Healthy Homes - Indoor Air Quality

About Asthma & Indoor Air Quality

Asthma is a serious problem in our society. It kills about 4,000 people a year and was estimated to cost $6.2 billion in medical care and lost time from school and work in 1990. Asthma is the leading chronic illness of children in the United States and the leading cause of school absenteeism due to chronic illness. Asthma deaths and the number of Americans diagnosed with asthma continue to increase each year.

The U.S. Environmental Protection Agency (EPA) supports asthma education and prevention as part of its general commitment to environmental and health protection and its specific commitment to environmental justice for all Americans. Environmental justice means that all people should have equal opportunity to live in a healthful environment. Where people are living in unhealthful environments, EPA is working to protect them by trying to reduce or eliminate their exposures to pollution.

Asthma can be aggravated by exposure to pollutant "triggers," such as certain components of vehicle exhaust and industrial emissions, tobacco smoke, pollen, and allergens from animals and insects. Often, urban environments have high levels of outdoor air pollution and pour housing conditions, which frequently are associated with increased levels of indoor air pollution. Disproportionate numbers of people of color and people from low income households live in these areas, and thus may be exposed to higher than average levels of air pollution, both indoors and outside. These exposures, along with other factors such as inadequate health care, may explain why roughly two to three times as many African-Americans as Caucasians die from asthma. Asthma also affects children disproportionately; five times more children than adults die from asthma each year.

EPA has made real progress in reducing air pollution that can cause problems for people with asthma. Levels of ozone, particles, and other contaminants in the outdoor air are decreasing in many places. EPA is also working to reduce pollution levels indoors, where many Americans spend 90% or more of their time. But there is still a long way to go, and everyone must be part of the solution. EPA can help people understand how air pollution can affect asthma, and how to prevent asthma episodes by reducing or avoiding exposure to potential triggers such as pollution.

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Simple Steps For Reducing Or Avoiding Pollutants That May Trigger Asthma Episodes

Outdoors

Use public transportation, carpool, and encourage everyone to limit polluting activities. Stay inside or avoid heavy outdoor exercise on days when pollutants such as ozone, sulfur dioxide, or pollen are high.

In the Home

Don't smoke indoors, unless you are in a room just for smokers, with a separate ventilation system to exhaust smoke outside. Never smoke around children or people with asthma.

Combustion gases and particles can cause breathing difficulties for people with asthma. Call the appliance service representative or local utility company to check combustion-powered furnaces, stoves, or heaters every year to make sure they're operating properly. Change furnace filters according to manufacturer's instructions, or every month or two during periods of use. Consider installing higher efficiency filters to reduce the number of particles in the air. Never use a gas stove to heat the home, and always use the exhaust fan when cooking on a gas stove.

Try to keep humidity levels between 30 and 50%, because high humidity can promote growth of biological agents that may trigger asthma episodes. Use exhaust fans or open windows in kitchen or bathroom areas when taking showers, cooking, or using the dishwasher. Make sure clothes dryers are vented to the outdoors, and use a dehumidifier in the basement if necessary.

If you're using a humidifier, clean it according to the manufacturer's instructions, and refill with fresh water every day so harmful microbes will not grow and be dispersed into the air.

Keep the house clean to reduce allergy-causing agents like microscopic dust mites, animal dander, and pollen. If you're allergic, use allergen-proof comforter and mattress covers, wash bedding in hot (130 F) water, and avoid furnishings which can collect dust. Get rid of cockroaches, and consider keeping pets out of the bedrooms of family members with asthma. Consider using a high efficiency vacuum filter or a vacuum system that's vented to the outside.

In Schools

Some people with asthma may be sensitive to allergens from classroom pets such as birds and gerbils. Keep cages clean and don't let animals roam.

Strong-smelling chemicals in laboratories or art supplies can trigger asthma episodes. Make sure ventilation is adequate.

Gyms, locker rooms, and libraries may be a source of dust and mold; make sure they are cleaned regularly and humidity levels are kept between 30 and 50%.

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FACTS ABOUT ASTHMA

Asthma is a serious lung disease. During an asthma attack, the body’s airways constrict, making it difficult to breathe. Symptoms of asthma include wheezing, shortness of breath, and coughing. Asthma can even cause death. The number of people with asthma increased by more than 150% from 1980 to 1998. It affects an estimated 17 million Americans, including nearly 5 million children.

What is Asthma?

Asthma is a chronic "reactive airway disease". This means that airways narrow, and breathing becomes difficult. The smaller breathing tubes (bronchioles) in the lungs react to an individual's "triggers" by narrowing: muscles in the bronchioles tighten, tissue becomes inflamed, and there is excessive mucus production. These factors combine to make breathing difficult. For a demonstration, try breathing through a drinking straw.

Asthma CAN be controlled. With proper care and treatment, most people with asthma can engage in nearly all activities and lead normal lives. While we are not sure why people have asthma, we do know what sorts of things cause asthma episodes.

Asthma...

• Cannot be "caught" from someone else
• Cannot be cured (but it sometimes becomes less serious)
• Can be controlled; the cause of asthma is not known, but we do know what triggers asthma episodes.

Health and Economic Effects

Asthma is especially worrisome because it is more prevalent among low income and minority groups. The national health and economic consequences of asthma are substantial, including:

• 5,000 deaths per year
• 470,000 hospitalizations
• 100 million days of restricted activity
• $7 to $9 billion a year in direct and indirect costs
• 10 million missed school days per year

People with asthma can lead normal lives. Control of asthma can be accomplished through:

• management of environmental asthma triggers
• proper selection and use of medications

The most important thing to know about asthma is that it can be controlled. While there is no cure for this disease, patients with even severe cases of asthma can learn to manage or avoid their asthma triggers. (They can set off an asthma episode, as explained below.) The other half of getting asthma under control is to identify and take the best medication.

"Almost all asthma patients can become free of symptoms with proper treatment. Patients and their families should expect nothing less."

Asthma is different from most other illnesses. There are many medications to treat this disease. (More about this later.) The important thing is that there is no one "best" medication. Different medications work better for some people than for others. This means that it is important for the patient to work with the doctor, telling him or her how helpful - or unhelpful - a particular medication is. In most cases, the doctor and patient must work together to find which medicine works the best. Likewise, the patient must become an "asthma detective", keeping track of the conditions and situations that are present when an attack occurs. Identifying common patterns will point to asthma "triggers" that will allow the patient additional control over this disease.

Asthma Triggers:

• What are triggers?
• How do I find out about my triggers?

An asthma trigger is something that can set off an asthma episode. There are hundreds of possible triggers, which differ from person to person. Triggers may be common allergens (dust mites, secondhand smoke, pollen, and mold); or they may have nothing to do with allergies. Some common, non-allergenic triggers include exercise, exposure to cold temperatures or strong emotions (fear, anxiety, excitement, etc.)

The best way to find out what your triggers are is to keep a diary. Write down what was going on before each asthma episode. List such things as indoors/outdoors, home (particular room), activity, time of day, season, presence of pets, dust, etc. This will show what the most common circumstances are when asthma episodes occur. Working together, you and your doctor should be able to determine common things, events or locations associated with asthma episodes.

Major Indoor Asthma Triggers

Asthma may be triggered by allergens and irritants that are common in homes. The following overheads in this presentation show what you can do to help control five major indoor triggers of asthma: secondhand smoke, dust mites, pet dander, molds, and pests.

Not all the asthma triggers shown here affect every person with asthma. Not all asthma triggers are listed here. You should see your doctor or health care provider for more information about the most effective way you can manage your child's or your own asthma.

Secondhand Smoke

Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or cigar, or the smoke exhaled by a smoker.

Children are especially vulnerable to secondhand tobacco smoke, and up to 1 million children with asthma have had their condition worsened by exposure to secondhand smoke. It is also a risk factor for new cases of asthma in children who have not previously displayed asthma symptoms.

In addition, children exposed to secondhand smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases, as well as ear infections.

Controlling Secondhand Smoke

Given the adverse health effects of secondhand smoke, it is important to avoid smoking in your home or car. Until you can quit smoking, you should smoke outside.

Dust Mites

Dust mites are tiny creatures that cannot be seen without magnification. They live in warm, humid places such as mattresses, pillows, carpets, fabric-covered furniture, bedcovers, clothes, and stuffed toys. Bedding provides an ideal environment for dust mites: warmth, moisture and an abundant supply of food (flaked-off skin).

Exposure to house dust mites and their droppings can trigger asthma attacks.

Controlling Dust Mites

Washing bedding in hot water has been shown to reduce dust mites. Since stuffed toys are a breeding ground for dust mites, choose toys that can be washed and thoroughly dried, and keep them off beds to reduce the exposure received during long hours of sleep. It may also help to put stuffed toys in the freezer for a day or so.

Zippered mattress and pillow covers that do not allow the mites to pass through appear to be effective in reducing the amount of exposure. While special "allergy" mattress covers are available, these are expensive. A less expensive alternative is to use a plastic mattress cover and a mattress pad. Launder all bedding in hot water (at least 130 degrees Fahrenheit).

Pets

Dander, urine, or saliva of warm-blooded animals (such as cats, dogs, mice, rats, gerbils, birds, etc.) can cause allergic reactions or trigger asthma. The most effective way to control exposure to triggers from animals is to keep your home pet-free.

Controlling Pet Problems

You might consider trying to find a new home for your pets, if necessary. If you do remove an animal from the home, do a thorough cleaning including floors, walls, and especially carpets and upholstered furniture. Also, be aware that triggers from pets can stay in the home for several months after the pet is removed even with cleaning. Some individuals may reduce their exposure by:

• Keeping pets in only one area of the home
• Keeping pets out of the bedroom and other sleeping areas at all times, and keeping the door closed
• Keeping pets away from fabric-covered furniture, carpets, and stuffed toys
• Keeping pets outside
• Ensuring individuals with asthma stay away from the pet

Molds

Some people's asthma can be triggered by mold. Molds can be found almost anywhere; they can grow on virtually any substance, provided moisture is present. There are molds that can grow on wood, paper, carpet, and foods. When excessive moisture accumulates in buildings or on building materials, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed.

There is no practical way to eliminate all mold and mold spores in the indoor environment. The best way to control indoor mold growth is to control moisture. Clean up the mold and get rid of excess water or moisture. Lowering moisture also helps reduce other triggers, such as dust mites and cockroaches.

Controlling Molds

To fix a mold problem, you should do two things:

• Fix the water or humidity problem
• Completely clean up the mold

Some examples include:

• Repairing a plumbing leak or raising the temperature of cold surfaces where moisture condenses by adding insulation
• If a leak or other water damage occurs, drying all water-damaged areas completely within 24 to 48 hours
• Washing mold off hard surfaces and drying completely - absorbent materials (ceiling tiles and carpet) may need to be replaced. Beware of mold spores when cleaning. Let a helper, without asthma, do the cleanup. A good quality dust mask or respirator may be necessary. Wet down dry mold before scrubbing.
• Keeping drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry
• Using exhaust fans or opening windows in kitchens and bathrooms when showering, cooking, or using the dishwasher
• Venting clothes dryers to the outside
• Maintaining low indoor humidity (between 35-55% relative humidity)

Be especially careful when cleaning mold. This is best done by someone other the person with asthma. Avoid producing dust when mold is cleaned - use a spray bottle to dampen dry mold. Beware of breathing mold spores released during cleaning. These can pose a serious health risk. If more than a few square feet are involved, get professional help (water damage restoration firms).

Pests

Exposure to household pests (such as cockroaches and rodents) can trigger asthma symptoms in some individuals.

An important key to pest control is to keep them from entering your home and to keep them away from food and water. Pesticides are toxic for people as well as pests, so try to use the least toxic methods for pest control.

Controlling Pests (visit Insects, Spiders, Mice & More for more)

Some steps to manage pest problems include:

• Do not leave food or garbage out
• Store food in airtight containers
• Clean all food crumbs or spilled liquids right away
• Wash dishes when you are done using them, and do not leave dirty dishes in the sink, especially overnight
• Keep counters, sinks, and tables clean and clear of clutter
• Fix plumbing leaks and other moisture problems
• Take piles of boxes, newspapers, and other items where cockroaches may hide out of your home
• Make sure trash in your home is properly stored in containers with lids that close securely, and remove trash daily
• Try using poison bait, boric acid (for cockroaches), or traps before using pesticide sprays

Housekeeping/Housecleaning:

• Avoid clutter, dust catchers
• Reduce or eliminate carpeting
• Use a high-performance vacuum cleaner (Let a helper without asthma do the vacuuming.)

Dust will aggravate asthma symptoms for many patients. Minimize knickknacks and dust catchers, which also make cleaning difficult. Carpeting can also hide many asthma triggers. If you have carpeting, vacuum regularly. Let another household member do this, or wear a good quality dust mask/respirator. Clean/shampoo carpets regularly. It is important to carefully follow instructions for carpet cleaning chemicals.

Asthma Medications:

Two types:

• Rescue meds (also known as bronchodilators)
• Maintenance meds (also known as Preventers)

Take your medicine! Make sure you are taking the right ones! We are not health care providers and can not be recommending medications. However, there is some general information about medications that is very important to convey:

• Bronchodilator medications open the airways and are taken to relieve the symptoms of an acute asthma episode.
• Maintenance medications (anti-inflammatory meds; corticosteroids) reduce the inflammation and sensitivity. If you think of the sensitive lung tissues of a person with asthma as being similar to sensitive skin after a sunburn, you can think of maintenance medication as protection for the lungs, much like sun blocker protects the skin from sunburn. Rescue medications are like treatments applied after the sunburn has happened.
• Sometimes patients get these two mixed up, and take the wrong ones. Sometimes people stop taking the maintenance medication because they feel better. This a mistake. (Consult your doctor before stopping or changing your medication.)
• Some people do not want to take steroids because of harmful effects they have heard of in athletes who take "steroids". This is also a mistake: a) steroids for asthma are different types of steroids and have very little harmful side effects; b) most steroids for asthmatics are taken by inhaler, directly into the lungs, so dosages are very small compared to pills or tablets.
• Medications to reduce lung mucus can also be prescribed.

Using Pesticide Sprays to Control Pests

If pesticide sprays are used to control pests:

• Limit the spray to the infested area
• Do not spray where you prepare or store food, or where young children play, crawl, or sleep
• Carefully follow instructions on the label
• Make sure there is plenty of fresh air when you spray, and keep people with asthma out of the room

Bill of Rights for Children with Allergies and Asthma

The Allergy and Asthma Network - Mothers of Asthmatics, Inc. (AAN-MA) is an organization dedicated to helping all people affected by allergies and asthma. The AAN-MA has released a Bill of Rights for Children with Allergies and Asthma. According to AAN-MA, a child with allergies and asthma and his/her family have the right to:

• Be presented with the proven scientific facts of asthma and allergies in a manner that raises appropriate concerns and avoids needless anxiety
• Be cared for by a supportive physician who provides preventive management of asthma and allergies as well as treatment for acute episodes
• Live in a smoke-free environment where reasonable attempts at eliminating relevant allergens are made
• Have full and personal access to appropriate medications and devices so that potential scholastic, athletic, and social achievements are not limited by otherwise uncontrolled asthma or allergies
• Learn self-management skills to minimize dependence on medical personnel, emergency clinics, and hospitalizations
• Expect teachers, school nurses, coaches, camp counselors, and other adults entrusted with their care to understand the enlightened handling of children with asthma and allergies
• More information about AAN-MA is available on their website at http://www.aanma.org
• To access an Asthma PowerPoint Presentation click here!

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