1. 1 Children’s Asthma and Environmental Triggers Susan Buchanan, MD, MPH University of Illinois at Chicago School of Public Health Chicago, Illinois

2. 2 Disclosures/Acknowledgements I have no commercial, financial, or other conflicts of interest to disclose. This material was developed by the Great Lakes Center for Children’s Environmental Health and funded under the cooperative agreement award number 1U61TS000118-01 from the Agency for Toxic Substances and Disease Registry (ATSDR). Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports the PEHSU by providing funds to ATSDR under Inter-Agency Agreement number DW 75-92301301-0. Neither EPA nor ATSDR endorse the purchase of any commercial products or services mentioned in PEHSU publications.

3. 3 What is asthma? National Heart Lung BIood Institute 2003: Asthma is a chronic inflammatory disorder of the airways … causes wheezing, breathlessness, chest tightness, and coughing, particularly at night or in early morning. Airway inflammation also causes bronchial hyperresponsiveness to stimuli.

4. 4 National Heart, Blood and Lung Institute

5. 5 Source: Global Initiative for Asthma Trends in asthma prevalence by age

6. 6 Factors that contribute to asthma Viral infections Allergens: dust mites, cockroaches, animal dander, molds Irritants: ETS, chemical fumes, air pollution Misc: exercise, food allergies, GI reflux, aspirin and ibuprofen sensitivity, other sensitivities

7. 7 Allergens Allergens – proteins in the environment that cause an immunological response By age 10-12, 90% of asthmatics will have allergies that trigger their asthma attacks

8. 8 How do environmental exposures cause an asthma attack? Act as a trigger in individuals with hyperresponsiveness Worsen airway inflammation Increase the immune response to inhaled allergen

9. 9 Environmental asthma triggers Indoor Pollutants

10. 10 Indoor pollutants may be more important than outdoor pollutants! *Americans spend more than 90% of their time indoors (home, work, school, daycare) Allergens – Dust mites – Cockroaches – Pets – Mold ETS Irritant chemicals (cleaners) Particulate matter (combustion: gas stove, wood stove, kerosene heaters) Ozone

11. 11 Indoor Allergens: Dust mites Thrive in warm, humid environments Grow in cloth-covered objects such as toys, bedding, furniture, carpets *Dust mite exposure in susceptible individuals may lead to the development of asthma

12. 12 Indoor Allergens: Cockroaches 36% cockroach sensitization rate in inner-city asthmatic children Patients/parents may not feel comfortable admitting to infestation Dust mite exposure in susceptible individuals may lead to the development of asthma

13. 13 Indoor Allergens: Cats 6 million Americans have allergies to cats Cat and dog allergens can be found in all homes, regardless of pet ownership Cat allergens may be transferred at school from children who have pets at home Dust mite exposure in susceptible individuals may lead to the development of asthma

14. 14 Indoor Allergens: Mold 60 species of molds are allergenic Common allergenic species: penicillium, aspergillus, cladosporium, alternaria

15. 15 Environmental Tobacco Smoke The combustion of tobacco, paper, and additives CLEAR evidence of link between ETS exposure and asthma attacks and more severe symptoms

16. 16 Chemicals Off-gassing of formaldehyde from furniture and building materials Cleaning products (chlorine, ammonia) No clear association with asthma

17. 17 Combustion devices Gas ranges used for home heating Improperly vented fireplaces Malfunctioning furnaces Wood-burning stoves Poorly-ventilated kerosene or gas space heaters

18. 18 Outdoor air pollution

19. 19 Outdoor air pollution Organic dusts – Soybeans, grains Industrial releases Hazardous air pollutants from combustion All have shown to trigger asthma attacks or exacerbate symptoms

20. 20 Criteria Air Pollutants Ozone (ground level) Carbon Monoxide Sulfur dioxide Particulate matter Nitrogen dioxide Lead

21. 21 Criteria Air Pollutants: Ozone (Smog) VOC + NOx + Heat + Sunlight = Ozone Increases airway inflammation and hyperresponsiveness

22. 22 Criteria Air Pollutants: Sulfur Dioxide Upper airway irritant Deep lung penetration during exercise Causes bronchoconstriction

23. 23 Criteria Air Pollutants: Particulate Matter Leads to more hospitalizations due to asthma

24. 24 Criteria Air Pollutants: Nitrogen Oxides Increases bronchial responsiveness during exercise

25. 25 Traffic-related pollutants and diesel exhaust Children living near heavily traveled roadways have higher rates of asthma and wheezing School bus diesel exhaust exposes children riding on the bus

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28. 28 Resources

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30. 30 Pediatric Environmental Health Specialty Units (PEHSU) Funded by federal EPA, ATSDR Staffed by: – Occupational/Environ- mental Med physician – Peds or Family Med physician – Medical toxicologist – Pediatric health nurse – Industrial hygienist

31. 31 PEHSU Services Clinical consultations – Telephone consults to health care providers and families – Clinic visits at UIC, Stroger Hospital, Cincinnati Children’s Hospital, Lurie Children’s Memorial Hospital Public Health Consultations to health departments and environmental agencies, media Training for physicians, nurses, and other health professionals in children’s environmental health

32. 32 Great Lakes Center for Children’s Environmental Health Region 5 Pediatric Environmental Health Specialty Unit (PEHSU) (312) 636-0081 or (866) 967-7337

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34. 34 Questions?