Good Health Starts at Home Asthma and Allergies

Good Health Starts at Home Asthma and Allergies
<your name here> Introduce yourself. Explain that this presentation will include interactive activities and that you are open to receive questions during the presentation. Although the presentation focuses on children, much of the information can be used for any age group. Ask participants if they have ever had asthma or know anyone who has. Notes to educator: This presentation can function as a teaching guide for the asthma and allergies chapter of the book: Help Yourself to a Healthy Home. Accompanying this presentation is the Lesson Guide on Asthma and Allergies. Important tips to emphasize in each slide are in bold print. Try to provide every participant with a copy of the book. Vulnerable populations: The book has a special emphasis for young children in the home . Some populations are more at risk to poor indoor air quality: children, the elderly, those with certain health conditions. A normal respiratory rate for adults is about 15 breaths per minute at rest. For their size, children breathe much more rapidly than adults. Think of how a young baby breathes—it is much more rapid. An infant may breathe at around 30 breaths per minute. People with health conditions such as cystic fibrosis, cancer and other illnesses may breathe more rapidly also. Also, about 60% of children under age 6 attend some type of child care or preschool—up to 40 hours per week—so the indoor environments at these places are important too. Remember—children play on the floor and put their hands in their mouths. This is normal behavior for children. They are exploring their environment. However, dangerous substances like lead paint, toxic cleaning products, etc. not only end up on the floor (and on children’s hands and toys—which they put into their mouths) BUT these hazardous chemicals have much more effect on children’s brains, livers and kidneys because their bodies are still growing and developing and their metabolic rates are much faster. Children are not just little adults—pound-per-pound, children drink, eat, and breathe more than adults and their organs and immune systems are still developing. April 2014

Knowledge: Describe symptoms and causes of asthma
Knowledge: Describe symptoms and causes of asthma. Recognize medical interventions for asthma AND environmental control of asthma triggers Comprehension: Identify asthma/allergy triggers in the home environment. Application: List examples of low-cost action steps to reduce asthma triggers. Identify resources for more help and information Learning Objectives We want to be able to understand the disease of asthma: its symptoms and that it can be controlled BOTH by medications AND by controlling environmental triggers. There are easy and inexpensive things we can do to limit our exposures to these triggers. We will discuss several low-cost action steps to improve the environment inside our homes. At the end, we’ll discuss local, state and national resources for more help and information. The home environment is especially important because Americans spend an average of 90% of their time in the indoor environment. We will learn of some of the things around our home that could be asthma triggers. There is an emphasis on indoor environmental triggers—because of the connection to the Healthy Homes Partnership, however, we will mention some outdoor triggers also.

Resource: Help yourself to a healthy home
Indoor Air Quality Asthma & Allergies Mold & Moisture Carbon Monoxide Lead Drinking Water Hazardous Household Products Pesticides Home Safety Resource: Help yourself to a healthy home Help Yourself to a Healthy Home is a booklet written by Cooperative Extension educators with funding from the Housing and Urban Development’s Office of Healthy Homes and Lead Hazard Control. It contains information about a variety of possible home health hazards, easy steps you can take to control these hazards and resources for additional information. These are the 9 chapters in the Help Yourself to a Healthy Home book. This presentation focuses on Asthma & Allergies Indoor Air Quality Asthma & Allergies Mold & Moisture Carbon Monoxide Lead Drinking Water Hazardous Household Products Pesticides Home Safety Each chapter provides information, action steps and resources for more information. A link to this book may be found on 3

Seven Tips for Keeping a Healthy Home
Keep It: Dry Clean Pest-free Ventilated Safe Contaminant-free Maintained Seven Tips for Keeping a Healthy Home Because looking at the indoor air quality inside homes (and other healthy homes principles) can involve many contributing factors, these seven tips help us to look at the house as a system. Think of some of the reasons several of the principles listed may contribute to allergy and asthma triggers. Dry: keeping down moisture problems helps to control mold. Mold spores in the air can contribute to asthma and allergies. Clean—clutter can hinder the ability to keep down dust/dust mites—also a asthma/allergy trigger. Also it can contribute to pest problems, another health hazard. Pest-free—pests like cockroaches, rodents, etc. can be asthma/allergy triggers. Also the use of pesticides, instead of a more coordinated approach to pest control (like Integrated Pest Management) can put toxic chemicals in the air. Ventilated—if not properly ventilated, combustion gases (from fuel-burning appliances) can contribute to poor indoor air quality. Also, a lack of fresh air in the home only increases potential environmental hazards. Contaminant-free—Hazardous household compounds like pesticides, toxic cleaning products, formaldehyde from carpets and furniture, can be asthma and allergy triggers. 4

Asthma: What is asthma? A chronic inflammatory disorder of the airways
It is treatable, but not yet curable It is not the same as allergies, but allergies MAY cause asthma Not contagious Can be life-threatening! It can be controlled Asthma: What is asthma? Key Point: Asthma cannot be cured, but it can be controlled through a combination of proper asthma medications and controlling things that trigger asthma. It is a chronic disease. Chronic means long-term or having many episodes. Asthma is the most common chronic disorder in childhood, currently affecting an estimated 7 million children under 18 years. Emphasize that we are not physicians or pharmacists and that our role is in helping consumers to control asthma by using simple, low-cost action steps that they can do themselves. 5

About 26 million Americans have asthma, including about 7 million children. It is the most common chronic childhood disease. Asthma causes more hospital stays than any other childhood disease. Cost of lost workdays for parents with asthmatic children is near $1 billion. It is a leading cause of school absences. Annual direct and indirect costs of asthma are more than $56 billion. Asthma Facts Costs of asthma in the U.S. are approximately $20 billion per year. This includes hospital stays, and physician and medical costs for direct costs. Source: American Lung Association. Trends in Asthma Morbidity and Mortality, January 2009. Indirect costs include missed school and work days and lower productivity at work and school, including lost productivity of the parent or caregiver who must stay home to care for the child. Educator: Review the EPA Asthma Facts publication: Facts: Asthma: Asthma rates have increased by over 160% since How many of you, or those in your family have asthma? Asthma is the 3rd leading cause of hospitalization among children.

Who suffers from Asthma
Children Low-income, urban residents Some minorities Allergic individuals People with hereditary disposition for asthma (genetics) Who suffers from Asthma Children may be at greater risk to environmental pollutants. This is because children are still growing and developing, especially during the first 6 years of life when their brains and nervous systems are still developing. When we think about possible hazards in the home…dust on the floor, pesticides and cockroaches, mold problems…can you think why these hazards may be more dangerous to children, especially very young children? Think about a young child who is crawling or just learning to walk. They spend a lot of time on the floor and putting their hands and many other things in their mouths (children are naturally curious and this is the way they explore!). Things like dust that falls to the floor, bugs, smoke particles on furniture and clothing, pet dander that has collected on the floor, etc. Also, for their size (they are much smaller than adults and still developing), children eat more food, drink more water, and breathe more air than do adults. If something is an allergy or asthma trigger it will affect them much more. They get a bigger dose than adults would. Remember—they take many more breaths per minute than an adult—pay attention to the rapid breathing of a very young child. 7

What happens during an asthma attack?
Airways narrow, caused by: tightening of the muscles that surround the airways swelling of the inner lining an increase in mucous production What happens during an asthma attack? Airways are the passages that carry air to the lungs. These airways become smaller and smaller as they progress into the lungs. An asthma episode is a series of events that results in narrowed airways. These include: swelling of the lining; tightening of the muscles; and increased secretion of mucus in the airway. The narrowed airway is responsible for the difficulty in breathing, with the familiar "wheeze”. The inflammation is caused by an increased reaction of the airways to various stimuli. It can be life threatening. Asthma breathing problems usually happen in "episodes,” or attacks, but the inflammation underlying asthma is continuous. Asthma causes breathing difficulties because of 3 reasons (above). Each symptom means asthma is getting progressively worse. Demonstration tool: if available, show models of airways

What happens during an asthma attack?
You Tube video: Asthma symptoms mQeKUEfnBc What happens during an asthma attack? This is a video of an Auburn University Pharmacy professor demonstrating a model of airways—both normal and those of an asthmatic individual. She discusses what happens during an asthma flare-up. Approximately 4 minutes

What does an asthma attack feel like?
Jog in place for about 30 seconds Place a straw in your mouth and breathe only through the straw by pinching your nose closed How do you feel? What does an asthma attack feel like? If you have asthma or breathing problems, don’t participate in this exercise. Demonstration Activity: Pass out small straws to each participant (recommend using the small coffee stirrer straws). Have participants do the following: Jog/March briskly in place for approximately 30 seconds. Place a straw in their mouth and breathe only through the straw by pinching their nose closed. The sensation of having a hard time getting enough breath is the feeling asthma sufferers have.

Warning signs of asthma
Coughing (especially when it is not a cold) Poor skin color Shortness of breath Wheezing (a squeaking sound when breathing) Hunched over posture Restless during sleep Fast breathing Vomiting Even when a person is not coughing or wheezing, the lining of the airways can become inflamed and this also requires medical treatment.

Warning signs of asthma
Strained breathing Prominent neck muscles Out of breath after physical activity IMPORTANT: These symptoms don’t necessarily mean it is asthma Warning signs of asthma 12

Asthma can be controlled in 2 ways
There are excellent medicines available now that can control asthma--some must be taken on a daily basis. Environmental “triggers” of asthma can be controlled to reduce asthma symptoms--which are different for everyone. Asthma can be controlled in 2 ways Emphasize: asthma can be controlled but not cured. Key Point: Asthma CAN be controlled in 2 ways by using proper medications and avoiding/preventing environmental triggers of asthma.

What can you do to manage asthma?
Everyone needs a written Asthma Action Plan. This plan includes: Medication Identification and avoiding of asthma “triggers” Peak flow monitoring (over age 5) Emergency plan What can you do to manage asthma? Educator: links to online asthma action plans are available in the lesson guide. Distribute and discuss one of the 2 plans listed below. Note that each one contains 3 zones: green (doing well), yellow (getting worse), and red (medical alert). There is a list for type and dosage of medications on the form and a physician/emergency contact number. NHLBI/NIH (This one has more of a focus on asthma triggers on second page) American Lung Association 14

What to do if a child has an asthma attack
Reassure the child with a calming manner Review Action Plan Use medication if necessary and available Identify what triggered the symptoms and remove child from triggers Inform parents/emergency contact if severe Call 911 in emergency What to do if a child has an asthma attack

Types of medications: 2 main types
Controller or “everyday” medications Intal, Singulair Pulmocort, Aerobid Azmacort, Serevent These control inflammation in the lungs on an everyday basis Rescue or “quick- relief” medications Albuterol, Serevent Xopenex, Ventolin These help to control broncospasms-- release “squeezing” of the airways Types of medications: 2 main types Medications: There are 2 kinds of medications: controller (everyday) and quick-relief (used during asthma flare-ups). The controller medications are to be used every day—EVEN IF THERE ARE NO ASTHMA SYMPTOMS. Rescue medications are added when there are significant asthma symptoms (wheezing, coughing, shortness of breath, etc.). Above are several brand names for the 2 different types.

Asthma medicines can be given in different forms
Metered-dose inhalers Inhalers can be used with “spacers” These are especially useful with young children Nebulizers Pills Asthma medicines can be given in different forms Inhalers are a common vehicle to deliver asthma medicines into the lungs. Spacers can be helpful to attach to inhalers—especially for children. Demonstrate how an inhaler works (if available).

Inhalers attached to spacers
Demonstrate if available Spacers are particularly useful for children who may have trouble coordinating taking a breath from an inhaler and getting a full dose of medicine into their lungs. The spacers have a 1-way valve that holds the medicine from the inhaler inside the chamber which is then breathed into the lungs.

A portable device that can help measure air flow in and out of the lungs
May not be useful for children under the age of 5 Can be a good indicator of air flow in and out of the lungs in those over age 5 Peak Flow Meters Demonstrate if available

Types of inhalers You Tube videos:
KE_PStY (Types of Asthma Medications) =player_embedded&v=NUob1sfL3Ig (American Lung Association: Quick Relief Medicines) Types of inhalers First You Tube video shows Auburn University pharmacists discussing different types of asthma medications and proper ways to use them. It is extremely important to use asthma inhalers correctly to ensure that the adequate dose gets into the lungs. Approximately 7 minutes. Second video from American Lung Association focuses on quick relief medicines. 30 seconds Educator: skip this video if you are not concentrating on educating your audience on use of medicines.

When emergency treatment is needed for asthma
Wheezing or coughing that does not get better after giving “quick-relief” medicines Peak flow is less than 80% of best Difficulty breathing that does not get better after asthma medicines Too weak or tired When emergency treatment is needed for asthma Review asthma symptoms and medications used.

Chemicals/cleaning compounds Molds Dust Animals Pollen Food Pests
Irritants Secondhand smoke Strong odors Ozone Chemicals/cleaning compounds Allergens Molds Dust Animals Pollen Food Pests Learning objective: Comprehension Identify asthma/allergy triggers in the home environment In addition to medications, the other main way to control asthma is by controlling triggers that aggravate asthma. Asthma triggers are things that cause airway narrowing. Now we’re going to focus on how we can control asthma by controlling those things that trigger asthma. Triggers can be divided into 2 main groups: allergens and irritants. These triggers are different for different people.

Other asthma triggers Respiratory infections colds flu
often worse at night after lying down Exercise Changes in weather cold air wind humidity Other asthma triggers Many times those with asthma who get a respiratory infection will also develop asthma symptoms. The infection itself can also cause inflammation and airway narrowing—making it even worse for asthma sufferers. It is often recommended for those with asthma to get an annual flu shot. Also, washing hands regularly with warm soapy water, especially during cold and flu season, to minimize risk of infections. For those exercising with asthma, using a quick-relief medicine 15 to 30 minutes before exercising may help reduce asthma symptoms.

Indoor Air Pollution: A Major Health Concern
Most people spend 90% of their time indoors Toxin levels indoors may be higher than outdoors because of energy tight buildings Most of the common asthma triggers are found indoors Indoor Air Pollution: A Major Health Concern Publication: EPA Asthma Home Environment Checklist Show participants that rooms in the home may contain various asthma and allergy triggers. This checklist helps identify triggers and action steps. 24

Five Most Common Indoor Environmental Triggers
Secondhand Smoke Dust Mites Mold Pets Pests Five Most Common Indoor Environmental Triggers

Other Indoor Triggers: Household Products
Vapors from cleaning solvents (non-water based), paint, liquid bleach, mothballs, glue Spray deodorants, perfume Bleach, pesticides, oven cleaners, drain openers, aerosol spray products Other Indoor Triggers: Household Products Use low-toxic and fragrance-free cleaners. Make your own if you’d like. A mixture of hot water with some vinegar added is a good all-purpose cleaner. Demonstrate: samples of fragrance-free or “green” cleaners.

Recognize asthma triggers
Not all triggers affect every person 3 Basic Strategies to improve indoor air quality: identify the problem control the source mitigation--get rid of the pollutant or triggering substance Recognize asthma triggers

Pollen Transported by wind Grass, ragweed, pine, birch, oak trees
Can get indoors during pollen season Close windows during pollen season Caulk and weather- strip doors and windows Pollen

Five most common indoor environmental triggers
Learning objective: Comprehension Identify asthma/allergy triggers in the home environment Secondhand Smoke Dust Mites Mold Pets Pests Five most common indoor environmental triggers

Contains more than 4,000 substances (over 40 are carcinogenic)
Is particularly harmful to young children Can trigger asthma attacks Causes coughing, excess phlegm, reduced lung capacity, and other lung irritation Secondhand Smoke

Particles such as nitrogen dioxide and sulfur dioxide may cause decreased lung function
Increased risk of respiratory tract infections (bronchitis, pneumonia) Not only tobacco smoke—asthma triggers also include burning wood, candles, coal, kerosene, and natural gas By-products of smoke

Avoiding Secondhand Smoke
Action Steps: Do not allow smoking indoors or in vehicles Limit use of fireplaces and candles Use exhaust fan over gas stoves Smoke particles stick to clothing--can affect young child when held in arms “Please don’t smoke around kids!” Avoiding Secondhand Smoke Educator: if you do any smoking-cessation education or have access to these materials, you may want to mention these. Emphasize it is very hard to quit smoking. Even though this is a good long-term goal a quick low-cost action that would help the asthmatic is to not allow smoking inside the home or in cars. There are free publications from EPA on secondhand smoke: 32

Dust mites Too small to be seen Found almost everywhere!
Live in soft bedding Feed on dead skin cells Mites and mite droppings can be asthma triggers Live in warm, humid places Dust mites

Dust mite triggers Action Steps:
Wash sheets and blankets once a week in very HOT water (130 F) and dry in HOT dryer Use air conditioner in summer to lower humidity levels Best humidity levels are between 30-50% Remove carpets if possible Use microfiber cloths Vacuum often with HEPA vacuum or microfiltration bags Dust mite triggers Demonstration tools: microfiber cleaning cloths—these are cheaper in the auto parts sections of stores HEPA vacuum and/or vacuum bag HOT water and a HOT dryer will kill dust mites. Wash bedding regularly and use bedding that is easily washable (avoid thick bedspreads/comforters that don’t have a washable cover). 35

Dust mite triggers Action Steps:
Cover mattresses and pillows in dust-proof (allergen-impermeable) zippered covers Vacuum mattress, chairs, and carpeting Replace pillows every 5 years Limit stuffed animals in bedrooms Freezing also kills dust mites Dust mite triggers Pad Demonstration tools: Pillow/mattress dust-proof covers—these are zippered to create a barrier to dust mites. Also available as bedbug proof. A plastic cover protects the mattress but isn’t comfortable to sleep on. Put mattress pad over the plastic cover. Freezing, like hot temperatures, also kills dust mites. This might be an option for small stuffed animals that are not easily washed. Plastic Cover 36

Cr Credit for picture: National Center for Healthy Housing
This is a picture of clutter. Clean up clutter to get rid of dust (and pests). Cr Credit for picture: National Center for Healthy Housing

Molds A type of fungus Grow on damp surfaces
Molds grow by releasing spores Grow on organic materials: wood, drywall, wallpaper, carpet, and foods Molds You may want to have available the EPA publication: Mold, Moisture and Your Home

Avoiding Mold Triggers
Action Steps: Mold problems are caused by excess moisture Correct the moisture problem first! Maintain low indoor humidity (between %) Warm air holds more water than cold air Fix leaky plumbing Empty and regularly clean refrigerator drip pans Avoiding Mold Triggers

Avoiding Mold Action Steps:
Run a bathroom fan during bathing—make sure the fan works Exhaust the dryer to the outdoors Control moisture in the crawlspace Replace carpet with hard-surface floors in basement Use air conditioner to lower humidity Avoiding Mold Mention the “Charmin Test”. Hold a 1 square piece of toilet paper next to the exhaust fan in a bathroom or kitchen. When the fan is on the paper should be sucked up to the vent—if not, the fan is not exhausting properly.

Don’t need to test for mold--if you see it or smell it--then you have mold
Clean up small areas with a bleach solution: 1 part bleach to 10 parts water BUT—you don’t have to use bleach! Limit houseplants--since soil/leaves contain mold--at least in bedrooms Clean when children are not present More on Mold You don’t have to use bleach. A soapy water solution, scrubbing well, and making sure area is dry will work. Bleach can be an irritant. Demonstration tool: N-95 face mask If a large area is affected by mold, call a professional. For smaller areas, if you are sensitive to mold, wear a N-95 face mask. Note about “toxic black mold”. This has been exaggerated by the media. MANY molds are black and there are 1000’s of species. If you are allergic to mold—you need to get rid of it. Don’t waste money testing for type of mold. A good resource on mold is EPA’s A Brief Guide to Mold, Moisture, and Your Home

Skin flakes, urine, and saliva of warm blooded animals can be asthma triggers
Triggers can remain inside for several months after an animal is removed, even with cleaning Pets

Avoiding Pet Triggers Action Steps:
Try to keep pets outdoors only—if possible Keep pets off beds and out of bedrooms Keep pets off fabric-covered furniture Use a HEPA vacuum to vacuum up pet fur Keep litter boxes, pet beds, and cages away from sleeping areas IF pets get on beds, wash bedding in very HOT water Avoiding Pet Triggers Remember—pets are loved members of our families too! However, if someone is sensitive to pet dander, try to at least keep pets off beds and out of the bedroom. Important note: Those in apartments and in urban environments (particularly in multifamily housing) may not have the option of keeping pets outdoors.

Pests (especially Cockroaches)
Many people are allergic to the body parts and droppings of cockroaches People who have dust allergies frequently have cockroach allergies Pests (especially Cockroaches)

Avoiding Pests Prevention Identification Control
3 steps to avoid pests indoors: Prevention Identification Control Avoiding Pests

Get rid of places for pests to hide and sources of food and water
reduce clutter (boxes, stacks of newspapers, grocery bags) do not leave food or garbage out clean up food spills and crumbs caulk cracks and crevices Pest-proof living space Preventing Pests Pests are like us—they like food, water, and shelter. Get rid of these hiding places! The first approach to preventing pests is to pest-proof the living space. Do not store paper grocery sacks or cardboard boxes around the house—cockroaches like the glue in these. Plus, those from grocery stores may have food particles. Clean up the kitchen. Even small amounts of food or crumbs are enough to feed cockroaches for a long time.

Action Steps Controlling Pests
Make sure you identify the pest before using pesticides Use less toxic baits, boric acid, or traps first-- before using toxic pesticides If you use sprays: Limit spray to infested area Ventilate room-- sprays may be a trigger for asthma or cause lung irritation Action Steps Controlling Pests Focus on a safe and effective way to control pests.

Integrated Pest Management
IPM IPM is a system of pest control that uses an “integrated” approach—rather than just using pesticides. Control clutter, get rid of food, seal up cracks in walls where pests are entering the home—BEFORE using pesticides. Clean up the places where pests are likely to hide. Caulk/seal around holes to prevent pest entry. Place baits and traps out of the reach of children. These are less toxic methods to improve pest control and should be used before spraying pesticides. Demonstrate: less toxic methods of pest control: Baits Traps Low-toxicity products Caulk Remember: It is important to identify the pest first; Focus on WHERE the pest is living to control the pest; and Use the most safe and effective way to control pests.

credit for picture: National Center for Healthy Housing
This is a picture of cockroach frass (urine and fecal droppings) behind a bed. credit for picture: National Center for Healthy Housing

Air Cleaners and Filters
Action Steps Use air cleaners only as a last resort HEPA filters (High Efficiency Particulate Air) Do not use air cleaning devices that produce ozone Air Cleaners and Filters Pleated filters are much more effective than the fiberglass kinds. They are readily available in grocery and hardware stores. Demonstrate: fiberglass filter and pleated filter. Pour salt through the fiberglass filter to demonstrate that this type of filter does not trap many substances—especially those as small as dust mites.

Air Cleaners and Filters
Action Steps: Know the size of the room to be treated before purchasing the air conditioning/heater unit Clean or change filters frequently Some gases and very small particles are difficult to remove If updating an old unit, get an energy efficient one. Air Cleaners and Filters A unit too big or too small for the home is sometimes a problem. Too small won’t keep up with the demand of heating and cooling. Too big makes the unit run on too short a cycle and won’t be as efficient—and will cause the unit to burn out faster.

Other Asthma Triggers Exercise
People with asthma should be able to exercise Sometimes, taking inhaler medicine before exercising may help Colds/Flu/Respiratory infections Often these illnesses will trigger asthma symptoms or make them worse--get a flu shot Cold weather sometimes triggers asthma Strong fragrances Pollens Other Asthma Triggers

Let’s reflect: Application Action Steps to control asthma
Make sure everyone with asthma has an Asthma Action Plan Be aware of medicines used to treat asthma and have emergency contact numbers in case of asthma episodes Control the environment to prevent triggers: dust, pests, mold, secondhand smoke, strong odors, and cleaning solvents Let’s reflect: Application Action Steps to control asthma Review: 2 ways to control asthma: use of proper medications and controlling environmental triggers Have an Asthma Action Plan Show: EPA video: Breathing Freely: Controlling Asthma Triggers

Resources for Asthma & Allergies
The U.S. Department of Housing and Urban Development www. Healthyhomes.hud.gov The U.S. Environmental Protection Agency The American Lung Association Centers for Disease Control and Prevention Asthma Community Pharmacists, Mold Fire & Water Cleanup and Restoration Service companies, Pests Pest Control Companies—ask if they use IPM Secondhand Smoke Smoking Cessation: smokefree.gov, state Health, Department Quitline Resources for Asthma & Allergies Any questions?

Good Health Starts at Home Asthma & Allergies
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