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Imperial County leads state in treatment of children with asthma

Youngsters in the region are far more likely than those elsewhere to go to the ER or be hospitalized for the chronic respiratory disease. Experts don't know why.

July 16, 2012|By Anna Gorman, Los Angeles Times
  • Marco Cisneros relaxes on the sofa watched by his mother, Susana. Marco, who has asthma, has visited the hospital 50 times and been airlifted several times.
Marco Cisneros relaxes on the sofa watched by his mother, Susana. Marco,… (Mark Boster, Los Angeles…)

CALEXICO, CALIF. — As the relentless wind stirs up piles of dust and dirt and creates a gigantic funnel of haze in the vast, sweltering Imperial Valley, children like Marco Cisneros battle to breathe.

Marco wheezes and coughs and reaches desperately for his inhaler, but the medication doesn't always give him the relief he needs. Often, his mother has to call 911.

Since being diagnosed with severe asthma six years ago, Marco, who lives in this border town east of San Diego, has visited the hospital nearly 50 times. He has been airlifted on several occasions. The illness has affected much of his childhood, preventing him from playing sports, going to friends' houses and attending school for days at a time. Blowing out the candles on his 8th-birthday cake earlier this year, Marco had just one wish: "I just want to run."

PHOTOS: High asthma rates in the Imperial Valley

For children with asthma in California, there is no place worse than Imperial County. They are far more likely than children in any other county to end up in the emergency room or hospitalized. Kids go the ER for asthma at a rate three times higher than the state's average, according to the Department of Public Health.

"Imperial stands out," said Meredith Milet, an epidemiologist with the department. "There is obviously a disparity.... There is just a need for something to change. It should be possible for it to be different for the kids of Imperial."

Severe childhood asthma is also a major problem elsewhere in California, including the smog-filled Central Valley. Heavily agricultural Fresno, Merced and Bakersfield, for example, all rank high in the nation for the worst cities for asthmatics. Imperial County is different because it leads the state for asthmatic children going to the ER and being hospitalized, but experts are unable to pinpoint the cause.

Doctors and public health officials said that a combination of whipping winds, pesticide-tinged farmland dust and large numbers of low-income families lacking health insurance contribute to high rates of asthma hospitalizations and ER visits. Whatever the reason, uncontrolled asthma and frequent hospital visits aren't just an issue for those with the disease; many children are covered by Medi-Cal, meaning taxpayers often pay the tab for care.

In Imperial County, about 63% of asthma-related ER visits and 67% of the hospitalizations, for both children and adults, are paid through Medicare and Medi-Cal. Each hospitalization costs, on average, about $16,600.

The county spans nearly 4,600 square miles of mostly desert in the southeastern corner of California, just north of Mexico and west of Arizona. The county is hot and dry and depends largely on agriculture. About 20% of the 177,000 residents live in poverty.

One in five of Imperial County's children ages 5 to 17 has been diagnosed with the chronic respiratory disease, which cannot be cured but can be managed with medication. Uncontrolled asthma can lead to hospitalization and in rare cases, death. In 2009, a 16-year-old girl died after an asthma attack.

Asthma is so prevalent among the students at Barbara Worth Junior High School in Brawley that the principal sends air quality alerts to his teachers and regularly cancels outdoor activities. Students keep inhalers in multiple locations on campus, and paramedics respond to asthma attacks several times each year.

"It impacts everything," Principal Luis Panduro said. "It is a major issue."

One student, Joseph Leon, 13, who has been to the hospital numerous times and misses several weeks of school each year, started an effort to have youths with severe asthma wear identifying bracelets and to get more training for both teachers and students.

At El Centro Regional Medical Center, nurses look outside and know immediately how busy their pediatric unit will be. Is it cold? Are the farmers burning their fields? Is it windy? Of every 10 patients, nurse Jessica Ruiz estimated that seven are being treated for asthma.

Imperial County is known for its poor air quality, in part because of its unpaved roads, agricultural tilling and industrial pollution from Mexico. The county's air pollution control district has made progress in improving the air quality, but it still far exceeds federal health standards for airborne particulates. And that, according to the EPA, can increase the number and severity of asthma attacks among residents.

Kimberly Calderon, a nurse practitioner, said the valley is like a giant bowl, filled with a hazardous stew of pesticides, fertilizer and dust. "All that smoke and air lingers and doesn't go anywhere," she said.

In addition to the bad air, youths also frequently end up in the hospital because of asthma triggers such as cigarette smoke, mold or pets, or because they don't know how to correctly manage the disease, said Luz Tristan, a physician in Calexico.

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