A Citizen Potawatomi Nation tribal member, kindergartner JD Bromagem uses an inhaled steroid twice per day to keep his asthma in check. A second inhaler is on standby in case.
“I’m not scared to use it,” he said with a big smile.
For almost a year, his parents and doctors wrestled with what was causing him to have extended coughing fits at night, checking for allergies, ear problems or other potential sources.
“He was coughing to the point he was throwing up. It was a medical mystery,” said Mandy Bromagem, JD’s mother.
“Once we started treating him for asthma, it helped immensely.”
A common chronic disease among children, asthma is when inflamed or blocked airways in the lungs make it difficult to breathe. It can cause repeated bouts of wheezing, chest tightening, breathlessness and persistent, severe coughing fits.
During an asthma flare-up or attack, the insides of a person’s airways swell up, narrowing the space for air to pass in and out of the lungs. Additionally, the muscles wrapped around the airways in the lungs can constrict, making breathing even more difficult.
By comparison, seasonal allergies generally affect just the upper airway with a runny nose, sinus congestion, and when laying down, an intermittent dry cough.
Nationally, about 6 million children have asthma, or roughly one in every 12. According to data compiled by the Centers for Disease Control and Prevention’s Asthma Control Program, the pediatric numbers are slightly higher in Oklahoma, with asthma impacting almost 10 percent of the state’s children. Among Native American children in Oklahoma, the rate is an estimated 14 percent.
Although incurable, asthma can be controlled with medication — such as Bromagem’s inhaler — and by avoiding certain factors or triggers that can exacerbate the condition when breathed in.
Asthma’s exact cause is unknown, and individual asthma triggers vary from person to person. Ones that are more common include dust, mold, secondhand smoke, pet dander, exposure to mites or other pests, outdoor exercise in cold weather, acid reflux and strong scents, such as those from perfume or strong household cleaners. Additionally, people with an asthmatic family member are up to six times more likely to develop the condition themselves.
Oklahoma decriminalized medical marijuana in 2018. With federal restrictions still in place on marijuana-related research, not enough conclusive data is available to determine whether marijuana smoke is as much of an asthma trigger as smoke from commercial tobacco products. Also, not enough data is available to confirm the impact of vapor from electronic cigarettes on asthmatics, as noted by Oklahoma public health officials at a panel during the Southern Plains Tribal Public Health Conference.
“Smoke is still smoke though,” Oklahoma State Department of Health’s Christin Kirchenbauer said. “Medical marijuana smoke still has fine particulate matter in it. With e-cigarettes, we need more research. It also varies from product to product, so it is hard to nail down the average (secondhand smoke) exposure.”
Dr. Fausat Adediji is a board certified pediatrician at Citizen Potawatomi Nation’s West Clinic. Acknowledging the research limitations on medical marijuana and e-cigarettes, she often encourages parents of asthmatics who smoke to either drop the habit or at least take it outside to reduce their child’s exposure.
She also acknowledges that pediatric asthma patients sometimes outgrow the condition but does not see that as grounds for summarily dismissing a child’s wheezing as a passing problem unworthy of medical attention.
“If left untreated and severe enough … it can lead to scarring and reduce overall lung capacity as they get older,” Dr. Adediji said. “If you have restricted lung volume, there’s a limit on how you can do, which can lead to chronic problems. If they do outgrow it, that’s a plus, but not everyone does. So, that is no excuse to leave it untreated.”
Meanwhile, with an inhaler dose scheduled for later that evening, JD Bromagem is able to breathe easily as he scales the playground with friends at his midtown Tulsa elementary school.
“It’s literally changed our lives,” Mandy Bromagem said.