A certificate for perfect attendance from a North Hills elementary school hangs on the wall of the Breathmobile, a mobile asthma clinic that visits schools in the Los Angeles area.

The certificate, awarded to a young patient who used to habitually miss school because of his asthma, is one of many reasons why Gloria Wessel, RN, a former pediatric emergency room nurse, loves coming to work.

"It feels so good," said Wessel, who works with a physician, a respiratory therapist and a financial services worker. "His mother said she had tried everything, and now [after his visits to the Breathmobile] he had perfect attendance. It's really nice to hear these stories."

Collaborative effort
Working out of a white 34-foot Winnebago motor home, Wessel and her team provide free asthma and allergy testing, medicine and education to 21 elementary and high schools in the San Fernando Valley.

Patients are referred by school nurses and have scheduled appointments. Two other Breathmobiles work in East and South Central Los Angeles. A fourth is scheduled to visit schools in Southeast Los Angeles.

The program, which was started in 1995, is a collaborative effort of the Los Angeles Unified School District, the Los Angeles County-University of Southern California Medical Center, the South Coast Air Quality Management District, an asthma watch program, and the Southern California chapter of the Asthma & Allergy Foundation of America (AAFA).

Asthma rates have increased nearly tenfold in the last 100 years.

More than 5 million children in the United States have asthma, including half a million in California, according to the AAFA.

It is a leading cause of school absences and considered the main reason for childhood visits to the emergency room.

Transportation barriers
Although asthma cannot be cured, it can be controlled with medication.

But because medication regimens can be complicated and costly, many low-income, uninsured and inner-city children are not receiving the care they need, asthma specialists say.

Hence, the birth of the Breath-mobile.

Craig Jones, MD, the Breathmobile program's medical director, came up with the idea of a traveling asthma clinic at an AAFA retreat, said Cathy Pollak, MPA, health educator for the foundation's Southern California chapter.

Jones, an allergy and immunization specialist with USC, was concerned that inner-city children with asthma were going untreated because their families did not know about free or low-cost asthma clinics or were unable to bring them to the clinics.

"What the Breathmobile does is to take away that transportation barrier," Pollak said. "It creates access to care for children who really need it."

The Breathmobile visits a school every six weeks. The schoolchildren run to greet the medical team they've come to know well.

Parental involvement
Parents usually accompany the young patients, especially on initial visits. Wessel checks the lung capacities of the students, asking them to blow out virtual birthday candles on a computer screen through a long tube.

Loran Clement, MD, an allergy specialist, examines them and prescribes nasal sprays, inhalers and other medicines to those who have insurance.

Those without coverage receive the medicines at no charge.

Low-cost insurance
The team's financial service worker helps eligible families sign up for free or low-cost insurance.

Wessel and her team spend a lot of time showing children and their parents how to use the medicines and inhalers.

"It's a constant teaching process," Wessel said.

"Parents are really pleased because we take time with them. A lot of them say, 'I didn't know what this thing was.' " By the second visit, both parents and students usually have it down, Wessel explained.

The team also assures parents and students that they can be as active as nonasthmatics if they take their medicine properly.

Elementary school students usually store their medicines with the school nurse, and ask for them before a P.E. class or if they feel symptoms of an attack.

High school students usually are allowed to carry around their medicines with them.

Statistics from the Breathmobile's first year of operation show that more than 67 percent of 549 children treated were able to control their asthma, compared with 10 percent of children in a control group.

Breathmobile patients reported a 17 percent drop in emergency room visits. Meanwhile, elementary school students had 80 percent fewer absences and high school students had 50 percent fewer absences after receiving Breathmobile treatments.

Similar programs
The Breathmobile's success has sparked similar programs in Phoenix and Baltimore, Pollak said.

When the Breathmobile first rolled onto the campus of Fourth Street Elementary School in East Los Angeles, both parents and students were skeptical, said school nurse Nancy Hamamoto, PHN, RN.

"They really weren't sure what it was all about."

Now, she said, she has 15 students on a waiting list for Breathmobile appointments. She's also sending fewer kids home with asthma attacks.

When children come to her to use their asthma medicine, they know what to do.

"My cohorts from other schools ask me, 'How did you get the Breathmobile?' " Hamamoto said. "I just cannot say enough good things about it."