Indoor Environmental Quality: Health Effects, Asthma, and Asthma Triggers

1. Indoor Environmental Quality: Health Effects, Asthma, and Asthma Triggers John W. Martyny, Ph.D., CIH Tri-County Health Department

2. Sources of IAQ Pollutants • Outdoor pollution • Indoor pollution • Building material off-gassing • Inadequate ventilation

3. Forms of Indoor Pollutants • Particles • Liquids • Fumes • Mists • Gases • Vapors • Physical Agents

4. Dose Response • The higher the dose the greater the response. • Exceptions: • Allergens • Carcinogens

5. Chronic 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.

6. Examples of specific pollutants

7. Carbon 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)

8. Nitrogen 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

9. Fibrous 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

10. Formaldehyde • 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

11. Suspended 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

12. Volatile 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 = < 1mg/m3) • Acceptable Limits: • Varies with compound

13. Lead • Sources: • Lead paint, lead products, indoor firing ranges. • Health Concerns: • Children - Decreased learning, neurotoxicity. • Adults - neuotoxicity, joint pain, weight loss, CNS damage • Normal Concentration: • <1 ug/m3 • Acceptable Limits: • < 50ug/sq.ft. floor space

14. Radon • Sources: • Soil, building materials • Health Concerns: • Lung cancer • Normal Concentration: • 1.5 pci/l • Acceptable Limits: • 4 pci/l

15. Ozone • 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

16. Environmental Tobacco Smoke AKA • Passive Smoking • Involuntary Smoking • Side-Stream Smoke • Secondhand Smoke

17. ETS Components • Composed primarily of sidestream smoke and exhaled mainstream smoke • complex mixture of >4,000 compounds • Contains: > 40 carcinogens (e.g., benzene, nitrosamines, polycyclic aromatic hydrocarbons), respiratory irritants (e.g., ammonia, formaldehyde, sulfur dioxide), reproductive toxicants (e.g., carbon monoxide, nicotine).

18. Why Focus on Children? • Need is the greatest • Children particularly susceptible • Exposure is involuntary • Most children of smokers are exposed in the home

19. What’s 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. What’s 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

21. Lower 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

22. Respiratory Symptoms • Chronic cough, phlegm, and wheezing • strong consistent evidence, especially for preschool children • increased risks of about 20 to 40% • Asthma exacerbations

23. Middle 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 (<10%), but significant reduction in lung growth/function • Decreased Fetal Growth • consistent evidence of small effect for nonsmoking mothers during pregnancy

25. Emerging 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

26. Conclusions • 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

27. Hypersensitivity Illnesses

28. Types of Hypersensitivity Illnesses • Allergies • Allergic Rhinitis • Hypersensitivity Pneumonitis • Asthma

29. Allergies • 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

30. Common Indoor Allergens • Pollen grains and fungal spores • Bacteria, protozoa, and fungi • House dust mites • Cockroaches • Birds • Mammals

31. Immune System Responses Depend Upon • Source material • Host factors • Duration of exposure • Intensity of exposure

32. Source Material • Can it be allergenic? • Will it penetrate into the lungs? • Will it be removed quickly? • Have there been prior exposures?

33. Antigens • 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.

34. Host 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).

35. Duration 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?

36. Allergic 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.

37. Hypersensitivity 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

38. Hypersensitivity Pneumonitis (Cont) • Frequently named after exposure: pigeon-breeders disease, farmers lung. • Attack rate may vary from 15% to >50%. • Examples: Hot tubs, Pools, Mold exposure.

40. Asthma www.epa.gov/iaq/asthma/index.html

41. What is Asthma? • Chronic Inflammatory Disorder of Airways • Characterized by: • Recurrent Episodes of Airflow Limitation • Airway constriction • - Usually Reversible * Spontaneously, or * with Appropriate Treatment

42. What Happens During Attack? • Airways Narrow • Mechanism: - Tightening muscles surrounding airways - Swelling of inner lining of airways - Increase in mucus production &/or inflammation

43. Asthma Symptoms • Coughing • Wheezing • Chest Tightness • Shortness of Breath

44. Asthma 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

45. Asthma 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

46. Rise in atopic diseases • Allergies, eczema etc Atopy [familial tendency to certain hypersensitivities] also on increase Why? Research is ongoing…

47. High-Risk Populations (for asthma) • Children • Low-income, urban residents • Minorities • Those with hereditary predisposition • Allergic individuals

48. Emerging Science • Overweight = Possible risk factor • # of Siblings = Possibly protective • # of Early Life infections = Possibly protective

49. Children 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

50. Low-Income, Urban Residents and Asthma • Likely contributing factors: - poverty - exposure to higher levels of allergens & air pollution episodes - limited access to medical care