Regaining Life's Breath
At 29, Jamie Contreras was physically fit and allergy-free — the picture of health. An active wife, mother and career woman, Contreras ran five miles a day, lifted weights, and had never smoked cigarettes. During her second pregnancy, however, she began to notice changes. "I felt claustrophobic," she recalls. "I had trouble breathing and suffered from back pain and insomnia. But I thought my symptoms were caused by stress due to family and financial worries."
After three years of chronic bronchitis, wheezing, shortness of breath, and fatigue, Contreras went to her primary care physician. He told her she had asthma and prescribed medication and use of an inhaler. Over the next two years, Contreras' health continued to decline. Debilitating asthma attacks not only robbed her of breath, but made her feel anxious and helpless. "I wanted to believe my condition was temporary," she explains. "I thought if I ignored it, the asthma would go away." But Contreras had joined the ranks of 17 million children and adults nationwide who suffer from asthma, many of whom are women. Because women have smaller airways and undergo more hormonal changes than men, being female is a major risk factor for severe attacks, and bronchial asthma has become a serious women's health issue.
Contreras became sleep deprived and lived in constant pain. The asthma depleted the oxygen in her blood, causing chronic fatigue, and her medications proved ineffective. Fear of an attack kept her apprehensive and on edge. Unfortunately, many people do not understand asthma and prejudge asthmatics as hypochondriacs who are weak or overreactive. Contreras often encountered this kind of response, which only added to her discomfort. "During an attack, when you feel like an elephant is sitting on your chest and you practically lose consciousness, it's difficult to remain calm," she relates. "But some people still don't believe asthma is real because they haven't experienced it." Contreras resigned herself to a life with asthma - a life that was not going to get any better.
Two years ago, a serious attack sent her to the emergency room, where doctors told Contreras she might have died had she not sought treatment. For Contreras, this was a turning point. Her physician referred her to pul- monologist Samuel Louie, director of the UC Davis Asthma Network (UCAN), an asthma management program designed to improve care for people who have moderate to severe asthma. UCAN also seeks to reduce health-care costs by targeting asthma patients who repeatedly visit the emergency room or urgent care clinic. While only 20 percent of the asthma population, patients with moderate to severe asthma account for 80 percent of asthma treatment costs, estimated at more than $6 billion a year.
"At UCAN, we provide coordinated specialty services with a sensitivity to the needs of asthma sufferers," explains Louie, "including evaluation of disease severity, patient education, treatment recommendations, and follow-up care." Louie first determined that Contreras did in fact have asthma (and not an allergy or other condition). He then devised an individualized asthma action plan combining proper amounts of appropriate medication and a suitable diet. "We help our patients work out a self-management plan by organizing their medications, educating them on how to control the disease, and motivating them to stick with the regimen that dramatically improves their quality of life," says Louie.
Contreras' written action plan helps her monitor her asthma. Each day, she measures how much breath she can exhale with an asthma thermometer that uses colored "zones" to indicate lung ability. If she moves from the green zone (80 percent to 100 percent asthma free) to the yellow or red zone (action required), Contreras adjusts her medications or inhaler use to prevent an asthma attack. She does not wait until she is in trouble, and she takes responsibility for her own health. The results have been spectacular, both physically and mentally. "I can sleep and breathe," Contreras happily reports. "I have a normal life now - I can handle daily activities at home, work and school and do moderate exercise without getting tired. I feel much more like myself, instead of constantly being nervous and stressed out."
Contreras is one of hundreds of success stories at UCAN, which has reduced emergency visits and hospitalizations for its clinic patients by 91 percent. "Our patients tell us that we've given them their lives back," says Louie. "Being able to help them really charges my batteries!" He hopes to expand the program with a Breathmobile, while encouraging more primary care providers to use UCAN as a resource when asthma education and specialty care are needed.
"We provide state-of-the-art care for a very common, disabling disease that is often misunderstood by patients and providers alike," explains Louie.
"We owe much of our success to having the time to ask questions and listen to our patients." For Contreras, it was that personal attention that made all the difference. "I had learned to cope with a miserable quality of life, but in fact, I was struggling," she notes. "The doctors at UCAN really listened to me - they accepted the fact that I had a serious problem and designed a treatment plan that worked into my life." Contreras urges anyone who suffers from asthma to seek help from the doctors and respiratory care practitioners at UCAN, who understand both the physical and psychological demands of asthma. "The UCAN team is the best," she says. "My asthma is under control, and I feel free and relaxed and safe."