Gin g er L . C h e w , - PowerPoint Presentation

Slide1

Gin

ger L. Chew, ScDEpidemiologist, National Center for EnvironmentalHealthDivision of Environmental Hazards and Health EffectsCenters for Disease Control and Prevention

Co

n

t

r

olling

Mol

d

and

Moi

s

tu

r

e

f

or

B

e

tt

e

r

Co

n

t

r

olled

A

s

thma

Slide2

M

old, Allergy, and AsthmaGinger L. Chew, ScDHealth ScientistAir Pollution and Respiratory Health BranchNational Center for E

nvi

ronme

ntal

Hea

l

t

h

D

i

v

i

s

i

o

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f

E

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ro

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en

ta

l

H

a

z

a

r

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s

a

n

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He

a

l

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h

E

ff

ec

t

s

Slide3

C

urrent atle iesRyc grass BermudaD. pterooyssinus Ra vedD. farinae

Oak

R

u

ssia

n

t

h

i

s

tl

e

B

i

rc

h

A

.

a

lt

er

n

a

t

e Peanut CockroachA. fionigaiusShrimp Cowls milk E white Mouse

Among general population, where are indoor allergens in the hierarchy?

10

20 30 40 50*NHANES 2005-6 IgE data

Salo et al., J. Allergy Clin. Immunol, 2011

Slide4

Mol

d or Dampness and AsthmaType of reviewCriteria for sufficient evidenceConclusionInstitute of Medicine (IO

M)

re

port (

2004)

An

asso

c

i

atio

n

betw

e

e

n

th

e

ag

en

t

an

d the outcome has been observed in studies in which chance, bias, and confounding can be ruled out with re

asonable confidenceWheeze (yes)Asthmasy

mptoms

in sensitized persons (yes)Asthma development

(no)World Health Organization (2009)Same as above, but added this

text:

“For e

xample

, if

sev

e

r

a

l

s

ma

ll st

u

di

e

s

th

a

t

a

re

fr

e

e

fr

om

bias

an

d

c

o

nfo

u

n

di

n

g

sh

ow

a

n

asso

c

i

atio

n

tha

t is

c

o

nsiste

n

t

in

m

a

gn

itud

e

an

d

dir

e

ction

,

t

her

e

ma

y be s

u

f

f

i

c

i

e

n

t

e

vide

n

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e

of

a

n

asso

c

i

a

tion.”

Wh

ee

ze

(

y

es

)

A

s

th

m

a

s

y

m

pto

m

s

in

se

n

s

i

t

i

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d

p

ers

on

s

(

y

es

)

A

s

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m

a

d

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v

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lop

me

nt

(

y

es

)

S

y

s

t

ema

tic

Re

v

i

e

w (

M

e

nd

e

ll

e

t

a

l

2011

)

S

a

m

e

as above, but

a

lso

in

c

l

u

ded

e

vide

nc

e

fr

om qu

a

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ati

ve

met

a

-ana

lys

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s.

A

s

th

m

a d

e

v

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lop

me

nt

(

y

es

)

M

e

t

a

-

a

n

a

l

y

s

is

of bi

r

th

c

oho

r

t

s

tudi

e

s (

T

i

sc

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e

r

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l

2011

)

Si

gn

ifican

t

a

djust

e

d

odds

ratio

s

(

O

R

a

)

A

s

th

m

a d

e

v

e

lop

me

nt

(

y

es

)

M

e

t

a

-

a

n

a

l

y

s

is (Qu

a

n

sa

h

e

t

a

l

2012

)

Si

gn

ifican

t

summar

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eff

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t

estimates

A

s

th

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me

nt

(

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)

Slide5

Mol

d or Dampness and Asthma (2015 Review)“There is sufficient evidence of a causal associationbetween dampness or dampness related agen

ts

and

exa

cer

b

a

t

io

n

o

f

a

s

t

h

m

a

i

n

c

h

ildren.”Env. Health Perspectives 123(1):6-20, 2015

Slide6

Q

uantitative measurementsof mold·Proteins (i.e., Asp f 1 )·C a r b o h y

d

r a

t

e s

(

i

.

e

.

,

E

P

S

,

g l u c a n )·E r g o s t e r o l ( m e a s u r e d

by G C / M S )·M y c

o t

o x i n s·M i c r o b

i a l v o l a t i l e o r g a n

i c

c

o m

p

o

u

n

d

s

(

m

V

O

C

s

)

Slide7

W

hy are Mold Allergens so Difficult to Study?Which ones to choose?Batch-to-batch differences in

ext

rac

ts

Slide8

A

lternaria SpeciesAlternaria alternata– 57 different strains listed in the American Type CultureCollection (ATCC)·Alt

erna

ria

br

assi

c

ia

e

·

A

.

b

r

a

ss

i

c

ol

a

·

A

.

c

alendula

e·A. carthami·A. cassiae·A. chlamydosp

ora·A. chyrsanthemi·

A. c

ichorii·A. cinerariae·

A. circinans·A. citri·A. c

onso

rtiale

Slide9

A

llergens ingerminating vs. non-germinating mold sporesGreen, Tovey, Beezold, Perzanowski, Acosta, Divjan, and Chew. Sur

vei

lla

nce

of

f

u

ng

a

l

a

ll

er

g

i

c

s

e

nsiti

za

tio

n

usin

g fluorescent halogen immunoassay. J. Mycol. Med. 19(4): 253-261, 2009

Slide10

H

uman Activity affects airborne mold levelsConcentration of culturable spores (CFU/ cubic meter)Moldy bread into gar

bage

can

40

,0

0

0

30

,

00

0

20

,

00

0

10

,

00

0

0 22

48

96

1

26Time (minutes)Adapted from: Lehtonen and Repo

nen, Int. Biodet & Biodeg. 1993

Slide11

Ch

eaper and sometimes moreaccurate methodsQuestionnaireInspection

Slide12

M

old exposure and childhood asthma incidencein a Finnish prospective cohortJaakkola et al. Env. Health Perspect., 2005

Slide13

P

art A: Occurs in the clinic officeTool to Determine if a Home Assessment is Warranted forMold and Dampness(Part A)1During the past 12 months, have there b

een wa

ter p

roblem

s or dam

pn

e

ss

in

your

ho

m

e

f

r

om b

r

ok

e

n

pi

pes, leaks, heavy rain, or floods?Ii YesIi NoIi Don’t know2In the last 12 months, how often have you noticed

any moldy/musty smells inside your home?Ii Daily

Ii Wee

klyIi MonthlyIi A few times a yearIi Never

3In the last 12 months, was there fu

ngal g

rowth

cover

in

g

a

n

a

r

e

a

g

r

e

a

te

r

t

h

a

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qu

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s

ize

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a

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8

"

x

11

"

pi

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c

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p

a

p

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r

in

yo

u

r

h

o

m

e

?

Ii

Y

e

s

Ii

No

Ii

Don

’

t know

4

In

the past

12

m

onths,

h

ave

you no

t

ic

e

d

c

ond

e

nsation

on

w

i

n

dows in

your

ho

m

e

?

Ii

Y

e

s

Ii

No

Ii

Don

’

t know

5

Have

any

of

your

f

u

r

nis

h

i

n

gs,

c

lothes,

possessio

n

s

b

ee

n in

a buildi

n

g

that had

w

a

te

r

da

m

ag

e

?

Ii

Y

e

s

Ii

No

Ii

Don

’

t know

Slide14

Slide15

Pa

rt B: Occurs in the waiting room

Slide16

*

f r o m A S H R A E9 0 . 1 - 2 0 1 0 a n d B r i g g s R S , Z T T a y l o r , a

n d

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G L

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.

“

C l i m a t e C l a s s i f i c a t i o n f o r B u i l d i n

g E n e r g yCodes and Standards.

C

limate Zone Map of United States

Moist (A)Marine (C) Dry (B)

Roches

ter

:

r

;

1

Sn

att

h

a

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r

:

I

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n

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nat

i

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umbu

s

—

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ure

k

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a

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Jose

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ilmi

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on C

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ac

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—

W

il

mington

`—Washington,\--Washington,D.C.

—Durham- Raleigh

Werm•Humid Below

Red Line

Mi

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m

i

1

Slide17

G

reen vs. Control homes in Cincinnati(example of real-time data)90 80 70 6050

40

30

20

10

0

1

2

3

4

5

6

7

8 9 1 0 1 1 1 2 1 3 1 4 1 5 1 6 1 7 1 8Temperature

Mean Temperature of Green homes (Fahrenheit)

Mean T

emperature of Green homes (Celsius)Mean Te

mperature of Control homes(Fahrenheit)Mean Temperatu

re o

f Contr

ol ho

m

e

s

(

Cel

s

iu

s

)

H

o

m

e

Slide18

T

emperature Variation

Slide19

L

eads to humidity variation

Slide20

L

eads to mold growthMushroom

Slide21

A

cknowledgmentsThe EnvironmentalAllergens WorkgroupJay Portnoy (Chair) Charles Barnes Sachin BaxiGinger Chew Carl Grimes Elliott Horner Kevin KennedyDésiré

e Laren

as-

Linn

ema

nn

E

st

el

l

e

Leve

tin

D

a

v

i

d

Mil

l

er Wa

nda

Phipat

anakulJames Scott Brock Williams

Slide22

Th

ank youFor more information please contact Centers for Disease Control and Prevention1600 Cli

fton

Ro

ad

NE,

A

tl

an

t

a

,

G

A

3033

3

Tel

e

pho

n

e

:

1

-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: http://www.cdc.govTh

e findings and conclusions in this report

are those

of the authors and do not necessarilyr

epresent the official position of the Centers for Disease C

ontrol

and P

reven

tio

n.

N

at

ion

a

l

C

en

t

er

fo

r

E

nv

i

r

on

m

e

n

ta

l

H

e

a

l

t

h

A

ir

Pollu

t

i

o

n

a

nd

Respir

at

o

r

y

H

e

a

l

t

h

B

ra

n

c

h

Slide23

Richa

rd Johnson, PresidentCo-Chair, Fulton Asthma Improvement & Reduction Coalition (FAIR), Georgia Healthy Homes Coalition Air Allergen & Mold Testing, IncControlling Mold and

Mois

ture

for

Bette

r

Co

n

t

r

olled

A

s

thma

Slide24

Mold

& the Indoor EnvironmentRichard JohnsonFulton Asthma Improvement & ReductionCoalition co-chair

Slide25

277

Slide26

278

Outdoor SamplesAvg CountFrequency Found% Spores Identified% of 5,870SlidesBasidiospores18,8015,73776.19%97.7Aspergillus / Penicillium1,3615,4295.22%

92.5

Clado

sporium

2,654

5,160

9.67%

87.9

As

c

o

s

po

r

e

s

1,961

5,086

7.04%

86.6

98.13%

Slide27

279

Indoor SamplesAvgCountFrequencyFound% of SporesFound% of 13700SlidesAspergillus / Penicillium23,58712,58581.72%91.86Basidiospores3,6871

2,474

12.66%

91.05

C

la

d

o

s

p

o

ri

u

m

801

9,227

2.03%

67.35

Asc

o

s

p

or

e

s

367

7,7540.78%56.6097.20%

Slide28

Qua

ntity of Aspergillus/Penicillium Spores in theIndoor Air of Houses

< 5

0

0

49%

50

0

-

2

K

24%

2 K -

1

0 K

10

%

10

K

-

50 K10 %> 50 K7%280

Slide29

Number

out of 72 Spore types found in carpet dust associated with Health ConcernsAllergies: 25Respiratory issues: 27Headaches: 20All Health Issues: 62 of 72

Slide30

Th

e missing Piece of the puzzle282

Slide31

R

educing Indoor Mold & ParticulateFilters(Airborne Triggers) (Surface Triggers)Mold Spores Respirable particulateDust MiteCockroachRodentsHousekeeping Dehumidifiers

Mold in

Carpets

Dust

Mi

t

es

Cock

r

oa

c

hes

R

ode

n

ts

P

e

s

t

Co

n

t

rolHouse Dust(Humidity) MoldDust Mites Cockroaches Rodents Humidity Bacteria/VirusMake Up Air: Chemical and Gases Dilution283

Slide32

Who

is telling the People?Drug Companies sell PharmaceuticalsAllergists treat allergiesEnvironmentalists focus on outdoor airPharmacists dispense drugsPulmonologists repair the lungsEmergen

cy roo

m doct

ors

stabi

l

i

z

e

the

p

a

tie

n

t

Landlo

r

d

s

min

i

mi

z

e

expensesHealth care educators focus on treatmentInsurance Companies pay for healthcareNone are responsible for hom

e improvement284

Slide33

R

emediationStop the water intrusionPrevent the spread of mold spores.Remove materials that cannot be cleaned.Kill the mold with a fungicide.Remove spores by wiping o

r vacuum

ing

,exhau

sti

n

g

the

v

acuum

out

s

id

e

.

Sea

l

the

r

emain

i

n

g

spores.Protect yourselfUse safe chemicals and encapsulants.285

Slide34

I

ntegrated Care ModelAsthma, COPD, and other diseases.PulmonologistAllergist

Pharmaci

s

t

I

ndoor E

n

vi

r

onme

n

t

a

l

i

s

t

Leg

i

s

l

a

ti

o

n

and Legal IssuesCase Worke

r/ Hospital/ Primary Care/ Parent286