Title: Indoor Environmental Quality: Health Effects, Asthma, and Asthma Triggers
1Indoor Environmental Quality Health Effects,
Asthma, and Asthma Triggers
- John W. Martyny, Ph.D., CIH
Tri-County Health Department
2Sources of IAQ Pollutants
- Outdoor pollution
- Indoor pollution
- Building material off-gassing
- Inadequate ventilation
3Forms of Indoor Pollutants
- Particles
- Liquids
- Fumes
- Mists
- Gases
- Vapors
- Physical Agents
4Dose Response
- The higher the dose the greater the response.
- Exceptions
- Allergens
- Carcinogens
5Chronic 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.
6Examples of specific pollutants
7Carbon 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)
8Nitrogen 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
9Fibrous 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
10Formaldehyde
- 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
11Suspended 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
12Volatile 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
13Lead
- 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
14Radon
- Sources
- Soil, building materials
- Health Concerns
- Lung cancer
- Normal Concentration
- 1.5 pci/l
- Acceptable Limits
- 4 pci/l
15Ozone
- 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
16Environmental Tobacco Smoke
- AKA
- Passive Smoking
- Involuntary Smoking
- Side-Stream Smoke
- Secondhand Smoke
-
17ETS 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).
18Why 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
21Lower 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
22Respiratory Symptoms
- Chronic cough, phlegm, and wheezing
- strong consistent evidence, especially for
preschool children - increased risks of about 20 to 40
- Asthma exacerbations
23Middle 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
25Emerging 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
26Conclusions
- 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
27Hypersensitivity Illnesses
28Types of Hypersensitivity Illnesses
- Allergies
- Allergic Rhinitis
- Hypersensitivity Pneumonitis
- Asthma
29Allergies
- 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
30Common Indoor Allergens
- Pollen grains and fungal spores
- Bacteria, protozoa, and fungi
- House dust mites
- Cockroaches
- Birds
- Mammals
31Immune System Responses Depend Upon
- Source material
- Host factors
- Duration of exposure
- Intensity of exposure
32Source Material
- Can it be allergenic?
- Will it penetrate into the lungs?
- Will it be removed quickly?
- Have there been prior exposures?
33Antigens
- 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.
34Host 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).
35Duration 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?
36Allergic 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.
37Hypersensitivity 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
38Hypersensitivity 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)
40Asthma
- www.epa.gov/iaq/asthma/index.html
41What is Asthma?
- Chronic Inflammatory Disorder of Airways
- Characterized by
- Recurrent Episodes of Airflow Limitation
- Airway constriction
- - Usually Reversible
- Spontaneously, or
- with Appropriate Treatment
42What Happens During Attack?
- Airways Narrow
- Mechanism
- - Tightening muscles surrounding airways
- - Swelling of inner lining of airways
- - Increase in mucus production /or
- inflammation
43Asthma Symptoms
- Coughing
- Wheezing
- Chest Tightness
- Shortness of Breath
44Asthma 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
45Asthma 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
46Rise in atopic diseases
- Allergies, eczema etc
- Atopy familial tendency to certain
hypersensitivities also on increase - Why? Research is ongoing
47High-Risk Populations (for asthma)
- Children
- Low-income, urban residents
- Minorities
- Those with hereditary predisposition
- Allergic individuals
48Emerging Science
- Overweight Possible risk factor
- of Siblings Possibly protective
- of Early Life infections Possibly
-
protective
49Children 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
50Low-Income, Urban Residents and Asthma
- Likely contributing factors
- - poverty
- - exposure to higher levels of
- allergens air pollution episodes
- - limited access to medical care
51Minorities 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
52Hereditary 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
53Common Asthma Triggers
- Allergens
- - molds
- - dust mites
- - cockroaches
- - animal dander
- - pollens
- - foods
- Irritants
- - ETS
- - strong odors
- - aerosols
- - VOCs
- - ozone
- - particulate
- matter
54Common 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)
55EPA Targeted Triggers
- Irritants (e.g. ETS)
- Dust Mites
- Cockroaches And Rodents
- Animal Dander
- Molds