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From the resource-rich perspective of Le Bonheur Children’s Medical Center, Dr. Dennis Stokes can see across the gap to a place where asthma care merely means a mad dash to the ER.

To reach the families there, he just needs a better bridge.

Since joining Le Bonheur in September as chief of pulmonology, Stokes has been focused on building the quality and effectiveness of the hospital’s asthma-care program.

The challenge, he said, is not a shortage of methods and information for keeping the chronic condition in check. Today’s controller medications are highly effective, and newly revised guidelines from the National Institutes of Health set clear standards for asthma care.

“We have lots of tools to manage asthma, but getting them into the hands of families is the critical part,” Stokes said.

“One of the most important things is just having a care plan — knowing how to step up their therapy when a child has an asthma exacerbation. Many of them don’t have that simple written care plan, other than to go to the ER.”

In fewer American cities is the challenge greater than in Memphis. For 2008, it ranks fifth among the nation’s “Asthma Capitals,” according to a study of risk, prevalence and medical factors by the Asthma and Allergy Foundation of America.

That study cited Memphis for a range of troubles, including poverty, pollen and air quality. The city also scored worse than average on factors like self-reported asthma prevalence and the crude death rate for asthma.

Compounding those challenges, Stokes said, is the difficulty of dealing with both a large urban population and a referral population that’s largely rural, as well as navigating the various Medicaid regulations in Tennessee, Arkansas and Mississippi.

For Le Bonheur, which sees emergency asthma patients from across all those segments, a key goal is improving asthma care in order to reduce related hospital admissions. That means not only equipping patients and their families with quick-relief medications to treat asthma symptoms, but also maintaining their use of ongoing controller medications such as inhaled steroids.

“Getting them on those, making sure they’re on a high-enough dose and stepping down the dose when they’re doing well — it all requires ongoing monitoring,” Stokes said. “Not all patients get that.”

Le Bonheur’s effort to make asthma care one of its quality-of-care markers encompasses tracking its hospital admissions, following up with inpatient education and getting its “frequent flyer” ER visitors into asthma specialty programs.

Among asthma patients, particularly in places like Memphis, the obesity epidemic further complicates efforts to get asthma under control, Stokes said. In the long term, the same steroids that work so well to control asthma also predispose children to develop obesity. Obesity, in turn, works to aggravate asthma symptoms, creating a vicious cycle.

“Those are two huge problems in Memphis and they come together very frequently,” he said. “That’s often the most difficult group of kids to manage.”

In Memphis City Schools, asthma has been the most prevalent chronic condition among children, as it hits the poor, minorities and inner-city kids the hardest. A partnership in recent years between the school district and Le Bonheur showed the efficacy of school-based asthma case-management programs.

Stokes said he’s encouraged by efforts to improve asthma care in local schools, and hopes the healthcare and education communities in Memphis can continue to come together to reach families effectively.

“We really need a comprehensive approach within the city, because it’s too huge a problem for just one pulmonologist or even one hospital,” he said.

In seeking solutions for the asthma-care challenges in Memphis, Stokes said he’s also encouraged to be working in a healthcare atmosphere that spurs collaboration rather than competition.

“Developing multidisciplinary programs that serve the needs of patients is really what I’m interested in doing,” he said. “As long as we keep our focus on doing that and are providing a useful service, we’ll be fine.”

Stokes came to Memphis from Children’s Hospital of Dartmouth in New Hampshire. He received a master’s degree in public health in 2007, after working for many years on epidemiology and quality improvement for chronic illnesses like asthma. His other chief focus today is cystic fibrosis.

Stokes is one of four pulmonologists practicing together on primarily an outpatient specialty basis. They serve clinics in Memphis, Germantown and Jackson and are set to add a fourth clinic in Tupelo, Miss. They serve both Le Bonheur and St. Jude Children’s Research Hospital as pulmonary consultants.

Stokes previously practiced in Memphis at St. Jude from 1982-90, and at Vanderbilt Children’s Hospital from 1990-2000.

A native of western Kentucky, he completed his pediatric training at Johns Hopkins Hospital, where he was also a chief resident. He completed a fellowship in pediatric pulmonary diseases at Children’s Hospital Boston and has also worked at Riley Hospital for Children.

He and his wife, Pam, have two grown children: David, an artist living in Los Angeles, and Laura, a writer living in New York.



April 2008

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