Since he was 2 years old, Gaites Fisher has had trouble breathing. In addition to severe asthma, Gaites has a condition in which his right aortic arch compresses his trachea, making it difficult for him to breathe. His mom, Angelaka Johnson, tried everything to help; she bought an air purifier, tried to track what triggered his attacks and researched endlessly for solutions to his asthma attacks.

But despite her best efforts, Gaites still ended up being hospitalized six times between the ages of 2 and 5. Allergies or a cold would sometimes trigger the attacks, and she would quickly find child care for her other two children and rush Gaites to the hospital.

“(I felt) like I failed as a mom because I couldn't get his asthma under control. And I didn't know how to help him more,” she said. “And I always felt so defeated having to go to the hospital, knowing we’ll probably end up staying overnight.”

In June 2025, after another hospital stay at Cook Children’s, Angelaka got a phone call about a program that aimed to help her and her son with his asthma.

“I didn’t know what to expect. I thought we would just be on the phone and she would give me info that I already had; that it would be more redundant,’ she said. “And it ended up being a lot more helpful than that.”

The Cook Children's Healthy Homes Program, which celebrated its 10-year anniversary in January, provides free resources, support and education for families and children with severe asthma. Since its inception in 2016, staff have served 1,556 children across the eight-county service area. The goal of the program is to identify and manage the source of kids’ asthma - like dust, dander or mold - and keep families from getting to the point where they need emergency care.

Marquietta Jones was formerly a Healthy Homes program coordinator for eight years and was recently promoted to care coordination supervisor.

She explained how families are brought into the program. Community health workers reach out to families who have had multiple asthma-related emergency department or urgent care visits in the previous six months. The staff reach out to the family and schedule either an over-the-phone or in-person assessment and questionnaire about their home environment and asthma history.

Over three months, families get free one-on-one support by a community health worker to identify home environmental triggers, secure supplies and services and, if needed, obtain referrals to social and medical support.

Angelaka says she was a little skeptical when Community Health Worker Cristina Cantu took her through the assessment, but she quickly realized Healthy Homes didn’t just talk about resources and support; they followed through.

“Usually when you do these things where people say they aren’t going to charge you, they make you jump through hoops to get the things you need, or it wasn’t the things you need. Where in this case, they kind of over delivered. I was surprised,” she said.

The most common triggers for asthma are respiratory infections, weather changes, pollen and dust, but it can be difficult to narrow down what factors in a home exacerbate those triggers. For example, dirty A/C vents, dusty ceiling fans and leaky sinks are all commonly overlooked household issues that can make asthma worse. A large part of the Healthy Homes program is educating families on how to identify and clean those problem areas.

Angelaka had done plenty of research on her own about how to help her son’s asthma, but he still often had flare-ups that sometimes led to hospital visits. The mother of three is a full-time graduate school student, and Gaites’ asthma and hospitalization were hard for the entire family.

To help with Gaites’ breathing, Angelaka bought an air purifier, cleaned the house frequently, monitored his time outside when the weather changed and tried to track his triggers. So when Cantu from Healthy Homes called to talk to her about asthma, Angelaka wondered what the community health worker could tell her that she hadn’t already looked into herself.

But Cantu did not just dump information on Angelaka; she asked her questions. Through the program’s opening assessment, Cantu and Angelaka were able to figure out what she was already doing and what other resources could help further. Then, Healthy Homes provided those resources.

For example, Cantu taught Angelaka how to make her own cleaning solution that seems to be healthier for Gaites. Angelaka used to clean with a standard, store-bought cleaner and assumed any kind of dust removal was helpful for her son. But when she switched to the other cleaner made with Castille soap, vinegar, baking soda and hot water, she noticed he seemed to be coughing less.

Similarly, Angelaka didn’t realize that not all air purifiers clean the air in the way her son needs; Jones recommended an air purifier that has both a carbon and a HEPA filter. Healthy Homes gave Angelaka this more powerful air purifier, which she said has made the biggest change.

“I can’t explain enough the difference the air purifier makes,” she said. “It has definitely made a difference to me. When he’s in here, he’s playing, he’s not coughing, not sneezing. When he comes in from playing in the backyard, the air is clean in here.”

The Healthy Homes’ website includes a plethora of information and tips on identifying and managing asthma triggers. 

Perhaps most importantly, Cantu gave Angelaka emotional support. Gaites is on the autism spectrum, and Cantu showed Angelaka a Facebook group for moms of children with autism. She checks in with the family about once a week and sends Angelaka info on community resources. She and Angelaka created a binder with all of Gaites’ medical information, triggers, and emergency plans that Angelaka gave to family members, babysitters and Gaites’ school.

The binder of emergency information has made Angelaka more confident that Gaites’ teachers or school nurses will be able to help him if he has a flare up. That sense of security has made it easier for her to focus in classes, because she’s not constantly worried about him.

“When you’ve exhausted all your other resources that you may know on your own to do, it's good to have a program like this that helps you find resources…so that you can be more proactive instead of reactive with those asthma symptoms,” Angelaka said.

Healthy Homes is intentional about providing that all-encompassing support for families, Jones said. Aside from providing families with supplies, the program can provide resources for financial support and other basic needs. Community health workers give parents information about all kinds of community resources, not just those related to asthma. And with monthly check-ins throughout the three-month program, community health workers help families feel less isolated.

Beyond the initial improvement in child’s asthma, community health workers want families to be empowered to continue that care for the rest of their lives.

“We encourage our parents to be advocates for their child,” Jones said. “We want to be able to empower those parents to find ways to eliminate those triggers and to make sure everyone that's in contact with that child is on one accord.”

About 9% of the children in Cook Children’s eight-county service area have asthma. While serious, asthma is manageable.

For families who don’t qualify for the full program, Healthy Homes mails out information that includes a link to the Healthy Homes website. The website has videos on common asthma triggers and medication methods, as well as downloadable booklets available in nine languages.

For families like Angelaka's, the Healthy Homes program can mean all the difference for kids with asthma. On average, families who go through the Healthy Homes program have a 75% decrease in the number of emergency room visits, according to Healthy Homes’ data. In the six months since Gaites completed the program, he has not been to the emergency room at all.

This is a change, his mom said, from the two visits per year he has had since he was 2 years old.

Angelaka said she’s glad that Gaites and his siblings can focus on just being kids instead of worrying about being sick.

“Because he likes to run, he likes to run and he likes to jump. And that means a lot to me for him to just be happy and to just play without worrying,” she said.

If your child has asthma, you can check out Healthy Homes website for resources on identifying and managing asthma triggers.

Michael Ramirez’s asthma has landed him in urgent care multiple times after asthma attacks that scared him and his mother. Recently, he visited Cook Children’s new clinic focused on helping kids with asthma: the Nelson Ku High Risk Asthma Clinic.

The clinic is named in honor Nelson Ku, an 11-year-old who died after an asthma attack in February 2024. Nelson’s parents, Peter and Beth Ku, are working with Cook Children’s to educate families, schools and sports organizations about the serious health impacts of asthma and the tools available to intervene when a child experiences an attack.

The clinic addresses the needs of high-risk asthma patients, both in a one-on-one clinical setting and through community education.

Kate DeVore, LCSW, Case Management Social Work Team Lead, was one of the social workers who introduced an initial quality improvement project that came before the high risk asthma clinic. Three years ago, she and her colleague Sarah Pitman, LMSW, started to identify barriers to care among kids who sought emergency care for asthma attacks. The goal was to reduce hospitalizations by helping patients and families manage their asthma.

“Sometimes a patient is in the hospital a lot because they have bad asthma, but sometimes it's because they don’t have access to their medications for a variety of reasons, or they don’t understand why they need their medications or how to use them correctly,” DeVore said.

Karen Schultz, M.D., medical director of Pulmonary Services at Cook Children’s, proposed a multidisciplinary program operating out of the multi-disciplinary clinic space on the third floor of the Dodson Specialty Clinics Building.

Patients are referred to the program if they meet the criteria to be considered “high-risk;” by having a certain number of visits to urgent care or the emergency room, hospitalizations or PICU admissions due to asthma.

Michael’s Urgent Care visits are why a doctor referred him to the clinic. When he and his grandmother, Yolanda Ramirez, arrived at the clinic, they met with the team of pulmonology clinicians and hospitalists. As the six-year-old played with plastic dinosaurs (his favorite is the Pterodactyl), Michael was evaluated by the team.

First, the respiratory therapist took Michael for a pulmonary function test, followed by an evaluation by Sara Gill, RN, who is the program coordinator. Miriam Alexander, M.D., a hospitalist, saw Michael next, followed by Child Life Specialist Abigail Hoekstra, who brought along “Asthma Abby,” a doll who helps the team demonstrate asthma symptoms. DeVore wrapped up the clinic time with a biopsychosocial assessment.

Together, the team seeks to figure out why a patient’s attacks are happening, how to better manage their asthma symptoms and possibly prevent future attacks.

Michael’s grandma said the visit was helpful in learning more about his triggers and his medication needs. For example, Michael will now take his inhaler every day instead of only when it seems like he needs it. They also plan to make sure the school has a spacer he can use with the inhaler. She also appreciated that the team gave her printouts of a lot of the information, so she can share it with Michael’s mom, who had to be out of town for the appointment.

Michael’s mom also has asthma, and Yolanda said it would have made all the difference to have the same resources for her daughter that her grandson now has. When her daughter first started having respiratory issues as a young girl, Yolanda did not realize it was asthma. It took a few months for her to realize what was going on and get the treatment she needed.

For his part, Michael said he listened to the doctors and that what they told him will help him with his asthma.

“Everybody was talking with him,” Yolanda said. “He’ll start asking a bunch of questions, sometimes random, but they’re listening to him.”

So far, the clinic is only open on Fridays, but that may change in the future. It has been open since May 2025 and the team has seen 88 kids so far. The team hopes that each family takes away a better understanding of their asthma triggers, care and management.

“Asthma is on such a spectrum,” said Gill, who herself has asthma. “It can be very manageable but it can also be so severe. A lot of people don’t take it that seriously until they’re hospitalized. I would like to be able to get a lot more education out there and get it to the point that they are taking it more seriously and have the education they need to stay out of the hospital.”

The clinic’s reach also stretches far beyond the hospital walls. Patients and families have access to Cook Children’s Healthy Homes Asthma Disease Management Program, which sends community health workers into patients’ homes to manage triggers.

A large portion of the program is focused on creating more partnerships with community groups and schools. The Nelson Ku High Risk Asthma Program will join existing programs, like Asthma 411, and the School Nurse Symposium in June, as well as pursue new collaborations.

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Nelson Ku didn’t just attend school, he starred in it. The hallways and classrooms of Fort Worth’s All Saint’s Episcopal School were center stage for his uncanny ability to make his friends and classmates laugh. Nelson was known as a smile maker and deeply loved for it.

“Nelson loved going to school because of his love for his classmates,” said Nelson’s father, Peter Ku, D.D.S., a long-time Fort Worth dentist and a member of the Board of Trustees for Cook Children’s Health Care System. “He loved hanging out with them. His love for his friends is why he enjoyed so much being silly and trying to make others laugh.”

So when an asthma attack during Lacrosse practice took his life in February 2024, it devastated the All Saint’s community and left Nelson’s father, mother, Beth, and big brother, Marshall, reeling from their loss. Nelson was just 11 years old when he died.

“That morning I woke up and got ready to go to the office, kissed him in the back of the head and said, ‘Nelson, I love you.’ And he said, ‘Dad, I love you too,’” Dr. Ku said. “I never imagined I’d get a phone call at 4 that evening and never hear him again.”

It’s a call that no parent can fathom, and many question how anyone could go on after. Yet, while still walking through their own deep sorrow, the Ku family is finding comfort and purpose in their faith in Christ and in bringing awareness to the complications of asthma.

Finding Purpose in Tragedy

Dr. Ku and his wife, Beth, believe proper training and education, coupled with the use of rescue tools, could have made a difference in Nelson’s life that day. In hopes of saving others, they are working with Cook Children’s to educate families, schools and sports organizations about the serious health impacts of asthma and the tools available to intervene when a child experiences an attack. The couple hopes asthma rescue medications and resources will one day be as standard in schools, on practice fields and at every sporting event as automatic external defibrillators (AEDs) are today.

In June, Cook Children’s officially launched a new program to help children and families better manage asthma and its hidden threats. It’s known as the Nelson Ku High-Risk Asthma Program. The goal of the program is to identify and address the barriers to asthma care and symptom control of children who often seek care for the condition in the emergency department. The program aims to give them the education and tools they need to reduce the severity of their attacks and the need for hospitalization.

“We're glad to be able to recognize Nelson, but we don't want it to 100% be about him,” Dr. Ku said. “We want his story to make a difference. We want his story to inspire others to say, ‘Hey, asthma is important. We're going to do whatever we can to better protect our kids when it comes to this stuff.’ We’re trying to do things that make a difference.”

The Ku family wants parents, educators and coaches to know that asthma is a serious condition that cannot be taken for granted.

“I would imagine death from asthma isn't one of the higher children's fatality statistics, but at the end of the day, one life being lost to asthma is too many, which is, in my opinion, very controllable,” Dr. Ku said. “I love that the high-risk clinic allows those kids who really struggle with it to be able to find some hope in it.”

A Life Well Lived

In his 11 years, Nelson lived a lot of life.

When he wasn’t making his friends laugh, he did his best to pester his big brother, as most little brothers do. Although separated by a significant age gap, Dr. Ku says the brothers were “two peas in a pod.” They often spent time together down by the creek on the family’s property.

Marshall has a special memory of helping his little brother collect creek water to view under his new microscope, evidence of Nelson’s inquisitive nature and affinity for science.

“His favorite subject was science,” Dr. Ku said. “His science teacher told us that he would go to her classroom after school and when he had breaks to sit down with her and ask questions regarding things from outer space to creation to the human anatomy.”

In addition to collecting smiles from his friends, Nelson curated an impressive assortment of stuffed animals, including a life-sized plush black cat that became his favorite of all. Dr. Ku estimates he had about 15 piled high on his bed and would nestle into them every night.

“We would call it his nest,” Dr. Ku said. “He would put all his stuffed animals around and just kind of scrunch in the middle of all that, plus have covers on him. Looking back, it just showed his innocence, and I love that about him.”

Like it was for Nelson, that sweet collection of stuffed animals is now a source of comfort for his parents, reminding them of their son’s quirky nature, and in true Nelson fashion, bringing a smile to their faces.

The Nelson Ku High-Risk Asthma Clinic, named in honor of their beloved son, brings them a sense of solace, too.

“It means a lot to be able to find purpose,” Dr. Ku said. “I don't know how families do it if they aren't able to find how to utilize a tragic event to make a difference. It brings healing and it brings comfort and, honestly, in my opinion, it brings significance to nothing.”

RELATED STORIES:
A Breath of Fresh Air: Cook Children’s Healthy Homes Program Transforms Lives of Children with Asthma
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What is the Healthy Homes Asthma Program?

The Cook Children’s Healthy Homes Asthma Program, created in 2016, has helped thousands of families across the eight-county service area identify and minimize asthma triggers in the home. The goal is to manage the source of kids’ asthma -- like dust, dander or mold -- and keep families from getting to the point where they need emergency care. 

Weather changes, pollen and dust are the most common triggers the team identifies. The team will walk families through specific areas in the home that can become hot spots (like bedding, window blinds and ceiling fans) and how to manage them. Marquietta Jones, the program coordinator who has been a CHW for six years, is a big proponent of getting the kids involved in that cleaning process. 

The program is not just a conversation about cleaning, though. Healthy Homes provides education, coordination with community services and long-term planning to empower families to tackle their child’s asthma head-on. 

“Our families not only get the education, but they get it while walking hand-in-hand with the community health worker -- someone who is by their side to help them parse through the tons of information we’re inundated with and figure out which pieces are most applicable to them, putting it into practice.” Courtney Barnard, director of the Healthy Homes Program, said. “That’s where we see the success: in that the families walk away not only knowing more, but feeling confident that they can continue this beyond their time in the program.” 

The program begins when CHWs reach out to families who have had two or more emergency department visits or three or more urgent care visits in the past 12 months for asthma. The staff explain the program and schedule a home assessment. During the over-the-phone or in-home assessment, the CHW reviews the child’s asthma history and explores triggers that may be present in the home environment. 

Over three months, families get free one-on-one support by a CHW to identify home environmental triggers, secure supplies and services and, if needed, obtain referrals to social and medical supports. 

Families receive supplies like air purifiers, vacuum cleaners, mattress encasements, cleaning supplies and more. The team provides air duct cleaning, pest control and carpet cleaning free of charge for families. Through one-on-one coaching, families can talk through questions they should ask their doctor, how their child can be active safely and medication needs. 

One popular tool the team created is the action plan binder, which families say they use for years after leaving the program, said RoseMary Ragon, another CHW with Healthy Homes. The binder includes all the child’s medical information and a plan that lays out what to do for each stage of asthma symptoms. 

The team provides referrals to local social services, as well. Cristina Cantu, another CHW with Healthy Homes, said the team listens to the needs of the families that go beyond managing their asthma. 

“Our goal is to improve the overall health and wellbeing of the child by helping families address all the other needs they may have, like medical and dental providers, food, utility assistance, and counseling,” Cantu said. 

‘’It's About Having the Education"

Since 2018, Healthy Homes has enrolled 700 kids in the program and another 715 children who did not qualify for the full program have been provided with education and follow-up services. 

The data behind Healthy Homes is evidence of its success: families in the program saw an 85% decline in emergency room visits in the 12 months after enrollment. But the full impact of the program is even more apparent in family’s survey responses, which usually mention their CHW by name. 

One person wrote that their son was in the hospital at least every three months, and sometimes four times a month, for asthma attacks. But the CHW on their case helped them clean the air ducts, gave them an air purifier and cleaning soap that helped control his asthma. 

“[My CHW] and this program was such a blessing to my family…” they wrote. “My son hasn’t been to the hospital since with asthma related problems. Thank you sooooo much for the help and guidance.” 

“Mold and dust removal was the best thing,” another participant wrote in their survey. “[My CHW] was such a big help and she really went above and beyond informing me of all the asthma triggers. She is very well informed and that is what really helps, having the right people that want to help and not just doing a job. Thank you for all your staff members.” 

Jones said she loves those “aha” moments where a family discovers something simple, like changing a child’s clothes after they play outside, that makes a huge difference for their child’s asthma. 

“It’s about having the education, if you don’t know, you don’t know. It's not a curable disease, but it's manageable,” Jones said. “It can be something simple and they’re like ‘I didn’t think about that.’” 

Jones, Ragon, Cantu and Valcourt all emphasized the bond they form with their families, and the glow they feel when families become empowered in tackling their child’s asthma. 

“When your child has asthma, you have that overwhelming feeling, like ‘oh my gosh, what do I do?” Valcourt said. “To me, the biggest thing I take away from it is knowing that after they leave the program, most of the families say, now I can manage the treatment in the home.” 

For families who don’t qualify for the full program, the program provides education that can be just as life changing. The website has videos on common asthma triggers and medication methods, as well as downloadable booklets available in nine languages. The CHWs walk families through all of that information. 

Ragon said families have revisited the videos for years because of how useful they are.

“I get a lot of feedback on that video; Families who have had a child with asthma for years will say, ‘I learned new things from this,’ and keep referring back to it, just like that (Action Plan) binder,” she said. “And they can always give us a call."

Next Steps 

The Healthy Homes Program is also looking beyond care in family’s homes. The goal is to educate school nurses, P.E. teachers, coaches, teachers and others about asthma and how to keep kids safe while being physically active. 

“Asthma is not a death sentence, there is so much people can do to help,” Barnard said. “We want parents to feel empowered that they have a lot of options that they can do to help their child. And we want to make sure they know what those are and how to do it.” 

Overall, the team hopes people leave the program with an understanding of managing asthma triggers, a good plan with their physician, an Asthma Action Plan and, most importantly, knowledge and confidence. 

Asthma is a big problem across the country with about 25 percent of children age 9 diagnosed. Children ages 6-9 are three times more likely to have asthma than others in the state of Texas.

Fortunately, most of those cases are mild and require only rare treatments with albuterol inhalers. However, some of those cases can be severe and can result in significant issues for families.

The social complications of asthma are costly:

1. Missed school for doctor visits, emergency room and hospital stays.
2. Missed work for families.
3. Decreased activity level resulting in other poor health outcomes.

There are times where these complications might be unavoidable. But these should be very, very rare cases.

I don’t believe that any general pediatrician should use physical activity restriction as a means to manage a child’s asthma.

Why? Most cases of asthma can be managed by the pediatrician and involve the following treatments:

Avoid Triggers

Allergies - If the child has allergies, make sure that he or she is on adequate treatment using a step approach to include antihistamines up to nasal steroid sprays.

Viral infections -Train your children to wash their hands frequently especially during winter months. Get your child a flu shot every year.

Stop smoking - If you are smoking, you do not get to tell your child that they cannot participate in sports. It’s hard to quit smoking, but it’s harder to be a child who wants to do an activity but can’t because their parent’s smoking makes their asthma too severe.

Develop a Treatment Plan

Treatment plans for asthma are called “asthma action plans.” Children with have asthma need one.

Treatment for asthma generally starts with albuterol on an as needed basis. This might be the case in a child who has rare symptoms or who only wheezes once or twice a year when they get a bad cold.

Treatment for asthma should include some type of daily medication for control if either of the following is present:

• Symptoms more than twice a week or a limitation in activities due to asthma
• Symptoms at night more than twice a month (waking up coughing or with difficulty breathing).

Refer to a pulmonologist

If you and your general pediatrician cannot seem to get a handle on your child’s asthma, request a referral to a pulmonologist or allergist before telling your child that he or she cannot participate in physical activity.

Here are a few guidelines based on current asthma severity that might help when you are managing asthma and physical activity:

• Children with well-controlled asthma who are symptom free should not be restricted in any way. They don’t get to run less or skip out if they are feeling well.

• Children who are having mild symptoms (cough from an upper respiratory infection) may need to be modified but sometimes do not need to be completely sedentary. (They can walk around the gym if everyone else is running.)

• Children with moderate to severe symptoms should be receiving medical care by the school nurse or their pediatrician. Asthma can be serious, even deadly so don’t wait to call if you are concerned.

Children with asthma can and should participate in physical activity. I do not believe that they should be restricted based on the recommendation of a general pediatrician alone.

Everything should be done to allow them to play first: avoiding triggers, treating aggressively, even to seeing a pulmonologist.

For more information about what is being done in our area to help prevent and treat asthma, check out the report from The Center for Children’s Health’s Asthma Think Tank-Childhood Asthma: A Guide to Action.