Hawaii DOH amplifies local asthma triggers through campaign


Hannah Saunders


With Asthma Awareness Month right around the corner, Hawaii’s Department of Health (DOH) has launched their ‘Control Asthma’ campaign, which focuses on raising awareness of local asthma triggers with a focus on young children. While the campaign returns each spring, this year’s campaign has been revamped to have a greater presence in the community.

“We’re focusing on some of these triggers that might cause a flare up,” Control Asthma program lead, Jordan Fuhrmeister, told State of Reform.

DOH data from 2020 shows that one in 13 children in Hawaii, or 7.7%, currently have asthma —higher than the national average of 7.5%. Data from 2019 shows that there were about 689 emergency department visits and 66 hospitalizations related to asthma among children ages zero to four.


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While asthma is a chronic disease that can never be cured, symptoms may improve or worsen over time. Symptoms include tightness of chest, coughing, shortness of breath, and wheezing. Asthma symptoms also tend to follow patterns, which may come and go over time within the span of one day, or worse at night or in the morning. Since Hawaii doesn’t have a frost season, there are certain asthma triggers specific to the state.

“We do know that there are some common triggers that can affect people with asthma, so things like pollen, upper respiratory infections,” said Adeline Kline, clinical trainer at Hawaii Keiki under the University of Hawaii. “In terms of addressing these triggers, it doesn’t delay, necessarily the onset of asthma, but it allows an individual who does have asthma to manage their symptoms along with medications if needed.”

The ‘Control Asthma’ campaign focuses on four common triggers of asthma in Hawaii: cockroaches and their droppings, dust mites, mold, and secondhand smoke and vape. DOH produced four infographics focused on these triggers, with posters displayed in malls across the state. The DOH is also running radio ads throughout the state, and social media posts through their Start Living Healthy HI accounts.

“What we know about asthma as well—it’s not specifically more targeted for lower socioeconomic individuals—the burden on people of low-income is a lot higher, and some of it has to do with access to healthcare, knowledge about triggers, ability to afford these meds. A rescue inhaler can be very expensive,” Kline told State of Reform.

Rescue inhalers are used during asthma attacks, which relaxes and opens up the breathing tubes in the lungs, but they can cost about $100 dollars out of pocket. Kline brought up how not being able to diagnose, treat, or afford medication is a burden in itself. The DOH directs individuals who can’t afford rescue inhalers or are uninsured to Federally Qualified Health Centers, which provides access to healthcare regardless of insurance. 

The DOH’s role throughout this campaign has been to promote access to services and to educate the public. Part of the initiative includes an action plan, which is a free, downloadable tool that can be filled out online. The plan is highly recommended for children and adults to fill out with their primary care providers in order to develop a plan, manage symptoms, understand what to do when a flare-up occurs and what medications to take, and know the different steps of the onset of an asthma attack.

“The action plan is a good tool to communicate to anyone around a child or adult with asthma,” Kline said, who works closely with school nurses to develop emergency action plans. While all school districts have their own emergency action plan form, the DOH’s action plan is a starting tool to assist school nurses with developing an emergency plan for children in school.

“Asthma, although it’s a chronic disease, meaning it cannot be cured—sometimes we do have symptoms that get much better as we age or our circumstances change—it can be managed, or you can have a very healthy and successful life living with asthma,” Kline said. “It might not even affect you at all. There’s many sports players who have asthma, professional actors, so as long as you have a good grasp and understanding of the disease, triggers, and the proper medications, then when you do get sick or experience a flare, you can go on and have a healthy life.”

Kline told State of Reform that asthma negatively affects individuals when they don’t have a robust understanding of the disease, or if individuals don’t have the resources to manage it. Kline said she thinks that a decent chunk of families are unaware of the difference between asthma and a cold.

“A cough is a symptom of both of those illnesses, but a cold is something that is short-term, and should get better,” Kline said. “Asthma is something that if it’s not treated properly in the beginning, it can lead to ongoing coughing [and] nighttime awakening. There are still, unfortunately, people who die in this country of asthma attacks because they don’t have the rescue medications they need in time.”

Kline compares the feeling of asthma to breathing through a straw, and recommends that individuals experiencing symptoms should undergo a spirometry test. The test requires individuals to take large breaths, and blow air into a tube to measure what the capacity of the lungs should be compared to how much capacity they actually have. Several blows are taken to determine a diagnosis.

Kline and Fuhrmeister encourage adults in the lives of young children to obtain an action plan, and while parents and the child’s school may be aware of the child’s asthma, an afterschool sports coach, for example, might not be aware. Fuhrmeister encourages parents of younger children to be highly communicative with schools. 

“Often, what happens is we know our kids’ history, and we put it on a form, but we don’t go that next step of, ‘What does that look like in my child’s life? What are their triggers? What do I expect the school to do?’,” Fuhrmeister said.

Since the COVID-19 pandemic has delayed in-person health check-ups, Kline recommends that individuals keep up with preventative health measures and discuss any asthma symptoms with their providers. Kline also recommends that individuals call Aloha United Way at 211, which can connect individuals with medicine and health questions.

“I’m really excited for families to hear our voices, whether it’s myself or Adeline, or we also have recorded radio scripts that are going out, and so I’m just excited for people to be able to hear something that they can relate to, whether that’s a nice reminder, or something that they might feel that they want to take action on for the health of their family,” Fuhrmeister said.