2 asthma deaths highlight dangers

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2 asthma deaths highlight dangers

By Anne Barnard, Globe Staff, 3/31/2001

Marquisse McGregor, 16, was rushed to Carney Hospital at 11:54 p.m on March

21 with an acute asthma attack that shut down his breathing and stopped his

pulse. Emergency workers pumped air into his lungs but could not save him.

The Brighton High School student's death hurt all the more because when he

was 8, his mother, Pearl, starred in a radio ad about asthma management,

explaining that with better control of the disease, the boy who used to miss

school because of shortness of breath could blow on a trumpet with gusto.

Nineteen hours after McGregor's death, another ambulance rolled up. It

brought a 13-year-old girl who lived in Mattapan, eight streets from

McGregor. She, too, was having an asthma attack, and despite the hospital's

efforts, she also died.

The deaths devastated parents who were trying to manage their children's

disease. They upset Carney's emergency room staff, who have made asthma

education a priority. And they stunned public health officials, who want to

know whether there is any link between the cases. While the incidence of

childhood asthma has soared since the early 1980s, especially in

neighborhoods where poor housing conditions and pollution exacerbate the

disease, deaths remain rare; asthma kills two to five children a year in

Massachusetts.

The deaths were particularly painful because they occurred despite the

efforts of community groups, hospitals, and officials to try to curb asthma

hospitalizations, which are often preventable and which disproportionately

affect African-Americans in urban neighborhoods.

''We can usually save these people'' if symptoms are noticed quickly enough,

said Dr. Kerman, director of emergency services at Carney, But, he

said, even parents who are well educated about the disease can miss the

signs of a more serious attack, which include fatigue and failure to respond

to medication.

The hospital would not release the name of the 13-year-old asthma victim.

McGregor's parents could not be reached for comment, but by all accounts

they were actively involved with his asthma.

''This was a kid whose parents took very good care of him, kept him right up

to date on his medical care,'' said Brighton High Principal

Skidmore. He said the school stresses asthma in health education, but did

not dwell on McGregor's cause of death for fear of alarming the many

students at the school with asthma.

Others are taking the opposite tack, using the occasion to remind students

that asthma can kill. They fear that asthma is so deeply embedded in daily

life in some Boston neighborhoods - at some schools in Roxbury, Dorchester

and Mattapan, 10 percent or more of students have it - that the disease can

seem like no big deal.

''So many people have mild asthma ... that I don't think people take it

seriously,'' said Maura Rowley, a full-time asthma case manager at the

Codman Square Community Health Center in Dorchester who visits the homes of

newly diagnosed patients to educate them about the disease.

At the O'Hearn School in Dorchester, which McGregor had attended and

where his younger brother is a student, 20 of the 220 students have asthma,

said Pat , the school nurse.

Last week, she reassured one boy who was worried about his brother, who had

been hospitalized three times recently with asthma. And she spent even more

time than usual showing students how to use their inhalers properly, read

the expiration date on their medications, and urge their parents not to

smoke by saying, ''Mom, can I open the window? This bad air really isn't

good for me.''

She said many of the children are diagnosed with asthma for the first time

in an emergency room and never get proper follow-up care.

Kerman said the deaths would spur Carney ''to redouble our efforts'' to

refer emergency room patients to primary care doctors.

''This is the best motivation of all to identify people that should be on

the right asthma medications, and when they're not, get them on,'' he said.

''We can prevent some other kids or adults from undergoing a similar fate.''

Asthma is a chronic disease in which the linings of the air passageways in

the lungs are super-sensitive. Smoke, chemicals, cockroach dirt, animal

dander, dust, pollen and other irritants make the passageways swell and the

muscles around them tighten. If the process goes too far, as it did with

both children who died last week, the tightening is irreversible and cuts

off oxygen, causing death. The state Department of Public Health is

investigating the deaths but says the hospital is not to blame.

Keeping the disease from the crisis stage can involve a complicated regimen,

with different medications for different situations. It requires extra hours

of housework to battle dust and dust mites, and sometimes daily monitoring

of a child's lung capacity. That can be hard for parents who work more than

one job, and many families that rent can't control problems like leaks that

encourage the growth of mold, or carpets stuffed with years' worth of dirt.

In 1992, McGregor's mother joined a program at Harvard Community Health Plan

designed to help families deal with the barriers to good asthma management.

She described her experience in the company's annual report.

McGregor had asthma from infancy. ''He'd play, then he'd wheeze and he'd

have to stop playing. He couldn't go out and play in the rain, do things

normal kids could do,'' she said.

When officials first approached her, she said, ''I felt like they were going

after me because I was a black mother, and maybe I wasn't giving him his

medication. I felt like they were singling me out, but I figured I'd go and

see what they wanted me to do.''

The program offered education, counseling, help with transportation and

coordination of social services. Pearl McGregor said it helped get her son's

asthma under control, and made her more comfortable dealing with the health

care system.

Similar initiatives include the Boston Public Health Commission's $1.9

million Healthy Homes Initiative, which provides funding for mattress

covers, new ceilings, vacuum cleaners and air conditioners.

The Boston Urban Asthma Coalition is holding a summit in May to look at the

various ways of fighting the disease.

Children's Hospital launched a program called Family to Family, where urban

parents mentor each other. And the state Department of Public Health is

studying 35,000 children in the Merrimack Valley to test the impact of

environmental factors on asthma.

But none of that will bring McGregor back to his little brother.

''He says he's sad because he thinks of his brother all the time and he

doesn't think he'll be able to get it out if his head,'' said. ''I

told him that was all right.''

This story ran on page A01 of the Boston Globe on 3/31/2001