Department of Pediatrics, North County Health Services, Oceanside, CA, USA.
J Dev Behav Pediatr. 2011 Jan;32(1):75-7. doi: 10.1097/DBP.0b013e318203e087.
Gerardo is an 8-year-old Latino boy who saw his primary care pediatrician with a second asthma exacerbation this year. His frustration with his illness was immediately apparent when he said, "I hate having to go to the nurse's office to take my albuterol!" His mother expressed concern that her son frequently refused to take his prevention medication for asthma, montelukast, each morning. When questioned about compliance with his inhaled steroid, his mother hesitated and then admitted that she discontinued the controller medication because she is afraid to "poison his body with so many chemicals." She consistently gave her son the inhaled steroid for 12 months, until care by the allergy specialist was unexpectedly transferred to a Spanish-speaking allergist. She complained that the new doctor is "cold and acts like a veterinarian, not a pediatrician." Gerardo is a first generation Mexican-American who was born in the United States to Spanish-speaking parents. There is no family history of asthma, although his mother fears that she may have contributed to Gerardo's condition. She explained that during pregnancy, she worked cleaning houses where she was exposed to many toxic household cleaners. She has always worried that by inhaling these fumes during pregnancy, she induced her son's asthma. Gerardo presented with his first episode of reactive airway disease at 9 months of age. His mother vividly recalled his high temperature, rapid breathing, and their ambulance ride to the hospital. He was hospitalized for 3 days, and he has not been hospitalized since. Allergy testing revealed sensitivity to weed pollen only. Gerardo sleeps with a nonallergenic pillow and bed cover. Gerardo's mother explained that 3 days before his current exacerbation, he was playing at an amusement park with his friends on a hot day. Gerardo and his friends ran through a large fountain. His mother reported that he was soaked in water and stated, "He knows that he will get sick with asthma if he gets wet!" She recalled that 3 years ago at a friend's birthday party, Gerardo abstained from running through the sprinklers with the other children without instruction from his parents. Since that event, she has trusted Gerardo to care for his "weak lungs." She is frustrated now with his regression in self-care.
杰拉尔多是一个 8 岁的拉丁裔男孩，今年他因哮喘第二次急性发作去看了他的初级保健儿科医生。当他说“我讨厌去护士办公室吸沙丁胺醇！”时，他对自己的疾病感到非常沮丧。他的母亲表达了她的担忧，因为她的儿子经常拒绝每天早上服用预防哮喘的药物——孟鲁司特。当被问及他吸入性类固醇的依从性时，他的母亲犹豫了一下，然后承认她停止了控制药物的使用，因为她担心“用这么多化学物质毒害他的身体”。她一直给儿子使用吸入性类固醇 12 个月，直到过敏专家的治疗意外转交给一位讲西班牙语的过敏专家。她抱怨说这位新医生“冷漠，像兽医一样，不像儿科医生”。
杰拉尔多是第一代墨西哥裔美国人，出生在美国，父母讲西班牙语。虽然他的母亲担心她可能导致了杰拉尔多的病情，但家里没有哮喘病史。她解释说，在怀孕期间，她打扫房子，接触了许多有毒的家用清洁剂。她一直担心在怀孕期间吸入这些烟雾会导致儿子的哮喘。
杰拉尔多在 9 个月大时首次出现呼吸道反应性疾病。他的母亲生动地回忆起他的高烧、呼吸急促以及他们乘坐救护车去医院的情景。他住院了 3 天，从那以后再也没有住院过。过敏测试显示他对杂草花粉过敏。杰拉尔多睡觉时使用非过敏原枕头和床罩。
杰拉尔多的母亲解释说，在他目前的病情加重前 3 天，他在一个炎热的日子里和他的朋友们在游乐园里玩耍。杰拉尔多和他的朋友们跑过一个大喷泉。他的母亲说他浑身湿透了，并说：“他知道如果他淋湿了，他会得哮喘病的！”她回忆说，3 年前在一个朋友的生日聚会上，杰拉尔多在没有父母指示的情况下，没有和其他孩子一起冲过喷泉。从那以后，她就相信杰拉尔多会照顾好他“脆弱的肺”。现在，她对他在自我护理方面的退步感到沮丧。
