Mission BREATHE program combines education and science to target asthma in South Texas

As a child growing up in South Texas, medical student Jacob Cobb remembers how difficult it was to control his asthma. Pediatricians and pulmonologists both told him about all of the environmental factors in and around his home that could affect his asthma.

But not all children who grow up in South Texas are fortunate to have such access to health professionals. That’s what prompted Robin Fuchs-Young, Ph.D., a professor of molecular and cellular medicine in the Texas A&M College of Medicine and the Texas A&M Institute of Biosciences and Technology, to develop a new program called Mission BREATHE, which stands for Better Recognition of Exacerbating Asthma Triggers in the Home and Environment.

“There is a high prevalence of asthma in South Texas due to agricultural pollution that blows in from across the border, high usage of agriculture pesticides and herbicides, and a variety of other issues associated with poverty, like open trash burning,” Fuchs-Young says. “We wanted to see if we could develop an effective, short intervention program that would be easy for busy families.”

During the summer of 2013, Fuchs-Young worked with medical students Cody Dornhecker and Johanna Villasenor and public health student Temi Ajayi to develop the curriculum for Mission BREATHE.

To gather information about asthma and other environmental health concerns along the Texas-Mexico border, the team visited several communities, including McAllen, Mercedes and Progresso, the later of which is home to one of the oldest colonias – unregulated settlements that lack basic utilities such as water and sewage and also lack environmental protection. Genny Carrillo Zuniga, M.D., Sc.D., an associate professor at the Texas A&M School of Public Health who has developed other asthma education programs in South Texas, helped organize these meetings.

Once the educational program was developed and the study approved, Cobb was one of three medical and public health students who helped test the program with families in McAllen, in collaboration with the Rio Grande Regional Hospital.

“There is much misinformation out there about what asthma is and what potential triggers can be,” Cobb says. “It was very enlightening and satisfying to be able to have real conversations with people directly affected by this disease. I learned that simple, non-invasive measures such as patient education can truly make a large impact on someone’s understanding of and compliance with a physician’s orders.”

Ebunoluwa Babalola, another medical student who participated in the project, says she also enjoyed the opportunity to interact with patients, as well as the other local health care workers who were involved in the project.

“I was exposed to many aspects of research and really had the opportunity to learn a lot,” Babalola says. “I am very glad I was given the opportunity to do this.”

While low-income people may not be able to go out and purchase expensive air purifiers, Fuchs-Young says there are simple things that can be done to reduce asthma triggers in the home. For example, she recalls that during one information-gathering session in Progresso, she asked about what kinds of cleaners the parents use in the home.

“The mothers were anxious to make me understand that they keep their homes very clean, so they talked about using bleach and Fabuloso and other strong cleaners,” Fuchs-Young says. “What they didn’t realize was that using cleaners that have scents or perfume can actually trigger asthma symptoms.”

Fuchs-Young notes that some traditions in the Hispanic culture can pose challenges for children with asthma. For example, it is common for several generations to live together under one roof and to be extremely hospitable to guests. It can be difficult to ask a senior member of the household not to smoke when that relative is the owner of the house. To help overcome this, Mission BREATHE educators describe strategies to guide discussions with members of the household and even provide opportunities for role-playing.

“The entire educational intervention is very gentle, respectful and conversational,” Fuchs-Young says. “It’s less of a formal lesson and more of a dialogue where we invite parents to ask lots of questions. These are very loving and concerned parents who are devoted to their children. We want to help them reduce asthma triggers and symptoms with the ultimate aim of improving quality of life.”

Driven by that goal, Fuchs-Young plans to expand the program with the help of Nicolaas Deutz, M.D., Ph.D., a professor in the Department of Health and Kinesiology at Texas A&M University. The next phase will involve taking blood samples from children to see if the intervention has worked.

“There are biological markers in the blood that go up when asthma gets worse,” Fuchs-Young explains. “We can use these to monitor their asthma over time.”

Fuchs-Young directs the Community Outreach and Engagement Core of the Center for Translational Environmental Health Research (CTEHR), which is funded by the National Institute of Environmental Health Sciences. She and Deutz have received a $50,000 pilot project grant from CTEHR to fund the study of biological markers and they hope to  begin collecting blood samples this summer.

Once they have the results of this study in hand, Fuchs-Young says they can apply for additional funding that will enable them to expand the program to other communities.

For his part, Cobb says he plans to return to South Texas to practice medicine, and what he learned from participating in the Mission BREATHE program will definitely come in handy.

“Asthma is a common disease process in both pediatric and adult populations,” he says. “I believe that regardless of what specialty I choose, I will see asthmatic patients. Therefore, being more knowledgeable about non-invasive, non-pharmaceutical interventions will be especially helpful. More and more often in medicine we are attempting to shift toward prevention rather than treatment of disease. If I can prevent an asthma attack from happening by avoiding environmental triggers, why shouldn’t I?”