WEEK 2 & 3: Primary Research

Interviewed stakeholders related to childhood asthma

We spoke with many people over these two weeks to really get a grasp of their experiences with asthma.

1. Beverly, developed asthma as an adult
2. Nikita, pre-school teacher
3. Conrad, had asthma as a child and is heavily involved with mentoring
4. Neil, had asthma as a child
5. Director and a Nurse from a K-8 School
6. Sonya, adult still dealing with asthma
7. Mr. Vanucci, gym teacher at an elementary school
8. Laura, a gym teacher and parent of two children with asthma

Then we’ll briefly discuss our thoughts on the information we gathered

Beverly, 23, developed asthma as an adult

“I was diagnosed with asthma last year (2016). A few months prior, I was on my way to Japan. At one of my layovers, I had to walk quickly to make it to my connecting flight. After speed-walking through half the airport to get to customs (I was taking a domestic flight from Tokyo to Osaka), I realized I could barely breath. My chest was really tight, and felt like cement. I wanted to pass out — but also didn’t want to miss my flight so I couldn’t rest. During my stay in Japan, I would continually cough, and would feel out of breath even during the smallest amount of activity.

My doctor diagnosed me with adult onset asthma. I was prescribed a rescue inhaler to use. At first, I used the inhaler after exerting myself. Then my doctor prescribed me a daily inhaler to use in the morning, and said I should use the rescue inhaler only before I work out. Honestly, I don’t even use my daily inhaler anymore since I stopped displaying signs of asthma in the Spring, Summer, and Fall. When it’s really cold and I’m walking outside, I do notice a slight shortness of breath, so I think I have seasonal asthma. For my rescue inhaler, I have to use it 15 minutes before I work out — which is kind of annoying since I usually lose motivation by then. Since I only have seasonal asthma, and it’s not that serious, it doesn’t affect my social life.”

Nikita, 26, Pre-school Teacher

Nikita is a pre-school teacher that deals with children between the ages of 3 and 5 years old. While she has only encountered a handful of asthmatic children during her teaching career, she shares that one of the biggest challenges of working with young children with asthma is that, as teachers, they are fully responsible for the children and their wellbeing while in school. This is especially in the early ages, when children are still learning to express themselves.

It takes a long time to really learn the severity and of each child’s condition and their limitations. And, as a result the tendency is for teachers to be overly cautious in ensuring that children do not get exposed to environments or activities that can potentially trigger their asthma. She noticed that parents and children, on occasion, err on the side of caution as a result of fearing asthma attacks.

When asked about the level of awareness amongst asthmatic children of their condition, she said it was typically limited to specific circumstances or situations, rather than general knowledge of asthma.

“Mommy told me not to touch dust”

“I cough a lot so I have to wear a mask”

“If I fall sick, my medicine is in my bag”

Conrad, Masters Student

Conrad had exercise-induced asthma in late middle school and high school (~13 years old). He doesn’t know why it started, but around the same time, he had gained some weight and also started having pollen allergies. His asthma was triggered specifically from playing tennis competitively, since it involves a lot of short sprinting sessions. After he quit tennis and lost weight, he stopped having asthma attacks. Since this was not something that he grew up with, there was a lot of anxiety and confusion surrounding it — he was often unsure of whether his difficulty in breathing was an asthma attack or just being out of breathe. In addition, since his mom was a big worrier, he often felt like she was too fast to jump to the conclusion that there was a problem.

As his mom also had asthma, he saw the inhaler as something cool to use and was never embarrassed by it. When asked about what specific advice or tips he was given for his asthma, he said he was not given much advice for prevention except to maybe lose some weight. Since tennis was something he was very passionate about, his asthmatic episodes did not affect his desire to continue playing — it was just one more annoyance that he had to deal with. His tennis coaches were aware of his asthma and were supportive in that they put their students’ health as a priority. His advice to younger children is that getting into routines and habits of taking the medication is helpful and important.

Neil, Masters Student

Neil’s asthmas was worse when he was younger; he does not have asthmas attacks anymore. He doesn’t remember his asthma ever preventing him from partaking in classes or activities. Having asthmas was just annoying to him because he would continually cough for days. However, he was comforted by the fact that he had a nebulizer at home and in the school’s nursing office that would relieve it immediately. On vacations, his family would bring the nebulizer with them.

In general, he prefers “sprint exercises” like swimming or softball, where he could exert a lot of energy and then catch his breathe after. He doesn’t like “endurance exercises” like running long distances because it’s harder for him to breath. He says that swimming is actually a good sport that forces you to exhale through your nose. The water pressure also pushes you to use your lungs more at certain intervals, which is helpful. This is different than running because when you run, you can breathe in and out as many times at you want.

He learned about his asthma mostly from his parents and his teachers. He never felt insecure because of it. He also didn’t have to educate his classmates much on it because they didn’t make him feel left out. His advice for younger children is that it will be okay and it might even get better over time.

Director and a Nurse from a K-8 School

The school’s nurse mentioned that a spacer and inhaler is better than the nebulizer. Education ahead of time for the teachers is lacking. It’s usually done on an as-needed basis. Parents resist using the word asthma. They tend to say that their child has a “persistent cough” or “cold.” Asthma is pretty accepted, so when the children feel bad, it more internally motivated.

The kids have at least one recess a day (either indoors or outdoors). They also have sports and clubs which involve physical exercises. Some students choose to stay inside if they know that the cold or physical activities might trigger an asthma attack. The parents can also choose to let the kids stay inside.

“The younger kids love the older kids. For example, they like to get attention of the older kids and sit on their laps. Sometimes we point to older kids that are wearing glasses to persuade the younger kids to wear it.”

20 out of 245 students leave but for the most part, most of the students stay from kindergarten until 8th grade. They try to have them be taught by the same teachers over multiple years since “we value interactions and relationships.”

“Sometimes the children who graduate will come back and visit, have lunch, or just hang out. Most of the graduates just go to high schools in the area.”

Sonya, Adult still dealing with asthma

I (Denise) met Sonya at bus stop while it was raining. I shared her umbrella with Sonya and it came up that Sonya had asthma and really struggled with it growing up.

Sonya’s asthma was triggered by her mother’s cigarettes; it was also genetic. She believed that the smoke the steel mills of her town, Hazelwood, was intoxicated.

She was born with asthma. It got better as an adult, but when she has asthma, she was coughing a lot, and had to go the hospital for breathing treatments and overnight monitoring about 7 times a year.

She had to us a combination of an inhaler, an inhaler necklace, a spacer, and a nebulizer through her day, starting in the morning.

She remembers vividly sitting out on dodgeball games during gym classes.

The teacher said, “Sit out, Sonya, and write me papers or read.”

She used to cry and question why. Her teachers often ignored her concerns. She even talked to her mom about it, but when her mom talked to the school, they explained that it was against school’s policy. On rare occasions, they would let her play for a short period of time. Her mother used to play racketball and skate with her. She would buy baby pools for her to swim in; she let her invite friends over. Sometimes during the after school programs, Sonya would sneak off to play sports with the other kids when the teachers weren’t looking.

Sonya remember her classmates making fun of her; they pretended like they couldn’t breathe. This stopped during 7th grade.

She remembers being able to talk to her brother’s friend about it because he also had it. He definitely made her feel more comfortable.

If she could give advice to children with asthma, she would say

“do what they can…do their best…learn great coping skills. Whatever you do, try to be the best in it. You’re not responsible for being down, but you are responsible for getting up. Keep asking, never give up, try to figure out some way to do others are telling you not to do.”

Mr. Vanucci, Gym Teacher at Weil Elementary School

We had a short phone interview with a local physical education teacher to see if there was an opportunity for us via a gym teacher.

Mr. Vanucci says that he’s seeing asthma cases increase over the years. He teaches in a tougher area, and says that many of the kids probably have parents that smoke or do drugs. Additionally, he has received a small amount of training, but says that they would definitely benefit from more training on how to handle asthma and other emergency medical situations.

But when the children are in gym class, they go all out, even the kids with asthma. He tries not to pull out children from class and lets them tell him that they need a break instead. Sometimes if a child comes in with a doctor’s note and he’ll let them sit out for a couple days.

From what he sees, he doesn’t notice any bullying or isolation of children with asthma. The other children recognize and accept that asthma is pretty common and just go along with it.

He says that he “[doesn’t] want to make a problem where a problem doesn’t exist”

Laura, Gym Teacher at the Falk Laboratory School

Laura is one of two PE teachers at Falk Laboratory School and a mother of two children with asthma.

In her experience, children with asthma play just as hard as other children. In particular, they all love playing tag and using their imagination while running around. If the an asthmatic child does start having problems, they already accustomed to their condition and know to sit out until they recover. Additionally, every teacher receives first aid training, knows which children have asthma, and know how to respond to attacks or get the right people involved. For newer teachers, it might take a little longer to learn all the necessary information about the child’s asthma condition, but they pick it up eventually.

When asked about raising children with asthma, she said that “it was absolutely exhausting.”

Having to learn about asthma from nothing and constantly worrying about her children was tiring. Her younger daughter’s asthma was not severe and she even plays on the soccer team. She is very relaxed about her asthma, but is still a bit embarassed to be using her inhaler in front of everyone.

However, her older son’s asthma was very extreme and caring for him was took so much of her time and energy. Laura claims that her son is very reserved which was caused by his extreme asthma conditions as a child.

After the interview questions, I showed her our service proposition storyboard to get her feedback. The first thing she did was ask about what triggered the asthma attack in the picture of playing outside. It could have been the heat, pollen, or running around. This does validate our idea of using weather data.

She really liked the idea of giving small children an older mentor that can relate to their struggles and support them. She noted that there would definitely need to be parental approval, and we could need parental supervision at all times. Finally, she liked the idea of having a reward (like free ice-cream), but said that it didn’t need to be the main focus. Instead it could be a random reward that pops up for meeting with the mentor.

Preliminary Insights/Considerations

• Different types of asthma have different needs, so it’s important to match mentors & mentees who have the SAME condition and severity. Otherwise, the advice is likely not applicable/not relatable.
• Tendency for teachers, parents, and children to be overly cautious and err on the side of caution due to fear of asthma attacks.
• Sports like swimming is recommended for people with asthma because the water pressure forces you to exercise your lungs and breathe in intervals.
• Support from family members and teachers heavily influences the child’s perception and attitudes towards his/her asthma (e.g., a child seeing inhalers as cool because he always saw his mom using it).

Upcoming Interviews

In the next week, we have interviews lined up with the Director of Admissions, a school nurse, a gym teacher at Falk Laboratory School and a Physician specializing in Allergy and Immunology at UPMC’s Children’s Hospital of Pittsburgh.