Mindful Breathing for Kids:
Conquering Asthma in Washington D.C.
One Stress-Free Breath at a Time
Written By: Anthara G nanakumar, Sasha Narain, Helina Sirak, Lauren Sullivan, and Lola Tijani MD Candidates atthe George Washington School of Medicine & Health Sciences, Class of 2025
In a time of concurrent crises-a global pandemic, racial trauma, climate change, economic hardship and social disconnectedness-wellness may seem elusive to many. The burden is particularly high for families with young children who suffer from chronic illness, the most common of which is asthma (CDC, 2021). In addition to environmental pollutants and indoor allergens, stress can be a trigger for children who have asthma, and there has been no shortage of stress for children and their families in the past couple of years. Daily asthma control requires children and their caregivers to adhere to complex treatment regimens in order to avoid acute exacerbations, which can lead to ER visits and hospitalizations. Poorly controlled asthma increases absenteeism, limiting child engagement in school and parents’ ability to work (Dean et. al 2009). This creates short and long-term implications for household financial stability and access to treatment, potentiating existing disparities in asthma prevalence. If that isn’t enough, this stress is compounded by the stress of processing world events, and for many, dealing with housing and food insecurity, as well as other barriers to wellness.
One D.C. mother of five children with asthma, who also suffers from asthma herself, describes COVID-19 as the “worst experience ever.” Managing concurrent exacerbated asthma symptoms and COVID-19 symptoms, on top of the usual challenges of missing school and navigating insurance coverage issues, made the past few years extremely stressful. Stress is a potent trigger for inflammation. Mindfulness techniques to reduce stress may therefore be a beneficial complement to traditional medicinal practices. As future physicians intent on delivering evidence-based and comprehensive care, we are advocating for the use of breathing techniques as a tool for children with asthma and their caregivers to manage their condition and the stress associated with chronic illness. Thus, we seek to run workshops that teach breathing techniques to children with asthma to reduce symptoms and stress while promoting community.
A myriad of scientific studies and programs have explored mindfulness techniques in the pediatric population and have embraced their potential to supplement standard asthma care. For example, a study that reviewed yoga and mindfulness interventions for physical and mental health in children and adolescents with asthma found the interventions were associated with clinically significant improvements in lung function, as well as improvements in anxiety, and quality of life (Lack et. al 2020). Programs that implemented a variety of techniques, including relaxation and breathing training for children and their parents, reduced stress and anxiety related to asthma (Lack et. al 2020).
Washington D.C. is a pediatric asthma hotspot. Approximately 15,000 children in Washington D.C. have been diagnosed with asthma (IMPACT DC, 2019). Moreover, Southeast D.C., specifically Wards 7 and 8, have pediatric asthma rates that are twice the national average (Asthma Surveillance, 2017; D.C. Asthma Coalition). Alarmingly, the racial and socioeconomic disparities in asthma prevalence in D.C. are also evident geographically in these areas.
Black children are disproportionately affected by asthma, making up 32.1% of pediatric asthma cases in D.C. as compared to white children, who make up 20.5% of the cases (DC Health Matters). Mindfulness and stress management is an evidence-based intervention that can serve as a costeffective and accessible supplement to standard therapies.
Despite alarmingly high pediatric asthma rates, Washington, D.C. fortunately has a number of well-established organizations that may facilitate the introduction of breathing techniques to children and families struggling with asthma. One such opportunity presents itself here at the George Washington University School of Medicine and Health Sciences. A studentrun free clinic, Bridge to Care (B2C), offers free care to the medically underserved in Seat Pleasant, Maryland.
In line with other B2C operations, the breathing exercise workshops could be student-run. Collaborating with local yoga non-profit organizations, such as Yoga District or Little Flower, could ensure that students receive the proper training to lead breathing exercise workshops tailored towards children and their families. In addition, by partnering with pediatric pulmonologists through Children’s National and IMPACT DC, the program could recruit children across Washington, D.C. with asthma and introduce goal-oriented aspects to the program. These workshops could personalize measurable objectives for each child to reflect their unique goals, whether that be reducing medication dependence or management of stress related to chronic illness. Ultimately, this program would aim to augment the traditional treatment regimen children receive from their asthma care team.
For those families without access to transportation, virtual classes can be offered. While a virtual format may present challenges for younger children’s engagement, volunteers leading the classes may encourage other family members to participate, thereby also promoting stress management for the family at large. To increase ease of access, students would offer virtual breathing classes immediately after each asthma follow-up appointment with a provider, as a way of ensuring retention in this long-term effort. For in-person classes at the B2C clinic site, expanding the routes of the Children’s National Shuttle Service could eliminate possible transportation barriers for patients.
Offering in-person and virtual breathing exercise classes led by health professional students to children with chronic asthma and their caregivers is a cost-effective, resourceful, and medication-independent method of improving the quality of life of children with asthma. This proposal targets communities in D.C. that are most in need of physical and mental health care, while imposing minimal additional burdens on patients and their families. Growing research on the acceptance and efficacy of mindfulness interventions for children with asthma and their families in the U.S. supports the broader trend of utilizing non-pharmacological approaches to chronic illness management.
References
Centers for Disease Control and Prevention. (2021, June 14). Asthma. Centers for Disease Control and Prevention. Retrieved January 26, 2022, from website
Centers for Disease Control and Prevention. (2021, March 30). Most recent asthma state data.
Centers for Disease Control and Prevention. Retrieved January 26, 2022, from website
Chlldren’s National. (2017). (rep.). Asthma Surveillance in DC Emergency Departments and Hospitals.
Chlldren’s National. (2019). (rep.). IMPACT DC: 2019 Annual Report.
Dean BB, Calimlim BM, Kindermann SL, Khandker RK, Tinkelman D. The impact of uncontrolled asthma on absenteeism and health-related quality of life. J Asthma. 2009 Nov;46(9):861-6. doi: 10.3109/02770900903184237. PMID: 19905909
Lack, S., Brown, R., & Kinser, P. A. (2020). An integrative review of yoga and mindfulnessbased approaches for children and adolescents with asthma. Journal of Pediatric Nursing, 52, 76-81. https://doi.org/10.1016/j.pedn.2020.03.006
Matters, D. C. H. (n.d.). Teens with asthma. DC Health Matters :: Indicators:: Teens with Asthma :: City: District of Columbia. Retrieved January 26, 2022, from website
Together we can make DC asthma-free. DC Asthma Coalition. (n.d.). Retrieved January 26, 2022, from website