Download 1–SettingStage

SETTING THE STAGE
HEALTH EFFECTS OF POOR IAQ, ASTHMA
AND INVESTIGATIVE PRINCIPLES
ITEP Training
April 24-27, 2012
Kathleen Norlien
Minnesota Department of Health
651-201-4613
[email protected]
1
Environmental Exposures
• Source (agent)
• Chemical and gases (VOCs)
• Particulate (dust, glucans, endotoxins)
• Biologicals (fungus, bacteria, viruses)
• Routes of exposure/ delivery (environment)
• Ingestion
• Inhalation
• Dermal absorption
• Occupant (host)
• Age
• Sex
• Genetics
• Health status
• Behaviors
Host
2
Environment
Agent
Social Risk Factors and Health
Increased risk
• Poverty
• Poor housing quality
• Environmental exposures
• Poor nutrition/ food
insecurity
• Safety
Decreased access
Development
of illness or
disease
Severity of
illness or
disease
• Language barriers
• Geographical barriers
• Inadequate health insurance
Adapted from the Medical Legal Partnership for Children
3
Asthma Facts from Minnesota
• Currently have asthma
• 7.6% of Minnesota adults or about 260,000 (about 1 in 13)
• 7.0% of Minnesota children or about 76,000 (about 1 in 14)
• Economic impact of asthma is $421 million/ year
(AHRQ)
• $240 million for hospitalizations, emergency department visits
and medications
• $181 million for lost school and work days
• Minnesotans with asthma
• Healthcare provider advised changes to home, school, or work
environment
o 42.9% of adults
4
o 25.7% of children
5
6
Exposures
Home
Up to 90%
Outdoors
School
Other
places
7
Home Inspections:
Hazards Found and Goals
8
Home Inspection Hazards (cont.)
9
10
What is asthma?
Chronic disorder of the airways involving
•
Airflow obstruction
– Tightening
of the muscles surrounding airways
(bronchoconstriction/spasm)
– Over-production of sticky mucus in airways
Bronchial hyper-responsiveness
• Underlying inflammation (swelling) of airways
•
10
11
Normal and Asthmatic Bronchiole
11
12
Common Symptoms of Asthma
 Frequent cough, especially at night
 Shortness of breath or rapid breathing
 Chest tightness
 Chest pain
 Wheezing
 Fatigue
12
Asthma Medications
• Daily preventative
Examples: Flovent, Pulmicort, Advair, QVAR, Singulair
• Quick-relief
Examples: Albuterol such as Ventolin, Pro-Air, Proventil,
Xopenex
• Emergency
Steroids such as Prednisone, Oraped, Prelone,
Prednisolone
13
Asthma can be controlled!
Medical management: EPR-3 guidelines
Asthma Action Plan
•Provide education about asthma
•Review medication plans
•Teach self-management skills
Trigger management
•Help families reduce or eliminate environmental factors
in their home that contribute to the to control of asthma
(home visits, checklists, RETA-Home)
•Provide a “Healthy Home” for all
14
15
Another tool is a peak flow meter
 Measures how well child’s or adult’s lungs are doing at
moment compared to personal best peak flow
 System to help manage asthma symptoms
Green (>80%)-Yellow (50-79%)-Red (<50%)
 Helps students and families self-manage asthma by
providing objective measure to compare to symptoms
 Consistent with asthma action plans
15
Development of Asthma in Sensitive
Exacerbation of Asthma in Sensitive
Biological
Biological
Chemical
Chemical
16
17
Common Triggers
 Exercise/sports
 Cold air
 Viral/upper
respiratory infections
 Air pollution (Ex. O3,
NO2, SOx)
 ET– including
secondhand smoke
• Dust mites
• Fungi & mold
• Pests
• Pets
 Chemical irritants
and strong smells
 Diesel fumes
 Cleaning supplies
 Chalk dust
 Wood smoke
Other – Strong
emotions, weather
changes, some
medications
17
Health Effects
In children, secondhand smoke causes
• Premature death and disease
• Sudden Infant Death Syndrome (SIDS)
• Acute respiratory infections
• Middle ear disease
• More severe asthma
• Respiratory symptoms
• Slowed lung growth
Scientific evidence indicates no risk-free level of exposure to primary or
secondhand smoke
18
Health Effects (cont.)
In adults, secondhand smoke causes
• Coronary heart disease
• Stroke
• Chronic lung disease (emphysema,
bronchitis, asthma)
• Associated with cancer of the lungs,
bladder, mouth, esophagus, kidney,
stomach, pancreas, blood (acute myeloid
leukemia)
• Premature death
19
20
Dust Mites
• Microscopic relatives of the spider
• Eat skin cells shed by people
• Thrive in warm, humid environments
• Found in bedding, pillows, mattresses,
upholstered furniture, stuffed toys,
carpet, etc.
20
Dust Mites–Recommendations
Reduce
house dust, especially in bedroom
Reduce
clutter and dust-collecting items (stuffed toys)
Damp
dust book cases and furniture frequently
Vacuum
often when people with asthma/allergies are
out of area using HEPA-filtered vacuum cleaner
Use
allergen-proof (dust mite) covers on bedding
Wash
bedding in hot water (130˚F or 54.4 C)
Keep
room humidity < 50% if possible
Remove
carpeting from bedrooms
21
Role of Cat Allergens in Asthma
• Cat allergens very “sticky”
• Very high levels (Fel d1) found in homes with cat
• Lower levels found in schools and homes without a cat
• Even lower levels can sensitize a person
• Living with cat does not increase sensitization–
high levels of exposure may produce tolerance
• IgE antibodies for Fel d1 are strongly associated
with lung inflammation and symptomatic asthma
22
Libby Kelly et al. Indoor air and Asthma
Causal Associations
• Strength of the association
• Dose-response relationship
• Consistency of the association
• Temporality of the association
• Specificity of the association
• Biologic plausibility
23
24
From the New Yorker Magazine
Traditional toxicology
The “dose” makes the
poison
•How much (dose)
•How long (duration)
•How often (frequency)
•Route of exposure
(ingestion, inhalation, dermal)
25
EHP- Loh, Levy, Spengler, et al.
26
Micro Environments
27
My Nose Knows
Estimated 70-80% of
citizen-initiated
complaints to air
pollution control
authorities are
complaints about
environmental odor
sources
Dr. Susan Schiffman
Journal of Agromedicine, 2000
28
Odor is not indicative of the potential
for harm
• Carbon monoxide
• No odor at levels that can
cause death
• Benzene
• Carcinogen at low levels;
odor sometimes perceived
as “sweet”
• Hydrogen sulfide
• Smells like rotten eggs at
levels lower than health
risk occurs
29
Groups Most Sensitive to Odors
• Asthma sufferers
• Epileptics
---------------------------------------------• Young vs. old
• Women vs. men
• Pregnant women
• Non-smokers vs. smokers
• People with an empty stomach
• Time of day- morning vs. evening
30
Odors can make you sick…
• Eye, ear, nose and
throat irritation
• Headache
• Nausea
• Congestion
• Shortness of breath
• Stress
Symptoms generally
resolve once odor is
removed…
31
Chemicals
(OSHA Sensory Irritants)
• Cause inflammation
• Increases susceptibility to other irritants
• Increases susceptibility to infectious agents
• May lead to permanent injury or dysfunction
• May permit greater absorption of
other hazardous materials
• Adaptation to irritant may increase
risk of overexposure
32
33
www.retahome.org
34