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ITEP Training April , 2012 Kathleen Norlien

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Presentation on theme: "ITEP Training April , 2012 Kathleen Norlien"— Presentation transcript:

1 SETTING THE STAGE health effects of poor iaq, asthma and investigative principles
ITEP Training April , 2012 Kathleen Norlien Minnesota Department of Health

2 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 Environment Agent

3 Social Risk Factors and Health
Increased risk Poverty Poor housing quality Environmental exposures Poor nutrition/ food insecurity Safety Decreased access Language barriers Geographical barriers Inadequate health insurance Development of illness or disease Severity of illness or disease Adapted from the Medical Legal Partnership for Children

4 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 42.9% of adults 25.7% of children



7 Exposures Home Up to 90% School Other places Outdoors

8 Home Inspections: Hazards Found and Goals

9 Home Inspection Hazards (cont.)

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

11 Normal and Asthmatic Bronchiole

12 Common Symptoms of Asthma
Frequent cough, especially at night Shortness of breath or rapid breathing Chest tightness Chest pain Wheezing Fatigue

13 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

14 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

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

16 Development of Asthma in Sensitive Exacerbation of Asthma in Sensitive
Biological Chemical Biological Chemical Institute of Medicine Reports (2000)

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

18 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

19 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

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.

21 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

22 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 Libby Kelly et al. Indoor air and Asthma Libby Kelly; Elizabeth Erwin and Thomas Platts-Mills The Indoor Air and Asthma- the role of cat allergens 1/15/2012; Current Opinions in Pulmonary Medicine Lippincott Williams & Wilkens

23 Causal Associations Strength of the association
Dose-response relationship Consistency of the association Temporality of the association Specificity of the association Biologic plausibility

24 From the New Yorker Magazine

25 Traditional toxicology
The “dose” makes the poison How much (dose) How long (duration) How often (frequency) Route of exposure (ingestion, inhalation, dermal)

26 EHP- Loh, Levy, Spengler, et al.
EHP August 2007 Ranking Cancer Risks of Organic Hazardous Air Pollutants in the United States Miranda M. Loh,1, 2 Jonathan I. Levy,2 John D. Spengler,2 E. Andres Houseman,2,3 and Deborah H. Bennett2,4

27 Micro Environments

28 My Nose Knows Dr. Susan Schiffman
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

29 Odor is not indicative of the potential for harm
Carbon monoxide Benzene Hydrogen sulfide No odor at levels that can cause death Carcinogen at low levels; odor sometimes perceived as “sweet” Smells like rotten eggs at levels lower than health risk occurs

30 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

31 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…

32 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



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