Homes - Indoor Air Quality
Asthma & Indoor Air Quality
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
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.
Steps For Reducing Or Avoiding Pollutants That May Trigger
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.
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.
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.
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
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.
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.
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.
chemicals in laboratories or art supplies can trigger asthma
episodes. Make sure ventilation is adequate.
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%.
is a serious lung disease. During an asthma attack, the
bodys 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.
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.
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.
be "caught" from someone else
be cured (but it sometimes becomes less serious)
be controlled; the cause of asthma is not known, but we
do know what triggers asthma episodes.
and Economic Effects
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:
deaths per year
million days of restricted activity
to $9 billion a year in direct and indirect costs
million missed school days per year
with asthma can lead normal lives. Control of asthma can
be accomplished through:
of environmental asthma triggers
selection and use of medications
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.
all asthma patients can become free of symptoms with proper
treatment. Patients and their families should expect nothing
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
do I find out about my triggers?
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.)
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.
Indoor Asthma Triggers
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,
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.
can be triggered by the smoke from the burning end of a
cigarette, pipe, or cigar, or the smoke exhaled by a smoker.
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.
addition, children exposed to secondhand smoke are more
likely to suffer from pneumonia, bronchitis, and other lung
diseases, as well as ear infections.
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.
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
to house dust mites and their droppings can trigger asthma
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.
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
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.
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
pets out of the bedroom and other sleeping areas at all
times, and keeping the door closed
pets away from fabric-covered furniture, carpets, and
individuals with asthma stay away from the pet
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.
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.
fix a mold problem, you should do two things:
the water or humidity problem
clean up the mold
a plumbing leak or raising the temperature of cold surfaces
where moisture condenses by adding insulation
a leak or other water damage occurs, drying all water-damaged
areas completely within 24 to 48 hours
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.
drip pans in your air conditioner, refrigerator, and dehumidifier
clean and dry
exhaust fans or opening windows in kitchens and bathrooms
when showering, cooking, or using the dishwasher
clothes dryers to the outside
low indoor humidity (between 35-55% relative humidity)
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).
to household pests (such as cockroaches and rodents) can
trigger asthma symptoms in some individuals.
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.
Pests (visit Insects,
Spiders, Mice & More for more)
steps to manage pest problems include:
Do not leave food or garbage out
food in airtight containers
all food crumbs or spilled liquids right away
dishes when you are done using them, and do not leave
dirty dishes in the sink, especially overnight
counters, sinks, and tables clean and clear of clutter
plumbing leaks and other moisture problems
piles of boxes, newspapers, and other items where cockroaches
may hide out of your home
sure trash in your home is properly stored in containers
with lids that close securely, and remove trash daily
using poison bait, boric acid (for cockroaches), or traps
before using pesticide sprays
clutter, dust catchers
or eliminate carpeting
a high-performance vacuum cleaner (Let a helper without
asthma do the vacuuming.)
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.
meds (also known as bronchodilators)
meds (also known as Preventers)
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:
medications open the airways and are taken to relieve
the symptoms of an acute asthma episode.
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.
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.)
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.
to reduce lung mucus can also be prescribed.
Pesticide Sprays to Control Pests
pesticide sprays are used to control pests:
the spray to the infested area
not spray where you prepare or store food, or where young
children play, crawl, or sleep
follow instructions on the label
sure there is plenty of fresh air when you spray, and
keep people with asthma out of the room
of Rights for Children with Allergies and Asthma
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
cared for by a supportive physician who provides preventive
management of asthma and allergies as well as treatment
for acute episodes
in a smoke-free environment where reasonable attempts
at eliminating relevant allergens are made
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
self-management skills to minimize dependence on medical
personnel, emergency clinics, and hospitalizations
teachers, school nurses, coaches, camp counselors, and
other adults entrusted with their care to understand the
enlightened handling of children with asthma and allergies
information about AAN-MA is available on their website
access an Asthma PowerPoint Presentation click
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