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Indoor Environmental Quality: Health Effects, Asthma, and Asthma Triggers

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John W. Martyny, Ph.D., CIH Tri-County Health Department Sources of IAQ Pollutants Outdoor pollution Indoor pollution Building material off-gassing Inadequate ... – PowerPoint PPT presentation

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Title: Indoor Environmental Quality: Health Effects, Asthma, and Asthma Triggers


1
Indoor Environmental Quality Health Effects,
Asthma, and Asthma Triggers
  • John W. Martyny, Ph.D., CIH

Tri-County Health Department
2
Sources of IAQ Pollutants
  • Outdoor pollution
  • Indoor pollution
  • Building material off-gassing
  • Inadequate ventilation

3
Forms of Indoor Pollutants
  • Particles
  • Liquids
  • Fumes
  • Mists
  • Gases
  • Vapors
  • Physical Agents

4
Dose Response
  • The higher the dose the greater the response.
  • Exceptions
  • Allergens
  • Carcinogens

5
Chronic vrs. Acute Effects
  • Acute
  • Immediately after exposure
  • May disappear quickly
  • Chronic
  • May appear months or years after initial exposure
  • Symptoms may slowly appear and not be reversible.

6
Examples of specific pollutants

7
Carbon Monoxide
  • Sources
  • forklifts, floor polishers, combustion sources
  • Health Concerns
  • headache, fatigue, poor vision, lack of
    coordination, CNS problems, coma, death.
  • Normal Concentration
  • Less than 10 ppm
  • Accepted Limits
  • ACGIH - 25ppm (lower at altitude)

8
Nitrogen Oxides
  • Sources
  • Fossil fuels, welding, outside air
  • Health Concerns
  • Upper respiratory irritation, pulmonary edema,
    asthmatic reactions.
  • Normal Concentration
  • Less than 0.1 ppm
  • Acceptable Limits
  • Nitrogen dioxide - 2 ppm

9
Fibrous Particles
  • Types - Asbestos Fiberglass
  • Sources
  • Insulation, duct lining, etc.
  • Health Concerns
  • Dermatitis, respiratory disease, cancer
  • Normal Concentration
  • Varies
  • Acceptable Limits
  • Asbestos - 0.1 f/cc Fiberglass - 1 f/cc

10
Formaldehyde
  • Sources
  • Insulation, pressed wood prod., textiles, etc.
  • Health Concerns
  • Mucous membrane irritation, chest tightening,
    asthmatic reactions, cancer.
  • Normal Concentration
  • Less than 0.01 ppm
  • Acceptable Limits
  • 0.3 ppm

11
Suspended Particles
  • Sources
  • Smoking, printers, building materials
  • Health Concerns
  • Eye Irritation, upper resp. irritation, etc.
  • Normal Concentration
  • Less than 0.01 mg/m3
  • Acceptable Limits
  • 5 - 10 mg/m3

12
Volatile Organic Compounds
  • Sources
  • Glues, carpeting, copy machines, cleaning
    compounds, paints, etc.
  • Health Concerns
  • Odors, headache, mucous membrane irritation,
    nausea, dizziness, etc.
  • Normal Concentration
  • Not well defined (TVOC lt 1mg/m3)
  • Acceptable Limits
  • Varies with compound

13
Lead
  • Sources
  • Lead paint, lead products, indoor firing ranges.
  • Health Concerns
  • Children - Decreased learning, neurotoxicity.
  • Adults - neuotoxicity, joint pain, weight loss,
    CNS damage
  • Normal Concentration
  • lt1 ug/m3
  • Acceptable Limits
  • lt 50ug/sq.ft. floor space

14
Radon
  • Sources
  • Soil, building materials
  • Health Concerns
  • Lung cancer
  • Normal Concentration
  • 1.5 pci/l
  • Acceptable Limits
  • 4 pci/l

15
Ozone
  • Sources
  • Copiers, air cleaners, outside air.
  • Health Concerns
  • Upper resp. irrit, pulmonary edema, asthmatic
    reactions.
  • Normal Concentrations
  • Less than 20 ppb
  • Acceptable Limits
  • 50 -100 ppb

16
Environmental Tobacco Smoke
  • AKA
  • Passive Smoking
  • Involuntary Smoking
  • Side-Stream Smoke
  • Secondhand Smoke

17
ETS Components
  • Composed primarily of sidestream smoke and
    exhaled mainstream smoke
  • complex mixture of gt4,000 compounds
  • Contains
  • gt 40 carcinogens (e.g., benzene,
    nitrosamines,
  • polycyclic aromatic hydrocarbons),
  • respiratory irritants (e.g., ammonia,
    formaldehyde,
  • sulfur dioxide),
  • reproductive toxicants (e.g., carbon
    monoxide,
  • nicotine).

18
Why Focus on Children?
  • Need is the greatest
  • Children particularly susceptible
  • Exposure is involuntary
  • Most children of smokers
  • are exposed in the home

19
Whats the Problem
  • 27 of homes with children age 6 under,
    regularly allow smoking
  • 9-12 million children under 5 are exposed in the
    home
  • 38 of children 2 mos. - 5 yrs are exposed in the
    home

20
Whats the Problem
  • Up to 1 million children have their asthma
    worsened (costing 200 million annually)
  • Estimated 700,000 - 1.6 million doctor
  • visits for ear infections
  • 150,000 - 300,000 cases of
  • bronchitis and pneumonia
  • annually in toddlers

21
Lower Respiratory Tract Infections
  • e.g., pneumonia, bronchitis, bronchiolitis
  • very strong, consistent evidence for infants and
    young children (up to about 3 years)
  • strongest effect from maternal smoking, but also
    evidence from paternal smoking
  • increased risks of about 50 to
  • 100 for young children
  • higher for young infants

22
Respiratory Symptoms
  • Chronic cough, phlegm, and wheezing
  • strong consistent evidence, especially for
    preschool children
  • increased risks of about 20 to 40
  • Asthma exacerbations

23
Middle Ear Disease
  • strong evidence for acute and chronic middle ear
    disease
  • fluid in the middle ear is the most common reason
    for operations in young children in the U.S.
  • increased risks of up to
  • about 20 to 40

24
Other Health Effects
  • Decreased lung function
  • small (lt10), but significant reduction in
  • lung growth/function
  • Decreased Fetal Growth
  • consistent evidence of small effect
  • for nonsmoking mothers
  • during pregnancy

25
Emerging Science
  • Cognitive and Behavioral Effects
  • Poor performance in school and
  • standardized and behavioral tests
  • Cardiovascular Effects
  • Adults and Children (stronger for adults)
  • Childhood Cancer
  • Suggestive evidence of leukemia brain tumors
  • SIDS
  • - Suggestive evidence of association

26
Conclusions
  • Strong international scientific consensus that
    ETS exposure causes increased risk of a variety
    of health effects in children
  • Increased risks of common ailments, coupled with
    widespread exposure, result in large public
    health impacts and financial costs
  • ETS exposure and resultant health effects in
    childhood may also increase the risk of further
    adverse effects in adulthood

27
Hypersensitivity Illnesses
28
Types of Hypersensitivity Illnesses
  • Allergies
  • Allergic Rhinitis
  • Hypersensitivity Pneumonitis
  • Asthma

29
Allergies
  • An immune-mediated state of hypersensitivity that
    results from exposure to an allergen.
  • Hypersensitivity is an exaggerated or
    inappropriate immune response.
  • Examples
  • hay fever, food allergies, horse serum

30
Common Indoor Allergens
  • Pollen grains and fungal spores
  • Bacteria, protozoa, and fungi
  • House dust mites
  • Cockroaches
  • Birds
  • Mammals

31
Immune System Responses Depend Upon
  • Source material
  • Host factors
  • Duration of exposure
  • Intensity of exposure

32
Source Material
  • Can it be allergenic?
  • Will it penetrate into the lungs?
  • Will it be removed quickly?
  • Have there been prior exposures?

33
Antigens
  • Must be recognized by the body as foreign.
  • Typically are relatively large molecules or are
    attached to larger molecules.
  • Plant and animal proteins are potent antigens.
  • Chromium, beryllium, etc.
  • Single amino acids and simple sugars are usually
    not antigenic.

34
Host Factors
  • ???????
  • Is the person atopic?
  • Do other family members have hypersensitivity
    diseases?
  • IgM, IgG, and IgE levels.
  • IgE is primarily responsible for release of
    histamine (Clinical allergy symptoms).

35
Duration and Intensity of Exposure
  • Will the allergen be in the lungs for a long
    period of time?
  • Can the respiratory tract remove the material?
  • Will the exposure be constant?

36
Allergic Rhinitis
  • Prevalence rate of 10 - 20 of population.
  • Sympt. - Runny and congested nose, inflamed
    throat and eyes, sneezing, etc.
  • Caused by IgE mediated inflammation and histamine
    release.
  • Allergens - dust mites, fungi, pollen, cats and
    dogs.

37
Hypersensitivity Pneumonitis
  • Caused by repeated or continuous exposure to
    antigenic substances.
  • Flu symptoms - chills, fever, malaise, cough,
    difficulty breathing.
  • Granulomatous lesions within the lung.
  • Easily misdiagnosed.
  • Sarcoidosis

38
Hypersensitivity Pneumonitis (Cont)
  • Frequently named after exposure pigeon-breeders
    disease, farmers lung.
  • Attack rate may vary from 15 to gt50.
  • Examples Hot tubs, Pools, Mold exposure.

39
(No Transcript)
40
Asthma
  • www.epa.gov/iaq/asthma/index.html

41
What is Asthma?
  • Chronic Inflammatory Disorder of Airways
  • Characterized by
  • Recurrent Episodes of Airflow Limitation
  • Airway constriction
  • - Usually Reversible
  • Spontaneously, or
  • with Appropriate Treatment

42
What Happens During Attack?
  • Airways Narrow
  • Mechanism
  • - Tightening muscles surrounding airways
  • - Swelling of inner lining of airways
  • - Increase in mucus production /or
  • inflammation

43
Asthma Symptoms
  • Coughing
  • Wheezing
  • Chest Tightness
  • Shortness of Breath

44
Asthma Facts
  • Over 27 million Americans have been diagnosed
    with asthma
  • Approx. 11 million Americans had at least 1
    asthma attack in the past year
  • On average, 14 people die each day from asthma

45
Asthma Facts
  • 6.2 billion spent on asthma in 1990
  • Self-reported prevalence rate increased 75 from
    1980-1994
  • National asthma-related hospitalizations
    increased 80,000 between 1979-1980
  • and 1993-1994

46
Rise in atopic diseases
  • Allergies, eczema etc
  • Atopy familial tendency to certain
    hypersensitivities also on increase
  • Why? Research is ongoing

47
High-Risk Populations (for asthma)
  • Children
  • Low-income, urban residents
  • Minorities
  • Those with hereditary predisposition
  • Allergic individuals

48
Emerging Science
  • Overweight Possible risk factor
  • of Siblings Possibly protective
  • of Early Life infections Possibly

  • protective

49
Children and Asthma
  • In 1980, 2.3 million American children had
    asthma. By 1995, the number of children with
    asthma had risen to 6 million.
  • 7.3 of children under age 18 have asthma
  • Asthma is the most common chronic illness in
    childhood the leading cause of missed school
    days due to chronic illness
  • Asthma mortality for children
  • is 5X higher than adults

50
Low-Income, Urban Residents and Asthma
  • Likely contributing factors
  • - poverty
  • - exposure to higher levels of
  • allergens air pollution episodes
  • - limited access to medical care

51
Minorities and Asthma
  • African-Americans
  • Children are 4X more likely to die from asthma
    than Caucasian children (in 1995)
  • Children have 3X greater hospitalization rate
    than Caucasian children
  • Some Hispanics
  • Prevalence of asthma is 11.2 in Puerto Ricans
    compared to 3.3 for non-Hispanic whites

52
Hereditary Predisposition and Asthma
  • Children with one asthmatic parent have 25
    greater risk of developing asthma than children
    of non-asthmatic parents
  • Children with two asthmatic parents have 50
    greater risk of developing asthma than children
    of non-asthmatic parents

53
Common Asthma Triggers
  • Allergens
  • - molds
  • - dust mites
  • - cockroaches
  • - animal dander
  • - pollens
  • - foods
  • Irritants
  • - ETS
  • - strong odors
  • - aerosols
  • - VOCs
  • - ozone
  • - particulate
  • matter

54
Common Asthma Triggers
  • Other
  • - viral respiratory infections
  • - emotional expressions
  • (stress, crying, laughing)
  • - changes in weather
  • (cold air, wind, humidity)
  • - exercise
  • - medications
  • - endocrine factors
  • (pregnancy, menstrual cycle, thyroid
  • disease)

55
EPA Targeted Triggers
  • Irritants (e.g. ETS)
  • Dust Mites
  • Cockroaches And Rodents
  • Animal Dander
  • Molds
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