What Is Asthma – How is it Connected to the Housing Environment? - PowerPoint Presentation

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What Is Asthma – How is it Connected to the Housing Environment?

Asthma is a serious lung disease. During an asthma attack, the airways get narrow, making it difficult to breathe. Symptoms of asthma include wheezing, shortness of breath, and coughing that typically require medications to get under control.

People with asthma are sensitive to very small particles that they breathe in from a variety of sources in the home that makes their breathing difficult. Most of the time these particles come from mold, dust mites, wood smoke, cigarette smoke, cooking odors, aerosol sprays, air fresheners, scented candles, paint fumes, pet dander and pollen.

When these particles affect someone with asthma, we often refer to them as asthma triggers. Which trigger causes someone with asthma to have breathing problems is difficult to identify. Someone may be bothered by one trigger and someone else by another. In most cases it may be more than one kind of trigger.

Children & Asthma

Asthma is one of the most common chronic childhood illnesses, affecting as many as 10% of children across the United States, with prevalence rates as high as 25% in some communities. Concentrations of substandard housing and poverty are major risk factors for asthma in US populations.

Indoor environmental exposures, particularly allergens and pollutants, are major contributors to asthma prevalence in children.

Children with severe and uncontrolled asthma are more likely to have allergic sensitization. Most children with severe asthma are sensitized to multiple environmental allergens.

While allergen exposure likely plays a significant, as many as 20% school-aged children with persistent asthma are not atopic, (not susceptible to allergen exposure), they are susceptible to pollutants and other airway irritants.

The Indoor Housing Environment

The indoor environment contains potentially numerous exposures to conditions that are suspected to influence the development, prevalence, and incidence of asthma.

Exposures include biologics (allergens, bacteria, or fungi), pollutant gases, and particulate matter from indoor (e.g., gas stoves and cigarette smoke) and outdoor sources Known indoor allergens and irritants include the house dust mite, domestic pets, mold, cockroach, mouse, environmental tobacco smoke, endotoxin, and air pollution.

Minimizing exposure to allergens and remediating the environment play a critical role in the treatment of asthma and allergies. The most effective environmental control measures are tailored multifaceted interventions which include education, thorough cleaning, using high-efficiency particulate air (HEPA) filters, integrated pest management, and maintenance of these practices.

What Are the Conditions in a Home that

Can Trigger an Asthma Attack?

Types of

Asthma

Triggers

There are generally two types of molecules that can trigger an asthma reaction:

allergenic

meaning someone has a sensitivity or is allergic to them or

irritant

meaning they produce distress reactions to their presence in the respiratory tract

Resulting in symptoms such as wheezing, coughing, and shortness of breath.

Sources of Asthma Triggers

Dust Mites

Dust mites are microscopic bugs found in everyone’s home. They live in dust and are often found on mattresses, pillows, carpets, upholstered furniture, curtains, bedcovers, clothes, stuffed toys, and fabric and fabric-covered items. They produce

tiny particles called allergens that can cause an allergic reaction. People with asthma who are sensitive to these allergens are at an increased risk of experiencing an asthma attack.

(Allergen)

Cockroaches

Droppings or body parts of cockroaches and other pests contain allergen particles that can trigger asthma.

These particles can become airborne and move around the home until they settle in dust or fabrics such as pillows, bedding or other dust-trapping fabrics. These particles can be present even when no cockroaches are observed.

(Allergen)

Mold

Molds grows on many surfaces and especially in damp places or where moisture accumulates like kitchens, bathrooms, and basements. Molds reproduce by sending spores into the air and when these spores are breathed in by someone who is allergic to them, they can trigger an asthma attack. (Allergen)

Dampness and Moisture

Damp or wet conditions in a home can contribute to the growth of mold, dust mites, and cockroaches. Damp conditions alone which tend to make rooms chillier also can lead to respiratory problems that can trigger asthma attacks. (Allergen/Irritant)

Sources of Asthma Triggers (cont.)

Rodents (Mice & Rats)

Skin, hair, and droppings from mice and rats produce allergen particles that for asthmatic children who are allergic to these particles can cause an allergic reaction which can increase their risk of an asthma attack. (Allergen)

Wood Stoves & Fireplaces

Emissions from wood smoke which include gases and solid materials including wood particles, carbon monoxide, nitrogen oxide, and other chemical compounds contribute to poor indoor air quality which can affect breathing and trigger an asthma attack. (Irritant)

Heating and Cooking Fuels

Nitrogen dioxide (NO

2

) is an odorless gas that can irritate eyes, nose and throat and cause shortness of breath. NO

2

 is produced from appliances that burn fuels such as gas, kerosene and wood. Exposure to NO

2

can make children with asthma susceptible to respiratory infections which in turn can increase the possibility of having an asthma incident.

(Irritant)

Secondhand Tobacco Smoke

When a person inhales tobacco smoke, irritating substances settle in the moist lining of the airway. Smoking also causes the lungs to make more mucus than normal which can build up in the airways and trigger an attack. Inhaling secondhand smoke, also called "passive smoke" may be even more harmful than actually 

smoking

. That's because the smoke that burns off the end of a cigar or cigarette contains more harmful substances (such as tar, 

carbon monoxide

, nicotine) than the smoke inhaled by the smoker and produce more irritant reactions.

(Irritant)

Sources of Asthma Triggers (cont.)

Pets

Asthma triggers from pets come from their dander (dead flakes of skin), feathers, saliva, urine, or feces that contain dust mites, pollen, and/or mold. (Allergen)

Cooking Odors

Certain food sensitivities can trigger an asthma reaction. Food odors can carry allergenic molecules that when breathed in can cause a reaction to some who is sensitive or allergic to the foods producing the odors. (Allergen)

Paints, Solvents, and Cleaning Product Fumes

Fumes from paints, solvents, and cleaning products such as bleach

contain

volatile organic compounds (VOCs) which can irritate the respiratory tract and exacerbate an asthma reaction.

(Irritant)

Perfumes/Fragrances/Air Fresheners

Perfumes and scents contain

volatile organic compounds (VOCs) which

can irritate the

respiratory tract triggering allergy symptoms, aggravate existing allergies and worsen asthma.

(Irritant)

Sources of Asthma Triggers (cont.)

Pollen

Pollen is a source of an allergen that can cause allergic asthma.

Most pollens that cause allergic reactions come from trees, weeds, and grasses, though some flowers also produce pollens that can cause asthmatic reactions. Grasses are the most common cause of allergies ragweed is the main source of weed allergies.

(Allergen)

Flowers

Some types of flower contain pollen that can cause an allergic reaction. For some people it is the strong fragrance of a flower that can produce respiratory irritants that can trigger or exacerbate an asthma attack.

(Allergen/Irritant)

Car Exhaust Fumes

A primary pollutant in car exhaust is nitrogen dioxide

(NO

2

). When inhaled in sufficient amounts it can strain airways and lead to inflammation and possible initiation or exacerbation of an asthma attack.

(Irritant)

Focus of Research on Addressing Conditions in the Home

Associated with Childhood Asthma

Elimination of moisture intrusion and leaks and removal of moldy items;

Improved insulation;

EPA air filtration;

Carpet cleaning and vacuuming;

V

entilation and dehumidification;

Bedding encasement and/or sheet and/or upholstery cleaning alone;

Use of pesticides for dust mite control

Integrated pest management (IPM) to reduce pest exposure - largely cockroach control;

Risk of

air cleaners releasing ozone

Multifaceted, tailored asthma interventions;

Focus of Research on Addressing Conditions in the Home

Associated with Childhood Asthma

Intervention/Remediation Programs

Crocker, D. D.,

Kinyota

, S., Dumitru, G. G.,

Ligon

, C. B., Herman, E. J.,

Ferdinands

, J. M., ... & Task Force on Community Preventive Services. (2011). Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review.

 American Journal of Preventive Medicine, 41

(2), S5-S32

.

Gruber, K. J., McKee-Huger, B., Richard, A., Byerly, B.,

Raczkowski

, J. L., & Wall, T. C. (2016). Removing asthma triggers and improving children's health: The Asthma Partnership Demonstration Project. 

Annals of Allergy, Asthma & Immunology

, 116(5), 408-414.

Krieger, J. W.,

Takaro

, T. K., &

Rabkin

, J. C. (2011). Breathing easier in Seattle: addressing asthma disparities through healthier housing. In 

Healthcare Disparities at the Crossroads with Healthcare Reform 

(pp. 359-383). Springer, Boston, MA.

Largo, T. W.,

Borgialli

, M.,

Wisinski

, C. L., Wahl, R. L., &

Priem

, W. F. (2011). Healthy Homes University: a home-based environmental intervention and education program for families with pediatric asthma in Michigan. 

Public Health Reports, 126

(1_suppl), 14-26.

Wright, L. S., &

Phipatanakul

, W. (2014). Environmental remediation in the treatment of allergy and asthma: latest updates. Current Allergy and Asthma Reports, 14(3), 419-427.

Focus of Research on Addressing Conditions in the Home

Associated with Childhood Asthma

Housing Code Violations

Beck, A. F., Huang, B.,

Chundur

, R., & Kahn, R. S. (2014). Housing code violation density associated with emergency department and hospital use by children with asthma. 

Health Affairs

, 33(11), 1993-2002.

Association of Childhood Asthma with Federal Rental Assistance

Boudreaux, M., Fenelon, A.,

Slopen

, N., & Newman, S. J. (2020). Association of childhood asthma with federal rental assistance. 

JAMA Pediatrics

, 174(6), 592-598.

Home Visits for Pediatric Asthma

Anderson, M. E., Zajac, L.,

Thanik

, E., & Galvez, M. (2020). Home visits for pediatric asthma-A strategy for comprehensive asthma management through prevention and reduction of environmental asthma triggers in the home. 

Current Problems in Pediatric and Adolescent Health Care

, 50(2), 100753.

Breysse

, J., Dixon, S., Gregory, J., Philby, M., Jacobs, D. E., & Krieger, J. (2014). Effect of weatherization combined with community health worker in-home education on asthma control. 

American Journal of Public Health

, 104(1), e57-e64.

Social Determinants of Health

Federico, M. J., McFarlane II, A. E.,

Szefler

, S. J., & Abrams, E. M. (2020). The impact of social determinants of health on children with asthma. 

The Journal of Allergy and Clinical Immunology: In Practice

, 8(6), 1808-1814.

Why Interventions May Not (

Appear) to Work

The volume or intensity of the intervention may fail to sufficiently reduce an exposure.

If the individual is not sensitized or exposed to the targeted allergen of the intervention,

there will not be a significant improvement.

Reducing exposure in one location, but not all, will likely be ineffective.

The intervention may be inadequate to reduce the level of allergen or airway irritant.

5. All sources of irritants may not be addressed with one intervention approach.

O'Connor, G. T. (2005). Allergen avoidance in asthma: what do we do now?. 

Journal of Allergy and Clinical Immunology

, 

116

(1), 26-30.

Contact Information

Kenneth Gruber, Ph.D.

Senior Research Scientist

kjgruber@uncg.edu

https://chcs.uncg.edu/