educate the parents as well as the children with the speed up program. We do provide an asthma education plan both in English and Spanish, but more importantly is having an asthma action plan for the school nurse and I always tell the parents to make sure that they know about the nurse, they know who it is, are they there daily, making sure that they have a medication at school, and I agree with you Lydia, I think that she should have had that inhaler with her at all times, especially whenever they do sports, exercise, gym, they should take the inhaler half an hour prior to doing any exercise, especially if the exercise is going to induce a bronchospasm. But I think more importantly also is making everybody understand it's just the parents and the children but also the school cause these children are there during the day and they have to be a part of that team as well to work together. And when we do our education, we talk to our parents about this, to be proactive. And we do -- after we do the presentation, we do have two home visits where we go home and see what are the triggers at home, are there anything at home that maybe a challenge to making the asthma uncontrolled, and we follow the families up a year later.

24:45 Dr. Evelyn Montalvo

So, I think that sometimes, there are certain things that it doesn't click in some parents, that they say, oh, you know, well, I didn't realize that having a dog in her room or smoking was going to affect her asthma, and this is all just education. And I think that once we do the presentation and once we do the home visit and they understand what changes they've made, I think it's a very positive one and I think that a lot of experience that I've had with some of the parents that they really feel like they have empowered themselves by learning a lot about asthma and how to manage the child and not feel scared about managing their children's asthma. So, it's a big problem and I think that we still have a lot to do, especially for our Latino population, I think that there is a lot more that we can actually do by delivering messages out there to everyone. One of the things is a lot of families don't have computers but do have TV and I think that we need to have the Latino media be much more proactive in learning about chronic diseases in the Latino population, which is important.

26:07 Elianne Ramos

I absolutely agree. And you can count on LATISM to help you spread the message as well. Now, many of our listeners today have kids with asthma and they're sending their condolences through the chat and to Twitter. We have a comment from Migdalia Rivera who said, "Lydia, please accept my condolences and thank you so much for sharing your daughter's story with us." Thank you Migdalia for sending that message. Migdalia is a very good friend or ours from Twitter. Now Chris, we've heard about Lydia and Steph's heartbreaking story and as a mother of a 16 year old, my heart goes out to her. I don't know that how I would be or something like that. What can parents and individuals across the country do to ensure that they have heard on this issue, that this issue becomes part of a public conversation out there?

27:13 Chris Espinosa

Sure. Well, first of all, I absolutely agree with you. I think it's so heartbreaking to hear Lydia and Steph's story and my condolences certainly go out to you, Lydia. On an individual level, I think it's critical, like has been mentioned several times, that the information and the awareness in the community increase and so people can be part of that proactiveness and encourage organizations locally to build their awareness on how asthma really affects people and what some of the concerns are. On a broader policy perspective, I think supporting stronger air quality standards is absolutely critical and that's something that all of us can do in terms of making sure that our voice is heard. The environmental protection agency released some estimates not that long ago that estimated about 58,000 asthma attacks could be avoided each year just by tougher air quality standards alone. And as many as 12,000 deaths across the country could be avoided. I mean there's real -- there's real solutions out there. The EPA has recently issued tougher standards and that's great. We need to make that those standards are enforced. So I would encourage everyone who is listening to this program, who wants to get involved to stay in touch with Moms Clean Air Force, to reach out to our organization and our partner organizations, we work with a group called Latinos -- the Latino Coalition on Climate Change.

29:17 Chris Espinosa

You can view our website at latinocoalitionforclimatechange.org. And we regularly work with the administration to ensure that those tough air quality standards are enforced. So stay up on the information, make sure that you let your voice be heard to you member of congress, that this is an important issue for you because we can't let this happen to anymore families. It's just so devastating and heartbreaking to hear.

29:56 Elianne Ramos

I completely agree with you. Thank you so much, Chris, for that and thank you for all the work you do to do work at the policy level on this important issue. It's essential that the same way that the parents in the community needs to be alerted but also that these regulations enforced to prevent from becoming even a larger issue than it is already. Now, we're going to be taking some questions from our listeners. We have a couple of people from our Twitter and from our chat room here who have been sending questions in and we have one questions from Karen. Karen wants to know if there is something we can give school nurses and principals to educate them. How prepare are school officials to handle this situation? Anybody want to take that?

30:59 Dr. Evelyn Montalvo

Yeah. I can answer on behalf of the listeners. In New Jersey, we have the Pediatric Adult Asthma Coalition in New Jersey and we actually do a lot of educating the teachers, the school nurses in New Jersey and they do a nice job because they do have not only providing the education for the school nurses and the teachers and principals but also providing them with gift certificate or a certificate itself that they have done something to be proactive in their schools. That in itself is very important because I think that teachers, not only the school nurses but the teachers also have to be educated so they understand that if a child is having an asthma attack in the class, they know what they will need to do and who to reach out to. So that is a very important thing. Nationwide, I think that it's important to develop a strategy for that. I know that the American Lung Association, I used to be on the national assembly, had many wonderful things, materials that can be given to healthcare providers as well as school nurses in schools in general and having an asthma action plan and having education materials. So it seeks on to empower some of these schools about this.

32:29 Lydia Rojas

Absolutely. I have become involved with the American Lung Association and I've been working with them for a year and now. We're coming up on doing our second Fight For Air Walk and they are the ones that are going to help me with my asthma 101 action, I mean asthma 101 training program where -- because my goal now is become an asthma educator where I would start my own program here in Manchuria county and go to the schools and educate the teachers and staff on how to prevent what happened to us from ever happening again. Not just parents but the teachers and the staff need to be educated as well, know what to do.

33:05 Dr. Evelyn Montalvo


33:06 Elianne Ramos

Okay. I agree. Again, we have some of our listeners, Abby says she has asked her mom who is an elementary school teacher and her mom has never had any training in asthma either. Karen is saying the department of different schools don't even allow kids to carry their inhalers. What do you think about this? Lydia, what do you think about the schools allowing kids to carry their inhalers?

33:42 Lydia Rojas

Well, from what I understand last summer, the last 5 states, the ban was passed were they are allowed -- the children are allowed to finally carry and self-administer their medication so it should never been an issue. I've always been on top of my doctors and on the school. I mean it gets harder in high school but from preschool, elementary, junior high school, I've always been able to stay on top of -- have a one-on-one relationship with the nurse, the office, the doctors that make sure, look, my daughter has asthma. She needs to -- yes, we're going to have back-up inhaler in the office but she also can carry and self-administer her own medication and I always make sure I pack her inhaler on her. And I've never had yet become in a problem with the school saying no, she can'', because I'm her parent. I'm her mom. Yes, she can. You can't let them you no. You should be able to say no, this is my child. I'm trying to prevent -- she can die from this.

34:43 Dr. Evelyn Montalvo

Exactly. Can I just...

34:45 Lydia Rojas

Go ahead. Go ahead.

34:47 Dr. Evelyn Montalvo

I just wanted to just say that it also depends on the different school policies. I know that for the most part, at least from New Jersey, any child that's greater than 12 years of age can carry their inhaler with them and we do -- physicians do write a permission for them to do so. Less than 12 years of age, we want to make sure that there is somebody there, whether it's a school nurse or a teacher that is proficient enough in knowing about asthma that can provide giving the medication to a child who needs assistance and who needs the medication. I'm not sure if the policy is the same throughout other states and I think that it is an issue that some children cannot take their inhalers at school and that becomes a major problem.

35:38 Elianne Ramos

Yeah. One of our listeners also brought up another point. She says her name is Jill and she says, "My kid's elementary school has more than a thousand kids, 8 to 5, and only one nurse who is helping the kids. So what's to happen if multiple kids have an attack at the same time?" That's another issue too, that our schools may not be prepared to handle many cases at the same time. I have another question. This one comes from Twitter and it is from Laurita Tearo and she is asking -- she wants to know about the role that heredity plays in asthma in the Latino kids population. Anybody want to take that one?

36:37 Dr. Evelyn Montalvo

I'm sorry. What was the question?

36:40 Elianne Ramos

The role that heredity plays in asthma in Latino kids.

36:46 Dr. Evelyn Montalvo

Okay. Heredity, really genetics, yes, there are studies recently showing that there is a very strong genetic component. If a parent has asthma, chances are that the child will have asthma. And so we see a pattern, if there is a very strong family history of asthma, that there is a good chance that your child will have asthma. Am I answering the question there for her?

37:20 Elianne Ramos


37:21 Dr. Evelyn Montalvo

Heredity do play of a major role. Yes.

37:23 Elianne Ramos


37:24 Lydia Rojas

I think both hereditary and environment.

37:27 Dr. Evelyn Montalvo

Exactly. It's very multifactorial, just not one thing. I mean there are many things that trigger the immune system to sort of turn on and say okay, I'm reacting to this in the environment, but it's your genes that's allowing you to turn on that system so that you react to that environment.

37:49 Elianne Ramos

Wow. And another question that's somewhat related to this is from Lucas Cito's mom on Twitter, and she is asking can allergy attacks always trigger at the asthma attack?

38:07 Dr. Evelyn Montalvo

Can allergy attacks...I don't understand.

38:10 Elianne Ramos


38:12 Lydia Rojas

Trigger an asthma attack.

38:14 Dr. Evelyn Montalvo

Can allergies trigger on asthma attack? Yes, absolutely. When you have -- for example, if you have high pollen count, on those days when you turn on the TV and you see that the pollen count is very high, that's already a little cue for you to know that your child needs to have his inhaler ready, make sure that they take their antihistamine, make sure that you close the windows in the morning where the pollen count is the highest, between 8 and 10 o'clock in the morning. So there are certain things in the environment depending on the season that can trigger an attack. So just -- allergens are just one thing. I mean there are other things as well that can trigger attacks such as irritants. We had mentioned about swimming pools and high chlorine. If the chlorine level is very high and strong and it's an indoor swimming pool, that can sometimes trigger an asthma attack. The same is true if you're in a chemical plant or if you're near somebody who's spraying perfume, using bleach, things like that can --strong odor can induce an asthma attack. Emotions, exercise, certain medications, some children are sensitive to aspirin and that can induce an asthma attack. Certain foods, peanut, the most common one that we see in children. If the child is allergic to peanuts, that can also have -- develop a reaction to peanut and give you an asthma attack. So, there are many things, there's a list a laundry list that -- we try to educate our families about they pay attention to so that they know that they need to be aware of what's going to trigger it and be prepared.

40:02 Elianne Ramos

And I think that's a key point. Whenever parents are aware that these triggers are going to be an issue that they should be even more reminding their kids to keep their medicine with them and be more on the watch, right?

40:24 Dr. Evelyn Montalvo


40:25 Elianne Ramos

What do you recommend that they do?

40:28 Dr. Evelyn Montalvo

Well, I think that, like I said, if they have an asthma action plan, it's very important. If they know what the triggers are, they can be prepared, and if we know that, for example, if the child has tree pollen allergies which is usually highest in the spring, they make sure that they take their antihistamines and take their daily maintenance medication and have their rescue medication at hand so that if they start to have a cough, they immediately start the rescue medication. So, it's all about the treatment plan and that's what we tell the parents, make sure that you have a plan of action so you know what you need to do in case your child starts with a cold, what you need to do with the medication. And I do the same thing for the adolescence. I think that they need to be proactive and learn about their asthma and know when to take the medication. But like I said, there they're stubborn so it's sometimes very difficult and it's a challenge.

41:31 Elianne Ramos


41:31 Chris Espinosa

I would also add about that.

41:32 Elianne Ramos

Go ahead.

41:33 Chris Espinosa

For those people that are -- that have a family member who has asthma or concerned about a family member or friend, there's a lot of resources on the American Lung Association's website, at lungusa.org, that may be very helpful to people.

41:57 Elianne Ramos

Nice, nice. Thank you for sharing that. Now, there's another issue, this is a question also from our listeners. Asthma chat said that a child is unique, some will be able to self-administer and other won't. So what do we do with those kids that maybe too small or maybe they don'' know how to handle the medication well? What can we do to protect them?

42:25 Dr. Evelyn Montalvo

Well, I think that the children, usually the ones that are like preschools, we're talking about 3 year old, 4 year old, 5 year old, I mean we usually have to have a plan of action for the daycare center or the school at hand. They cannot self-administer the medication. It has to be done by a school nurse who can give the inhaler or nebulizer when they're running into trouble. So by themselves, they can't do this. That's why I think that if they're greater than 12 years of age, they can actually self-administered their inhaler and they have to be reviewed by the healthcare provider to make sure they're doing it correctly, that they're using an AeroChamber spacer that connects with the inhaler and making sure that everything is done accordingly so that nothing gets missed.

43:22 Elianne Ramos

Very important. Now I want to remind our listeners that they can call in with their own questions. The number is 858 357 8425 and we'll be happy to answer your questions on asthma. The line is open right now. I have -- I have another question here. What do you do when your state rules don't allow kids to have inhalers with them? And this question comes from Karen.

44:05 Lydia Rojas

I'm sorry. What's that?

44:08 Elianne Ramos

The question is what do you do when state rules don't allow kids to carry their inhaler? What can you do as a parent?

44:19 Lydia Rojas

Well, I mean like I said earlier, I thought all of the states are now -- the kids are now able to carry and self-administer their inhalers. I think it was last summer that the last five states, it was on the East Coast, where -- I think it was Rhode Island, Pennsylvania, I can't remember the other states, but they were still not allowing the kids to carry and self-administer their medication but I guess there was bill passed last summer, is that right? I mean you are on the East Coast, right? Dr. Evelyn?

44:51 Dr. Evelyn Montalvo

Yes, and we -- on the tri-state area, they're allowed to take the inhaler as I mention based on age and we've been very proactive about that. I'm not sure about the other states. I really don't know what the other states are doing at this point and what are their rules and regulations, and it also depends on whether you're going to a private school versus a public school which is another issue and also the size of the school because as you heard from that question before, you might have one nurse that's probably sitting on to like a hundred kids or more than a hundred kids that have other issues and that becomes an issue as well so it's a difficult problem but I think that something that needs to be brought up and discussed as a rule. I know that asthma educators throughout the country, there is an organization that teaches they have the asthma educator course and they have brought this topic up many times. But I don't know about the other states. I am sure that that has been brought up many times from the state level.

46:05 Chris Espinosa

I also would say from a policy perspective, if you live in a state that has legislation like that, then people need to get active and work with the state legislature to change that because obviously, it has real consequences. I think on an individual level, parents need to do the same advocacy in the schools themselves, much like Lydia did with Steph in terms of going to the nurse and going to the teacher and letting them know what the consequences are and that the children carrying there inhalers is a must. People could die.

46:54 Elianne Ramos

Another caller is saying that -- she is talking about military schools overseas and she's in -- I don't know what the rules would be over there but she is saying, this is Karen, she is saying that the state's rule don't apply when military schools overseas are run by the Department of Defense in countries like Germany, Japan and Korea. What can a parent do in this situation if they have a kid in one of these schools?

47:28 Dr. Evelyn Montalvo

Oh my, I really think that all depends on first of all, number one, getting a letter written by the healthcare provider specialist as to what type -- how severe the asthma is, what medications they're on, and making sure that there is a connection with the corresponding doctor that they're away from school so there has to be a connection. I think that's where the parents come in to become proactive because they need to find out is there a physician in that school that in case something goes wrong and there's a problem that they know that they can go to that physician and get evaluated and making sure that they get their medication. I don't know the whole format for military schools but at least in my experience, the few that have gone to military school, we have written letters indicating exactly what they're on and making sure that there is a physician on the other end that they know who the child is or who is the adolescent is and know exactly what medications they're taking so that there is some continuity of care at that other end.

48:46 Elianne Ramos

Now, another question that is coming also from our chat. How -- this is for Chris. How aware is the Latino community about clean air issues and what are some of the initiatives you're seeing to activate in this community?

49:06 Chris Espinosa

I think the Latino community takes environmental issues very seriously, particularly when it comes to the Clean Air Act. There are a number of organizations that are very involved in that and they represent thousands of individuals across the country that are extremely active. Our coalition, the National Latino Coalition on Climate Change is one. There is also the National Hispanic Environmental Council and a number of other organizations that we partner with. So it is an important issue. It's something that we take seriously and for us it's a social justice issue. It's -- people have a right to live in a community that's clean and safe and environmental policy is part of that.

50:09 Elianne Ramos

Chris and Evelyn, they're both working in the community for outreach so I think this question -- if you can both give me your ideas on this question. This one comes from Lina Carol, and her questions is, would one characterization of the issue, either as a social issue, as a healthcare issue or environmental equity or public health, would it be more effective adding _50:39_ in the community action in garnering more attention for change?

50:48 Chris Espinosa

Yeah. I mean -- I will start with that. Absolutely, that's an important piece and that's something that we were to do. There was an advocacy meeting here in Washington, D.C., a couple of weeks ago in fact. It brought ordinary families from across the county into D.C. to talk about environmental issues and how they impact people's lives and actually met with members of congress in the Whitehouse to encourage them to enforce the regulations that are in place, strengthen the regulations that are failing in our community and take the issue seriously. So I think community activism is something that's important and if we're going to make progress on these issues that we all care about, it needs to happen on an individual level and comes from the community.

51:50 Dr. Evelyn Montalvo

I agree with Chris. I think -- with my program, we work very closely with the community. We actually service eight counties right now in New Jersey and it's so important that we work with churches, we work with any state-based organization, community organization, in our case Latino organization, daycare schools and become very proactive in terms of helping each other out. So if they identify families that have children who have asthma and they need help, they know that they can refer to Respira in order for them to be taught and provided with a game plan. The American Lung Association is also very active in terms of looking at these issues of air quality in congress so that's another avenue that would have been very proactive on that end. So I think it's -- we're actually doing it. I think it's just the response also that we need to deal with, how to sustain good program that can help the community because in reality is when you have a wonderful program going on, once this grant money ends, then there's no other way to fund the program. So, it's another issue right there and then, and how we can make a program sustainable at this point for education.

53:18 Elianne Ramos

Very important, very important. Now, I have a question and this is coming some our chat as well. As you know that many people in our community, in the LATISM community, are bloggers and one of our bloggers is saying, is asking, in terms of -- her name is Roxanna Romero, and her question is, in terms of educating the Latino population regarding the epidemic, what would be the most important piece of information that bloggers can provide the public with?

54:00 Lydia Rojas

As far as for me, I get so frustrated because like when I take my daughter to school and like the other parents there, the ones -- the non-English speaking parents, they have kids with asthma and that only recently this last year that I started speaking out about I lost a daughter to an asthmas attack and asthma is serious, it's nothing to play with. As the parent, like if I see a child wheezing and I'm like, "Does your son have asthma?" and they're all, "Yeah," and they treat it like it's a common cold and I just get so frustrated. I think I lost my daughter to an asthma attack and it's very serious. They say like, well, the doctor gives me a prescription for antibiotics and an inhaler and that's -- I give them a few puffs or whatever or he gets the breathing treatment and that's it and it's just -- and I'm like, "Is that all you do?" I said, "Do you have an action plan? Do you discuss this with your doctor? What does your doctor say?" And I think it's the language barrier because they're just like, "Oh no, he just gave me a prescription and sends me on my way", and I just gets so frustrated. I'm like, "Do you not realize -- I'm telling you, I lost my daughter to an asthma attack." And I think language is a big problem, it's just a big thing. And that's why, like I said, my ultimate goal now is just to become an asthma educator because they need education.

55:22 Dr. Evelyn Montalvo

Absolutely. I agree with you 100%. I think that it's very important. I think the problem is that some families think that asthma is just very -- it will go away. They don't understand that it's a chronic condition, it's a chronic airway obstruction that needs to be treated with appropriate medications and of course they are different severities of asthma. And education is important and I think that it also _55:52_ a lot of the healthcare providers that they also need to educate their families and their children about asthma, but the reality is when you have a very busy practice, I don't think they can spend that much time to really go into the details of educating families, in particular with the language barrier, of asthma and that's where an asthma program comes into place and asthma educator comes into place because that's where we need to focus, is to educating these families, understanding them that this is a chronic condition and it's not just going to go away and that needs to be treated.

56:31 Elianne Ramos

So you would recommend maybe that organizations out there partner with this bloggers to the disseminate information in Spanish? Would that be able to help them think?

56:43 Dr. Evelyn Montalvo

Absolutely. We have a website, it's called www.respiranj.org and we have information about asthma, ask about different types of questions that might pop into mind and other resources that are out there. And it's really interesting because as I'm doing my program, even the bilingual families that come to me always like to learn about things in Spanish because the majority of the time they speak Spanish at home even though they know English, and it's interesting and I think that for those families that does speak any English at all except for the child who is in school, it's an issue for the parents to understand how to manage the child's asthma and feeling comfortable and sitting down and really learning about asthma. I also have to say that it's been interesting for me because within the Latino population, we have our own cultural diversity and what we think on one level might be different and let's say, from Puerto Rican to let's say a Peruvian might be different thoughts about asthma. Using folk remedies which is another big issue in Latino population treating asthma. So there's a lot of things here that come into play when dealing with educating somebody's family, not just one thing, it's several things involved.

58:14 Elianne Ramos

Yes. Well, we're about to get to the end of the program, we're running out of time. And so what I would offer you is a part of Latinos in Social Media, I can post some of the resources. If you have resources, send them to me and I will post them and I will leave them on the LATISM blog and in Spanish. And what we can do is once the information is out there, I urge the bloggers to please share that information with people who may not be online and we can continue raising awareness about this issue. So now, I would like to thank our guests, Evelyn Montalvo, Chris Espinosa and Lydia Rojas for their participation today and for sharing such vital information about asthma and the importance of parental involvement. I also want to thank all of you here, our listeners, for being with us today, and Latinos in Social Media and I urge you to please join Moms Clean Air Force campaign by visiting www.momscleanairforce.org. Thank you so much for listening and thank you to our guests for being here. Goodbye.

59:37 Dr. Evelyn Montalvo

Thank you.

59:39 Lydia Rojas

Thank you.

59:40 Elianne Ramos


59:41 Dr. Evelyn Montalvo


59:42 Elianne Ramos