Air Pollution And Asthma Indoor Air Pollution
Private industry and governmental agencies have gathered a large body of evidence that clearly shows that indoor air pollution is a much more formidable health hazard than outdoor air pollution.
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He has calculated that the average working adult spends twenty-three hours a day in some sort of closed environment. It thus seems ironic that the regulations of the Federal Clean Air Act primarily focus on outdoor air quality and virtually ignore the problem of indoor air pollution.
- Common asthma-inducing indoor air pollutants include asbestos in schools, offices, and homes; formaldehyde in hotels and mobile homes; and carbon monoxide in sports arenas and underground parking garages. Vapor barriers, glazed windows, and tight insulation all increase the levels of air pollutants.
- A group from the University of Ottawa reviewed the influence of the indoor environment on asthma in a population of Canadian schoolchildren using a questionnaire developed by the American Thoracic Society.
- They found that physician-diagnosed asthma was more common in people living in damper homes where humidifiers were employed, smoking was allowed, and gas stoves were used for cooking.
- Wheezing children were also more common in homes with furry or feathered pets. One explanation for increased home humidity might be the overuse of humidifiers in homes.
- This study was consistent with other studies showing home dampness is directly associated with recurrent asthma and wheezing symptoms, possibly reflecting an increased concentration of dust mites, although they were not measured in this study.
- This study concluded that modifying the indoor environment, eliminating tobacco smoke and gas stoves, and curtailing the use of humidifiers were appropriate environmental recommendations.
The Sick Building Syndrome
Modern-day construction methods employ energy-efficient building techniques to control fuel costs. Eighty-five percent of new homes and buildings are super-energy-efficient: People who live and work in these structures rarely breathe fresh outdoor air. Workers in such buildings can never open their office windows.
- This problem is not confined to new structures. Older apartment and office buildings are remodeled with new energy conservation methods in which heated or cooled air is recirculated through a closed system of air ducts.
- People who live and work in these buildings can be afflicted with a new and controversial syndrome called the “sick building syndrome.
- ” Victims of the sick building syndrome develop many symptoms, including headaches, frequent colds, sinus infections, nausea, eye irritation, skin rashes, and even asthma Attack rates approach 70 percent in some buildings. This illness is thought to be due to inhalation of stale, recycled, contaminated air.
- Industry, governmental agencies, and medicine have been slow to respond to the hazards posed by indoor air pollution. In 1987 Congress appropriated millions of dollars for the study of air pollution, yet less than 10 percent was earmarked for indoor air studies.
- The National Institute of Occupational Safety and Health (NIOSH) has recommended that all office ventilation systems provide outdoor air circulation at a minimum rate of twenty feet per minute per occupant in smoking areas and five feet per minute in nonsmoking areas. There are no current standards for home ventilation.
- Asthmatics who are victimized by a “sick building” may require special alterations in their environment. In some cases, job relocation may be the only solution. One way to find out if you are living or working in a contaminated environment is to measure the level of carbon dioxide in the air.
- When the carbon dioxide level is high, it means that the heating or cooling system is not getting enough fresh air. Building managers often shut down the fresh air intake to control heating costs. Simply increasing the intake of fresh air into the system may solve a lot of problems if office windows cannot be opened.
Hot Air Heating Systems
A typical forced hot air heating system recirculates air through a home or an office building after it has been warmed by an oil- or gas-fired furnace or heat exchanger. Low costs entice builders and developers to install such systems in new homes, apartments, and condominiums.
- Hot air systems pose a serious threat to asthmatics, as they constantly recirculate dust, molds, pollens, and animal parts throughout a dwelling. The allergic asthmatic who resides in a home heated by forced hot air must take some special precautions.
- The system should be properly humidified and filtered. The family room and bedroom air vents should be covered with cheesecloth or fiberglass filters.
- In some cases, it may be necessary to seal off the ducts and install supplemental electric heat. Hot air systems should be vacuumed or professionally cleaned before the start of each heating season. I sometimes advise a very sick asthmatic to move out of a home or an apartment with hot air heat.
- Tenants who feel they are at the mercy of a tight lease or rental agreement usually have no problem breaking their lease after I write a letter to their landlord stating that their present environment poses a significant health hazard and that I recommend that the patient moves to a safer and cleaner environment.
- The ancient fuels of wood and coal are man’s oldest source of heat, but burning them produces more toxins and air pollutants than does oil or gas combustion.
- In communities where wood stoves are commonly used, wintertime air inversions trap wood smoke and produce a ground-hugging layer of contaminated air laden with particles and toxins that aggravate asthma.
- The most damaging wood smoke particles are microscopic in size and are inhaled deep into the lung. Several studies have shown that children who live in homes heated with wood or coal stoves have more colds, bronchitis, and asthma than do children who reside in homes heated by gas- or oil-fired furnaces.
Smoking And Asthma
Environmental tobacco smoke (ETS) is a combination of mainstream smoke, which is the smoke inhaled and exhaled by the smoker, and side stream smoke, which comes from the burning end of the cigarette.
- Reports indicate that sidestream smoke is a major component of environmental tobacco smoke and that inhalation of sidestream smoke is irritating enough to bring on an episode of asthma.
- People with asthma who reside in homes where smoking is allowed have more colds, bronchitis, and asthma symptoms than those who reside in smoke-free homes.
- Children with asthma whose parents smoke (especially smoking mothers) have more sick days, miss more school, and need more asthma drugs than those children with nonsmoking parents. In a recent study, ninety-four children with smoking mothers were compared to a second group with nonsmoking mothers.
- The children with smoking mothers were much sicker than the children with nonsmoking mothers. The severity of their asthma was directly proportional to the total number of cigarettes their mothers smoked each day.
- A study of sixty-three infants from Princess Margaret Hospital for Children in Perth, Australia, demonstrated that a twitchy airway can develop as early as four weeks of age and that the onset of wheezing was directly related to a family history of asthma and exposure to cigarette smoke.
Other studies have shown a higher frequency of respiratory infections in children. with asthma who reside in a home with smoking parents or siblings One such study enrolled forty-nine asthmatic children with an average age of seven and compared their past exposure to tobacco smoke with that of seventy-seven nonasthmatic controls.
- They evaluated the presence of urinary cotinine, a major metabolite of nicotine in the urine, as an objective measure of past exposure to tobacco smoke. Those with asthma had a statistically higher urinary secretion of cotinine than those without asthma, suggesting that the cotinine level in the urine may be a risk factor for asthma.
- Several epidemiologic studies in the early 1980s have addressed the effects of being exposed to passive smoke. It has been established that passive smoke can cause lung cancer and aggravate any previous pulmonary condition such as asthma.
- Asthmatics who know that they are going to be exposed to heavy smoke in a poorly ventilated, closed environment should consider appropriate premedication.
- Although true tobacco allergy is rare, the tremendous body of evidence that points out the inherent dangers of inhaling passive smoke makes it mandatory that every asthmatic’s home be designated a no-smoking area.
Weather And Outdoor Air Pollution
Air Pollutants: The three major air pollutants-sulfur dioxide, nitrogen dioxide, and ozone-are potent bronchoconstrictors for both asthmatics and nonasthmatics. Sulfur dioxide, the by-product of fossil fuel combustion in heavy industry, is more bothersome to people with asthma in cold, dry air than to those in warm, moist air.
- This may explain why asthma doctors do not see many severe asthma relapses in the summer months, even though this is a peak period for air pollution. California studies have failed to show any real significant increase in asthma hospitalizations or severe asthma relapses during air pollution alerts.
- Nitrogen dioxide affects the airway in much the same way as ozone does. Unlike the other major air pollutants, nitrogen dioxide, a major product of gas stoves, can be an important indoor health hazard.
- Ozone, the major component of smog, is the byproduct of sunlight’s action on automobile exhaust fumes. Ozone is a big problem for asthmatics who live in areas with abundant sunlight and heavy traffic, like Los Angeles.
- Fortunately, both asthmatics and nonasthmatics tend to adapt to low concentrations of ozone and have fewer symptoms with continued exposure.
Epidemic Asthma
Several cities throughout the world have experienced very sudden epidemics of asthma. The most dramatic example of epidemic asthma is in the city of New Orleans, where hundreds of asthmatics may seek emergency care at local hospitals during a single day.
- This phenomenon, called “New Orleans asthma,” has been thoroughly investigated by Dr. John Salvaggio of Tulane University. Dr. Salvaggio found that these asthma epidemics are more likely to occur on damp fall days when temperature and humidity levels are low and ragweed counts are high.
- The epidemic begins when a fast-moving cold air mass enters the city and causes a sudden drop in temperature. Similar epidemics have been reported in other areas and cities, including New York City; Philadelphia; Los Angeles; Donora, Pennsylvania; and Yokohama, Japan.
- From 1981 to 1987, twenty-six outbreaks of asthma occurred in the city of Barcelona, Spain, affecting nearly seven hundred individuals and requiring more than eleven hundred emergency room visits. Initially, an increased concentration of nitrogen dioxide was suspected as the asthma inducer.
- Additional epidemiological studies led to the conclusion that these outbreaks of asthma were caused by inhalation of soybean dust released during the unloading of soybeans from ships in the city’s harbor. The asthma outbreak in Barcelona indicates the need for regular monitoring of air quality, particularly in population areas located near grain or soybean plants.
- Air pollution is one of the major problems in most of the large cities in India. Smoke-belching factories, motor vehicles, and challahs (open hearths) have created a serious health- hazard. Delhi is one of the most heavily air-polluted cities in the world.
- It has earned this disrepute during the last two decades In this duration the percentage of asthma cases in the population has increased manyfold.
Guidelines for Air Pollution Alerts
People with asthma who reside in areas subject to thermal inversions, and pollution alerts. And asthma epidemics should monitor daily broadcasts and newspapers for weather and air pollution alerts.
The Weather and Air Pollution Committee of the American Academy of Allergy and Immunology has published a set of guidelines to follow during air pollution alerts.
- Avoid unnecessary physical activity.
- Avoid smoking and smoke-filled rooms.
- Avoid dust and other irritants.
- Avoid people with colds or the flu.
- Stay indoors and use air conditioners.
- When possible, leave the area.
- Know your medicines.
- Keep instructions handy.
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