Home Sweet (Healthy) Home?

1. Home Sweet (Healthy) Home? Michael Tsangaris MD Riley Children’s Specialists Pediatric Pulmonology

2. Scope of the problem In the midwest, about 9% of all children have asthma Asthma is the most common reason a child goes to the doctor when sick Asthma is the most common reason an adult has to miss work for a sick child

3. Asthma in America Every day…. • 40,000 people miss school of work due to asthma • 5,000 people visit ER for asthma • 1,000 people admitted to hospital for asthma • 11 people die from asthma Asthma and Allergy Foundation of America

5. Asthma in America • Asthma is the #1 cause of school absenteeism among children accounting for more than 14 million total missed days of school • African Americans are three times more likely to be hospitalized due to asthma Asthma and Allergy Foundation of America

10. Asthma in America • The annual cost of asthma is estimated to be nearly $18 billion • Direct costs accounted for nearly $10 billion (hospitalizations the single largest portion of direct cost) and indirect costs of $8 billion (lost earnings due to illness) Asthma and Allergy Foundation of America

13. Asthma in America Ethnic differences in asthma prevalence, morbidity and mortality are highly correlated with poverty, urban air quality, indoor allergens, and lack of patient education and inadequate medical care Asthma and Allergy Foundation of America

14. Air quality Ethnicity Asthma Morbidity And Mortality Socioeconomic status Indoor air quality Lack of patient education Inadequate medical care

16. Biologicals Dust mites Pet dander Cockroach Mold Chemicals Environmental tobacco smoke Nitrogen dioxide Formaldehyde and other volatile organic chemicals What can make a home unhealthy?

17. Dust mites • Tiny relatives of spiders • Live on mattresses, bedding, upholstered furniture, carpets, and curtains • Feed on the flakes of skin that people and pets shed daily • Thrive in warm, humid environment • CAN NEVER BE TOTALLY ELIMINATED! • They can reduced in number……

18. Dust mites-preventative strategy • Encase mattress & pillow in allergen impermeable covers • Wash all bedding and blankets weekly in hot water (130-140°F) • Use air conditioner or dehumidifier to keep relative humidity at < 50% • Use damp mop or rag to remove dust • Use vacuum with either a double-layered filter bag or HEPA filter

19. Pets and animals People react to proteins……. • secreted by oil glands and shed as dander • found in saliva and stick to fur when animals lick themselves • aerosolized urine from hamsters and guinea pigs

20. Pets and animals-preventative strategy • If possible, remove pets from home • Keep them out of bedrooms and confined to areas without carpet or upholstery • If possible, bathe the pet • Wear a dust mask and gloves when around hamsters • Wash hands after playing with pet • Dust often with damp cloth

21. Cockroach NIEHS and HUD survey 1998-2002 • About 2/3 of American homes have detectable levels of cockroach allergens • 10% of homes had cockroach allergen levels above the asthma symptom threshold • Cockroach allergen may be the most important risk factor in inner-city asthma

22. Cockroach eradication • Labor intensive and probably expensive • Efforts work, but effect is short lived • Best intervention is combination of education, home visitation, and professional extermination

23. Molds (not the root of all evil) • Good evidence to link molds to respiratory symptoms in people with asthma • No good evidence to link molds to a wide array of other health problems commonly associated with molds (chronic fatigue, neuropsychiatric disease, etc.) • Not all people develop respiratory symptoms around mold

24. Mold eradication • Identify sites of mold growth and clean with a fungicide • Dehumidify (25-50%) • Repair leaks • Maximize drainage • Run vent in bathroom • Clean refrigerator, dehumidifier and humidifier with fungicide

25. Environmental tobacco smoke(probably the root of all evil) • Exposure is hazardous from (before) cradle to grave • Don’t start (it is an addictive habit) • Get help to stop (NCI, ALA, CDC, ACS) • Seek smoke free environments in public areas • Don’t smoke in home or in car • Smoke outdoors. Leave “smoking jacket” outdoors

26. Nitrogen dioxide (NO2) • Primary source is gas-fueled cooking appliances • 2000 census: over 50% of US homes cook with gas • Vehicle emissions are a major source of NO2 • NO2 dissipated by wind patterns. Use exhaust fans while cooking with gas.

27. Nitrogen dioxide (NO2) • High concentration of NO2 can exacerbate underlying asthma • Lowering NO2 improves asthma symptoms • No evidence that high NO2 will lead to development of asthma

28. Nitrogen dioxide removal • Use vented space heaters • Use stove exhaust fan vented to outdoors • Make sure fireplace flue is open when in use • Make sure doors on wood stoves fit tightly • Do not idle cars inside attached garage

29. Formaldehyde • Commonly known as a preservative in medical labs and mortuaries • Also in permanent press fabrics • Widely used as a fungicide, germicide, and disinfectant • New carpet and new furniture are common sources of residential formaldehyde exposure

30. Formaldehyde removal • Use “exterior-grade” pressed wood products, building materials, cabinetry • Use air conditioning and dehumidifiers • Increase ventilation, especially after bringing new sources of formaldehyde into the home (new furniture, carpet, fresh paint job)

31. Toxic Mold • Stachybotrys chartarum (aka “black mold”) • Rarely grows alone. Often found with more common Aspergillus and Penicillium spcs • Implicated as a possible cause of hemorrhagic pulmonary hemosiderosis in 10 babies in Cleveland in 1994 (CDC report)

32. Toxic Mold • 1999 CDC reviewed the 1994 data and found no evidence of a link between toxic mold and HPH • Topic remains controversial and the basis of legal disputes throughout the country • No evidence for a link between toxic mold exposure and the development of asthma

33. Words of Wisdom Your not going to have an allergic reaction to something if you aren’t allergic to it!!