Drawing it out

Elementary students express their struggles with asthma through artwork
Fifth-grader Zyren Lopez and his school nurse, Kathryn Cruz, RN.

Fifth-grader Zyren Lopez stands with Kathryn Cruz, RN, school nurse at Driggers Elementary
and an alumna of the School of Nursing.

Zyren Lopez just can’t tolerate cats. “Cats and dust,” he said in a polite whisper.

In the second grade, Zyren recalled, “I started getting really sick. My chest was hurting and it was hard to breathe, so I went to the nurse and she called my mom. And they wanted to take me to the doctor. They wanted to rush me to the hospital.”

Zyren was soon diagnosed with asthma, a chronic lung disease that inflames and narrows the airways, making it hard to breathe. Asthma affects one in 10 people, including an estimated 7 million children in the United States.

Now 11 and soon to be a fifth grader at Driggers Elementary on San Antonio’s northwest side, Zyren considers himself a normal kid, albeit one who must be aware of symptoms and triggers and who takes daily long-term asthma control medications.

Zyren and his family are exactly the kind of people that Mary Kay Hart, M.S., wants to help through the Asthma2Art program she developed, first in Dallas at Baylor University Medical Center, and now at the UT Health Science Center, for school-aged children with asthma.

“I am a registered respiratory therapist certified in asthma education and I’m an artist. I believe Asthma2Art is a great way for children to express what it feels like to live with asthma,” said Hart, assistant professor and director of clinical education in the Department of Respiratory Care in the School of Health Professions.

The program for children who have already been diagnosed with asthma has two components, Hart explained: education and artistic expression. First, she and a respiratory care team go to a school and provide asthma management education to the students with asthma. Three education stations are set up for the students to rotate through during the program, each focused on a different subject.Artwork

“The ‘What is Asthma?’ station teaches the students how the lungs work and signs and symptoms of asthma,” Hart said. “Another station is focused on asthma triggers. Students identify their own asthma triggers, how these triggers make their asthma worse, and which triggers can cause them to have an asthma attack.”

Common triggers include allergens such as pollen, dust mites, cockroach droppings and mold, she said. Frequently, triggers are in the schools themselves, where carpeted libraries and stacks of books can gather dust mites, and water leaks in the ceiling or beneath sinks can accumulate mold.

The final station is about asthma medications and the difference between controller and quick-relief medications. While some children require a daily dose of medicine, others have intermittent asthma and require a quick-relief inhaler to prevent or treat an attack.

After the stations comes the art.

Artwork“Some kids choose to draw pictures of what triggers their asthma,” Hart said. “Others draw pictures of being totally isolated indoors and unable to go outside with friends, because that’s the way they’ve lived. The pictures I most enjoy seeing are the ones they create of them participating in the fun activities they enjoy when their asthma is controlled.”

Kathryn Cruz, RN, is the school nurse at Driggers Elementary and an alumna of the Health Science Center’s School of Nursing. About 100 of Driggers’ 640 students have been diagnosed with asthma, and most participated in the Asthma2 Art program in January, she said. Cruz called the artwork the students created meaningful and amazing.

“One child [expressed] that during an asthma attack it felt like barbed wire, just very tight and painful on his chest,” Cruz said. “Another little girl who was a second grader drew a very nice picture of her and her dad there in a house, and the dad was smoking, and she said, ‘Dad, please stop smoking. I can’t breathe.’ And I was just very taken aback by that.”

Tobacco smoke is especially bad for kids who have asthma, Hart said.

“It’s very important for adults to know that just being around someone after they have smoked a cigarette can trigger an asthma attack. Even emotions such as crying hard or laughing can trigger asthma,” she said.

Since children spend most of their days in school, Hart and her team surveys the physical condition of the school and identifies potential asthma triggers. They recommend ways to maintain asthma-friendly classrooms and train teachers and staff to recognize signs and symptoms of asthma and respond properly to a child having an asthma attack.


“During the cold and flu season, lots of children come to class coughing and with runny noses, both classic warning signs of asthma,” she said. “Knowing in advance which children in the classroom have asthma may reduce the risk of an emergency situation. Otherwise, it may be missed.

“There are tragic instances where a child has died at school from an asthma attack. It was either not recognized as an emergency or the school did not have the medication readily available to treat the child soon enough. Having asthma action plans in place for the school to follow for each child and having school staff trained in asthma emergency management is key to preventing this from ever happening here in our schools.”

Asthma2Art allows students, like Zyren, to articulate their fears and frustrations about the disease. Indeed, art therapy has proven to decrease anxiety and increase quality of life for children with persistent asthma, according to a study from National Jewish Health. To date, six San Antonio schools have participated in Asthma2Art aided by a grant from the Environmental Protection Agency.

Zyren, who wants to be an artist, said he enjoyed drawing a dreaded cat in the Asthma2Art program “because I could tell what’s going on with my asthma.”

All artwork is judged by local artists and the winning artwork is published in a calendar.

“We’ve seen incredible pictures that speak louder than words, very emotional pieces describing what it feels like to live with asthma,” Hart said. “We are hoping through Asthma2Art to raise asthma awareness and offer tips to others about managing their asthma better.”

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