The children had to leave kickball games just as the fun started. They were taunted by classmates and often missed school. Worse, they were terrified of suffocating in an asthma attack.
Years of apprehension and repeated bouts of struggling to breathe have shaped the lives of thousands of Baltimore children. And during the last decade, national figures show that asthma cases have soared.
But in East Baltimore, a pilot project that educates children, parents and teachers -- and even sends health workers into homes to fight cockroaches and other conditions that worsen asthma -- has gained ground. Children have found confidence. Families have thrown off constraints that dominated everything from picnics to getting a good night's sleep.
Of the 200 children enrolled the Oliver Community School-Based Asthma Program, one-quarter used to go to the emergency room at least once during a six-month period. That has been cut to 5 percent over six months, said the asthma project's director, Dr. Peyton Eggleston, professor of pediatrics at Johns Hopkins University Hospital.
Asthma is chronic lung disease. But the victim experiences it through sporadic attacks, triggered by various factors.
The most common trigger is inhaling microscopic particles to which the person is allergic, such as dust, pollen or the dander of cats and dogs.
By age 10 or 11, children are braced for the routine.
George Buntin's eyes start to water. David Pollard coughs and Larelle Little wheezes. Kiara Wilson's chest tightens and her nose bleeds. Within minutes, the airways in their small lungs swell, narrowing the space for air to get through.
Like taking very deep breaths on a bitterly cold day, breathing hurts.
"I couldn't breathe. I just closed my eyes," said Bryant Pratt, 8, about the asthma attack he had on Christmas Eve.
He remembers the wet towel someone put on his forehead, and the needles paramedics put in his arm. "I was scared. I was thinking that I was going to die."
That feeling is increasingly common among children in urban areas, where the incidence of asthma is highest.
'Out of control'
Although a minor problem in the suburbs, physicians describe asthma as "out of control" in cities like Baltimore because of problems such as deteriorating housing and pollution.
Experts say asthma is the No. 1 reason urban children miss school, show up in emergency rooms and are admitted to hospitals.
After only two years, the Baltimore community outreach program has enrolled 200 children -- or about 6 percent -- of the roughly 3,500 children in four elementary schools. More are enrolling every year, and because of the rising number of affected preschoolers, the program soon will include them. Sponsored by Johns Hopkins and the Abell Foundation, the program costs $180,000 annually.
Federal officials calculate the national cost of asthma at about $6.2 billion a year, or 1 percent of the country's health care tab. They say it's the most common chronic disease in America. And it's becoming more common. From 1982 to 1992, figures from the U.S. Centers for Disease Control and Prevention (CDC) show the incidence rose by 42 percent.
Nearly 12 million Americans -- one-third of them children -- have asthma. Deaths, though rare, have increased by about 40 percent between 1982 and 1991.
"It's a public health problem," said Dr. David Mannino, a pulmonary medicine specialist and medical epidemiologist at the CDC who studied asthma trends.
Puzzled physicians and researchers at Johns Hopkins and many other institutions are exploring several theories, such as people spending more time indoors, increased air pollution, poor housing conditions and even the possibility that widely used asthma medications may be making the condition worse.
Having an impact
While those answers may be a long time coming, the Oliver Community School-Based Asthma Program already has had far-reaching impact. Educated about the disease, children and parents can better manage asthma -- and have learned it does not have to limit their lives.
Some parents whose children's asthma is affected by weather used to keep the children home if there was even a hint of a storm. Now, principals at the elementary schools -- Harford Heights, Dr. Bernard Harris Sr., Johnston Square and Madison Square -- say those students are coming to school.
"What the parents teach them in elementary school follows them through life. Their mind is set on, 'I have asthma, and I can't do this or that,' " said Doretha Galloway, Madison Square principal. "But this has freed the children. They now know they can be anything they want to be."
At Madison Square, a daily crisis used to be the rule. A child would come running to the office, screaming that a classmate couldn't breathe.
These days, such frantic moments are rare. And gradually, Mrs. Galloway has seen students' attitudes change.
"I can run as long as I want or play any sports I want in the winter, as long as I use my medicine," said George Buntin, 10, who is in the program. "We learned how to deal with our asthma without panicking."
Angela Barnes, a mother whose 8-year-old twin sons, Davon and Tavon Threet, are in the program, knows the sense of terror. She discovered her sons had asthma when they were infants.
"Their eyes were rolling back in their heads," Mrs. Barnes said. "I was shouting to them, 'Breathe, please, breathe, please! Don't let Mommy down. Be strong.' "
Mary Whitfield worries so much about her son Gregory having an attack during the night that she sleeps in the same bed with the 8-year-old.
"If I wake up, I just plant my ear on his chest and listen," she said.
Through the project, both families have learned about the
anatomy of the lung, how many puffs a child should take on an inhaler and when to go to the hospital. Health workers also visit the children's homes three times during the school year, link families with physicians and arrange free exterminations.
"I try to stick with my parents who have problems until they're resolved," said community health care worker Mayme Grant, who during her inspections has dealt with foot-long rats and stray bullets.
"Some of these families are so overwhelmed."
Educators and diplomats
While trying to teach families to advocate for themselves, the health workers also help fix conditions in the homes that might worsen children's asthma, from broken windows and leaks to cockroaches and mice.
This requires some diplomacy.
At a recent visit to the Whitfield house on North Avenue, Ms. Grant and Daphne Morgan, the asthma nurse educator, sat around the kitchen table with Mrs. Whitfield. They gently lectured her to stop smoking. They described what a great experience a summer asthma camp would be for Gregory. And then they casually asked if they could look around.
Ms. Morgan said she believes major leaks in two rooms, probably from the November tornado, have worsened Gregory's asthma. He's been to the emergency room seven times since the first of January.
"Moisture is a huge culprit," she said, making a note to call the public housing authority about the leaks and several holes in the plaster.
Ms. Morgan also wants to get the Whitfields a telephone line, so they'll be able to call 911.
At the Barnes house, changes have already been made. Angela Barnes quit smoking. She got rid of old stuffed animals. Health care workers gave her pillowcases to limit dust mites.
"All of us are a lot calmer with the asthma now. We don't get excited," Mrs. Barnes said. She remembers how a severe asthma attack used to start a round of screaming and rushing to the hospital.
"To have your child look up at you and say, 'Am I going to make it?' -- that's a scary feeling."