By Gary Fitzgerald
“Haley, you’re going to be okay.”
Barbara Pittenger can still hear the calming voice of Prem Menon, MD, talking to her 11-year-old daughter in his Baton Rouge, Louisiana office. Haley was recovering from an allergic reaction caused by accidental ingestion of peanut. She felt scared.
As Dr. Menon spoke, Barbara watched the worry slowly disappear from Haley’s face. “He’s very reassuring to her,” Barbara says. “She needed to hear that. She needed to hear she really is going to be all right.”
A board-certified allergist and immunologist and member of Allergy & Asthma Network’s board of directors, Dr. Menon has treated Haley’s allergies and eczema since she was 2 years old. Last year, she was diagnosed with asthma.
Dr. Menon is one of many who guide Haley and the Pittenger family through the challenges of managing a chronic condition.
Her pediatrician, Dawn Vick, MD, routinely corresponds with Dr. Menon about her asthma and allergies so there’s a consistent and cohesive treatment plan.
Her pharmacist fills medication prescriptions, makes sure the family is aware of expiration dates and answers insurance coverage questions.
At school, Haley’s teachers, the school nurse and cafeteria staff work with Barbara and other parents to ensure there’s a plan to prevent any asthma or food allergy emergencies.
Last year, Haley confided to her pediatrician that she felt left out of some school activities due to her asthma and allergies. The pediatrician counseled Haley, and referred her and her mom to a social worker.
It helped. “The social worker has been really great,” Barbara says. “She encourages her, letting her know she’s not the only one with these conditions, these feelings.”
Everyone involved with Haley’s healthcare is interconnected – all with the big-picture goal of keeping her healthy.
“It’s everybody working together to keep Haley safe,” Barbara says.
Building a Partnership
Collaborative, team-based healthcare works, especially for patients with chronic conditions such as asthma and allergies. According to research from the National Institutes of Health, patients involved with a healthcare team are hospitalized fewer days and see better outcomes from treatment.
Healthcare teams specializing in care and in providing resources may include:
- Primary care physician or pediatrician
- Family and friends
- Asthma educator
- Respiratory therapist
- School nurse and staff
- Emergency department physicians and nurses
- Social worker or psychologist
“Patients benefit with access to these healthcare professionals, each of whom have their fields of expertise,” Dr. Menon says. “An office visit to an allergist or pulmonologist may involve one-on-one meetings with the doctor, respiratory therapist and nurse. It’s time well spent. Patients are better informed about their disease, medications, devices and procedures.”
Earlier this year, Allergy & Asthma Network led a U.S. educational tour aimed at developing collaborative care teams and building relationships for referrals. Participants included primary care physicians, pediatricians, pharmacists, convenient care clinic providers, emergency room doctors and nurses, subspecialists and patients.
Pediatricians are often the first to hear of asthma flares or allergic reactions. In March 2014, The Network partnered with the American Academy of Pediatrics to provide asthma and allergy resources to pediatricians and a framework for collaboration with allergists.
School nurses work with parents and pediatricians to collect children’s health information at the start of each school year and develop individualized healthcare plans and emergency care plans, says Carolyn Duff, MS, RN, a nationally certified school nurse in Columbia, South Carolina and president of the National Association of School Nurses (NASN).
“Schools have healthcare teams — they include school nurses, teachers, guidance counselors, school psychologists and social workers,” Duff says. “We meet with parents to put in place accommodations that are necessary for students with asthma or allergies so they can fully participate in school activities.”
Respiratory therapists work with doctors to assess and treat asthma patients, often in emergency care settings. They also educate patients on asthma triggers and correct medication use.
“Sometimes doctors only have a few minutes to spend with a patient in a clinic or in the hospital, so education provided by respiratory therapists is key,” says Tom Kallstrom, RRT, CEO of the American Association for Respiratory Care and member of Allergy & Asthma Network’s board of directors. “We develop trust with patients and we educate to the patient’s health literacy level to make sure there’s a clear understanding of the treatment plan.”
Pharmacists are taking a more active role in chronic disease management by helping asthma, COPD and allergic rhinitis patients, according to the American Association of Colleges of Pharmacy (AACP). They counsel patients on correct use of medications, drug side effects and other issues.
Gaby Nafziger of Mesa, Arizona was diagnosed with asthma in her mid-30s. She became depressed – she loved to run but exercise was one of her many triggers. She had dreamed of running the New York City Marathon since she was 13.
Gaby’s healthcare team – her primary care physician and allergist – guided her as she learned to manage asthma. Now 44, she feels her asthma is well controlled.
“Doctors worked with me to identify what causes symptoms and what medication works best for my treatment,” she says. “My family and friends helped encourage me when I was feeling down.”
Last year, Gaby learned about Women Breathe Free, a program to help women manage their asthma through one-on-one coaching by a trained health educator. The Center for Managing Chronic Disease at the University of Michigan partnered with Allergy & Asthma Network and other national organizations to launch the nationwide program.
Gaby signed up for Women Breathe Free and was paired with asthma educator and respiratory therapist Cara Kraft from Plano, Texas. In a series of telephone counseling sessions, they discussed Gaby’s triggers and how to avoid them. Cara recommended that Gaby incorporate using a peak flow meter – a device that measures how well the lungs’ large airways are working – into her Asthma Action Plan.
“The peak flow meter helps me anticipate an asthma flare and take early action to prevent it,” she says. “It’s a must-have in my purse now, along with my bronchodilator inhaler and medications.”
Now Gaby’s dream is about to become reality. She is planning to run the New York City Marathon on Nov. 1.
“It won’t be easy, because the weather might be cold and that’s another one of my triggers,” she says. “But I’ll run with a mask on and I’ll use my inhaler before and during the marathon if I need it. I’m confident because my asthma control is the best it has been in the last eight years.”
Says Cara: “Asthma educators go that extra step to help patients understand how to manage their disease, the medication they use, and their triggers – and realize that asthma doesn’t control them, they control asthma.”
In many ways, Barbara Pittenger and her husband Joe are the leaders of daughter Haley’s healthcare team. “We coordinate everything, with her doctor appointments, her school,” Barbara says. “We make sure she’s included in everything we do.”
Family and friends are important – and sometimes overlooked – members of a healthcare team. They can reinforce the doctor’s prevention and treatment plan, provide support in social situations, and help lower stress. Often they are the first to notice asthma or anaphylaxis symptoms.
Haley’s brother Connor, 12, is mindful of his sister’s peanut allergy. “If we’re at a party, Connor will say, ‘Haley, there’s peanuts over there. You might want to stay away,’” Barbara says. “He’ll keep an eye out for her.”
Three years ago on Halloween, Haley wanted to go trick-or-treating but didn’t want to have to sort through candy that may or may not contain peanuts. So she decided to ask for canned goods instead. Connor joined her, and together they collected four bags of canned goods that they donated to the Greater Baton Rouge Food Bank.
Last January, the Pittengers wanted to raise awareness of food allergies, so Barbara and Haley joined forces with another local family — Tarsha White and her 10-year-old daughter Kaydence — to host a food allergy conference at the East Baton Rouge Parish Main Library. Twelve families attended.
“We wanted to get together a community of people to provide support for one another,” Barbara says. “When Haley gets together with Kaydence, they’re just two kids who want to have fun, want to fit in, want to play. And if they want to talk about their food allergies, they can do that on their own terms and not feel different.”
The impact of Haley’s healthcare team is proving immeasurable.
“It has given her a lot of confidence,” Barbara says. “She’s realizing that she can do anything.”
Reviewed by Martha Hogan, MD, and Prem Menon, MD