Noah Sweek, 10, of Washington, with his father, Joshua Sweek. Noah has asthma and is being treated at Children's National. (John Kelly/The Washington Post)
Columnist

Like a pair of old sea captains, 10-year-old Noah Sweek and his father, Joshua, keep their eyes trained on the weather.

Noah has asthma. When his condition is exacerbated, the airways in his lungs swell, narrowing the passageways and making it difficult for him to breathe.

Different things trigger asthma flare-ups in different kids: mold, dust mites, pet dander, the presence of cockroaches or mice.

“With Noah especially, the weather has a lot to do with it,” Joshua said. “Usually in summertime it’s not that bad. But wintertime is when we have to keep an eye on him and take preventative measures so he doesn’t have an attack.”

It was in February 2011 that Noah had his scariest episode. Chilly temperatures and dry air brought on a flare-up, both of his lungs collapsed, and he spent five days at Children’s National.

“When I’m wheezing, it feels horrible, like I’m going to cough and cough,” said Noah, a fifth-grader at Tyler Elementary in Southeast Washington. “And my chest hurts.”

“Is it scary?” his dad asked.

“Sometimes,” Noah said.

Said Joshua, who works as a server at Chef Geoff’s downtown, “It’s the hardest thing when you can’t take away your child’s pain. You pray to God and say, ‘Let me be sick instead of them.’ ”

Asthma is predominantly an allergic disease and, as with food allergies, doctors have seen an alarming rise of it among U.S. children.

“Asthma has more than doubled in prevalence since I was a young doctor in the 1980s,” said Stephen J. Teach, head of the asthma clinic at Children’s Hospital.

More kids with asthma means more trips to hospital emergency departments. That can lead to more overnight hospital stays. It’s a cycle Teach and his colleagues are determined to break. He’s the medical director of Impact DC, a program at Children’s Hospital that targets kids who are heavily dependent on visiting the hospital for their asthma, with all the expense in time and money that entails.

“The whole contextual model behind Impact DC is that asthma is not a disease that comes and goes,” Teach said. “It’s there all the time.”

As a chronic condition, asthma is best treated by primary pediatric care providers, rather than by desperate visits to the emergency room.

“Asthma is controllable in virtually every child,” Teach said. The key is understanding what triggers a flare-up.

Teach said he prefers that term — flare-up — to the one most of us have heard: asthma attack. “Attack” makes it sound “like there’s a war going on,” he said, when with forethought and preparation asthma can be made manageable.

The beginning of the school year is a troublesome time for many asthma sufferers. As kids return to classrooms, they start passing viruses back and forth. A common cold can spiral into pneumonia.

For Noah, cold weather is bad. Knowing that, Teach adjusts the medication Noah receives, switching to a more robust corticosteroid as the winter approaches. Noah inhales it twice a day, taking care, he explained, to brush his teeth after each dose. (Why? It’s to prevent swallowing excess medication and also to ward off thrush, a fungal infection that can take hold when inhalers are used frequently.)

Some common triggers should be easy to avoid: cigarette smoke, for example.

“I always tell my parents, you wouldn’t give your kid poisoned food to eat or poisoned water to drink,” Teach said. “Let’s be sure not to give them poisoned air to breathe.”

Noah is followed by doctors at Children’s Hospital as part of a long-range observational study, but he hasn’t had another frightening episode like the one that put him in the hospital nearly three years ago.

For that, his dad is grateful.

“You’re taking away the simplest thing for someone to do,” Joshua said of asthma’s insidious nature, “something you don’t even think twice about: breathing. I can’t imagine what he’s gone through. I tell him he’s the bravest kid I’ve ever known.”

Helping the hospital

Here’s something I didn’t know about asthma: According to Teach, before puberty asthma is much more common in boys. After puberty, it’s much more common in girls.

That’s just one of the puzzles that researchers are trying to tease out. Meanwhile, the Impact DC clinic is involved with more than a thousand kids in our area, helping them and their families learn to manage the disease.

You can help the hospital by participating in our annual fundraising campaign for Children’s Hospital. To make a tax-deductible gift, visit childrensnational.org/washingtonpost or send a check (payable to “Children’s National”) to Washington Post Giving Campaign, c/o Children’s Hospital Foundation, 801 Roeder Rd., Suite 650, Silver Spring, MD 20910. Our deadline is Jan. 10.

Bill and Joanne Conway, through their Bedford Falls Foundation, have generously offered to match all gifts to The Washington Post Campaign for Children’s National. All donations, up to a total of $150,000, made by Dec. 31 will be matched dollar for dollar.

Your gift today can make a difference in the life of a child.

john.kelly@washpost.com

For previous columns, visit washingtonpost.com/johnkelly.