Home Sweet Healthy Home

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Home Sweet (Healthy) Home?

• Michael Tsangaris MD
• Riley Childrens Specialists
• Pediatric Pulmonology

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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

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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

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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

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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

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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

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Air quality
Ethnicity
Asthma Morbidity And Mortality
Socioeconomic status
Indoor air quality
Lack of patient education
Inadequate medical care
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What can make a home unhealthy?

• Biologicals
• Dust mites
• Pet dander
• Cockroach
• Mold

• Chemicals
• Environmental tobacco smoke
• Nitrogen dioxide
• Formaldehyde and other volatile organic chemicals

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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

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Dust mites-preventative strategy

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

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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

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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

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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

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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

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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

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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

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Environmental tobacco smoke(probably the root of
all evil)

• Exposure is hazardous from (before) cradle to
  grave
• Dont start (it is an addictive habit)
• Get help to stop (NCI, ALA, CDC, ACS)
• Seek smoke free environments in public areas
• Dont smoke in home or in car
• Smoke outdoors. Leave smoking jacket outdoors

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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.

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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

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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

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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

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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)

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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)

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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

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Words of Wisdom

• Your not going to have an allergic reaction to
  something if you arent allergic to it!!