A Look at Some

Key Asthma

Irritants…Drew Evans, Leah Moore, James Waldron

EVE 486

October 21, 2009

What to expect… Asthma: General Overview Cockroaches Mold Environmental Tobacco Smoke

Presentation Overview

What is asthma? Asthma is a lung condition that makes breathing more difficult for asthmatics than for others

• Airways are inflamed (they swell and produce excess amounts of thick mucus)

• Oversensitivity to certain triggers (muscle around the airways tighten up when exposed)

The exact cause of asthma is unknown

• Hereditary

• Environment

Common Triggers

Exercise Allergens

• Pollen• Mold• Animal Dander• Cockroaches

WeatherAirborne Irritants/Pollutants

What to expect… Asthma: General Overview Cockroaches Mold Environmental Tobacco Smoke

Presentation Overview

Trigger: Cockroaches Most common:

• Blatella germania (German)• Periploneta americana (American)• Blatella orientalis (Oriental)

Proteins, referred to as allergens, that can affect asthma are primarily found in a cockroach’s digestive enzymes, feces, and body parts

These allergens are easily kicked up into the air while vacuuming, making the bed, or walking across the carpet

Cockroach Case Study #1Role of Cockroach Allergy and Exposure to High

Levels of Cockroach Allergen in Causing Morbidity Among Inner-City Children with Asthma (Nov. 1992 – Oct. 1993)

- 476 asthmatic children (aged 4-9) from eight U.S. inner-city areas

- 36.8% allergic to cockroach allergen- 50.2% of bedrooms contained HIGH levels of

cockroach allergen in the dust- The allergic children exposed to high levels experienced:

0.37 hospitalizations/year (versus 0.11 for other children)

2.56 unscheduled medical visits/year (versus 1.43 for other children)

Overall, more days of wheezing, missed school, and nights with lost sleep

Cockroach Case Study #2Early-Life Environmental Risk Factors for

Asthma: Findings from the Children’s Health Study

- Case-Control Study nested in the CHS - 691 Subjects: 279 cases (with asthma)

412 controls (asthma-free)

- Children exposed in 1st year and after to get ‘any’ asthma – OR = 2.03- Children exposed in 1st year and after to get ‘early persistent’ asthma – OR = 2.13- Children exposed in 1st year and after to get ‘late-onset’

asthma – OR = 1.85- Any exposure resulted in early transient wheezing – OR = 3.05

Cockroach Preventions Keep food and garbage stored in sealed

containers Clean up food and liquid spills

immediately Clean dishes as soon as you are done

using them Fix leaks and other moisture problems

quickly Keep counters and the floor free of clutter Remove boxes, piles of papers, and other

hiding places Seal cracks in and around cabinets

What to expect… Asthma: General Overview Cockroaches Mold Environmental Tobacco Smoke

Presentation Overview

Trigger: Mold Common Types:

• Cladosporium

• Penicillium

Molds can produce spores which, when disturbed migrate through the air and can grow on almost any type of substance as long as moisture is present.

Even if the spores are dead, the allergens associated with them can be problematic for years.

Mold Case Study #1Levels of Household Mold Associated with Respiratory Symptoms in the First Year of

Life in a Cohort at Risk for Asthma

- 880 infants were examined

- Respiratory symptoms increase by 20% for each increase in mold level found in home.

Mold Case Study #2Moisture Damage and Childhood Asthma: A Population-Based Incident Case Control

Study

- 363 new cases of asthma (12-84 months)

- Presence of visible mold in the home shown not only to strike up asthma, but also plays into the development of persistent asthma.

Mold Preventions Fix leaks quickly

Dry damp areas

Lower the level of humidity (dehumidifier or cracking a window to allow proper ventilation

Keep drip pans clean (heat pumps, dehumidifier)

Vent clothes dryers to the outside

What to expect… Asthma: General Overview Cockroaches Mold Environmental Tobacco Smoke

Presentation Overview

Trigger: Environmental Tobacco Smoke

Sources:– Exhaled smoke – Side Stream Smoke

Second hand smoke has 4,000 substances, including about 60 carcinogens.

Tobacco smoke irritates the bronchial passageways of people with asthma.

Cigarette Smoke Case Study #1

Environmental Tobacco Smoke and Adult-Onset Asthma: A Population-Based Incident Case–Control Study (Sept. 1997-March 2000)

- 239 Exposed Group- 487 Control Group

- Asthma patients reported higher exposure to tobacco smoke at both home and work place.

- 49.2% of asthma is attributable to ETS

Cigarette Smoke Case Study #2

The Burden of Environmental Tobacco Smoke Exposure on the Respiratory Health of Children

- Children ages 2 Months to 5 years with parents that smoke in the household1835 children exposed 1-19 cigarettes smoked in the house

1114 children exposed 20 or more cigarettes smoked in the house

-Odds Ratio : Ages 2 Months to 5 year1 to 19 >20 (cigs per day)

Diagnosed Asthma 1.2 2.1Chronic Bronchitis 1.3 1.3

Wheezing (3 episodes per year)

1.2 1.2

Cigarette Smoke Preventions

Don’t smoke in homes or cars

Don’t smoke around children and people with asthma

Don’t go to places where people smoke

References“Asthma.” kidshealth.org. The Nemours Foundation, n.d. Web. 9 Oct. 2009.

<http://kidshealth.org/teen/diseases_conditions/respiratory/asthma.html#>.

Stöppler, Melissa Conrad, and William C. Shiel Jr. “Indoor Allergens.” MedicineNet.com. MedicineNet, Inc., n.d. Web. 9 Oct. 2009. <http://www.medicinenet.com/indoor_allergens/article.htm>.

“Cockroaches and Pests.” epa.gov. U.S. Environmental Protection Agency, 29 Jan. 2009. Web. 9 Oct. 2009. <http://www.epa.gov/asthma/pests.html>.

Rosenstreich, David L. “The Role of Cockroach Allergy and Exposure to Cockroach Allergen in Causing Morbidity among Inner-City Children with Asthma.” The New England Journal of Medicine. Volume 336:1356-1363 (8 May 1997). Web. 9 Oct. 2009. <http://content.nejm.org/cgi/content/abstract/336/19/1356>.

ReferencesSalam, Muhammad Towhid. “Early-Life Environmental Risk Factors for Asthma:

Findings from the Children’s Health Study.” Environmental Health Perspectives. Volume 112:6 (May 2004). Web. 10 Oct. 2009. <http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1241973>.

“Mold Remediation in Schools and Commercial Buildings.” epa.gov. U.S. Environmental Protection Agency, 18 Sept. 2008. Web. 9 Oct. 2009. <http://www.epa.gov/mold/append_b.html>.

Gent, Janneane F. “Levels of Household Mold Associated with Respiratory Symptoms in the First Year of Life in a Cohort at Risk for Asthma.” Environmental Health Perspectives. Volume 10:12 (December 2002). Web. 9 Oct. 2009. <http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1241132&blobtype=pdf>.

Pekkanen, J. “Moisture Damage and Childhood Asthma: A Population-Based Incident Case-Control.” European Respiratory Journal. Volume 29:3 (2007). Web. 9 Oct. 2009. <http://www.ersj.org.uk/cgi/content/full/29/3/509>.

“Facts About Mold.” nyc.gov. New York City Department of Health and Mental Hygiene, 2009. Web. 9 Oct. 2009. <http://www.nyc.gov/html/doh/html/epi/epimold.shtml>.

ReferencesAAP - Journal of the American Academy of Pediatrics. Web. 19 Oct. 2009.

<http://pediatrics.aappublications.org/cgi/reprint/101/2/e8>.

"Environmental Tobacco Smoke and Adult-Onset Asthma: A Population-Based Incident Case-Control Study -- Jaakkola et al. 93 (12): 2055 --." American Journal of Public Health. Web. 19 Oct. 2009. <http://www.ajph.org/cgi/content/full/93/12/2055>.

"Environmental Tobacco Smoke." Cancer Information | Cancer Meds | Leukemia | Colon Cancer | Lung Cancer | HIV/AIDS | Hepatitis | Mesothelioma. Web. 19 Oct. 2009. <http://www.meds.com/lung/smoking/environmental.html>.

"Secondhand Smoke | Indoor Environmental Asthma Triggers | US EPA." U.S. Environmental Protection Agency. Web. 19 Oct. 2009. <http://www.epa.gov/asthma/shs.html>.

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