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The Asthma Regional Council of New England

The Asthma and Housing ConnectionA closer look at the impact housing can have on asthma

presents

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WhyAsthma and Housing?

Asthma is now the number one cause of hospitalization for children Children spend 90% of time indoors Examples of changing asthma:

- Children with well controlled asthma have attacks after changes in the home

- Children have asthma free periods in another home only to have asthma symptoms return when back

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What is Asthma?

Asthma is a chronic disease of the medium and small airways in the lung

These airways are hypersensitive to certain “triggers” in the environment

Asthma cannot be cured but its symptoms can be controlled with proper environmental changes and medication

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Asthma is a Serious Disease

Asthma attacks are allergic reactions to triggers or exposures

The airways swell and fill with mucus and secretions

The muscles around the airways contract and spasm

Airways can collapse from excess swelling and spasm, causing shortness of breath, even death

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02468

1012141618

19931998

Asthma is a Growing Problem

Americans diagnosed with asthma has risen

Close to 21 million Americans have been diagnosed with asthmain their lifetime

*MMWR December 04, 1998 / 47(47);1022-1025)

13.7

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Millions of individuals diagnosed

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0

1

2

3

4

5

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19831995

Asthma is a Growing Problem

Children diagnosed with asthma has doubled between 1983 and 1995*

*www.lungusa.org/data/asthma/asthmach_chg.html

2.8

5.3

Millions of individuals diagnosed

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Asthma is Getting Worse

The cost of asthmahas doubled in the past 10 years*

* www.cdc.gov1990 2000

$6.2 billion

$ 14.5 billion

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Asthma is Getting Worse

Deaths from asthmahave increased more than 50% in the past 20 years, and has increased more than 75% in children under 19*

*CDC MMWR April 24, 1998 / 47(SS-1);1-28

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Asthma is a Growing Problem

3 million lost work days

10 million lost school days each year from asthma

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Clearing the Air

The Institute of Medicine reviewed medical literature for causes and triggers of asthma. It found:

Dust can CAUSE asthma Second-hand tobacco

smoke, Molds, Cockroaches, Rats, Mice, Cats, Dogs, Cold air, and Dry heat can make asthma worse

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Asthma and the Home: Dust

Most common trigger for asthma in kids and adults Result of dust mites (microscopic insects who shed skin that is left behind) Home sources:

Carpets, drapes, overstuffed furniture, and bedding

Poor air sealing of windows and doors can allow outside dust into the home

DUST MITE

DUST MITE

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Asthma and the Home: Molds

Common irritants for asthmaand other respiratory illnesses Home sources:

Leaking plumbing, roofs and water damaged areas

Poor ventilation in bathrooms and kitchens

Basements and crawlspaces without proper drainage or moisture control

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Asthma and the Home: Pests

Infestations of cockroaches, mice and rats can cause allergic reactions Even after pests are gone, their skin, hair and feces can remain and cause allergiesAsthmatic children allergic to cockroaches were more than 3 times as likely to be hospitalized if exposed to roaches in their home

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Asthma and the Home: Temperature

Temperature shifts and extremes, either hot or cold, can cause asthma attacks Dry heat can make airways vulnerable to infections and allergic reactions

Excessive heat encourages dust, molds and infestations into homes

Cold swings can cause airways to swell

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Asthma and the Home: Ventilation

Poor ventilation can increase exposure to indoor triggers, causing more allergic reactions

Air exchange with unfiltered outdoor air can also cause attacks

Outdoor air can contain pollutants, such as ozone, sulfur dioxide and other particulates

VENTILATION FAN

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High Rates of Childhood Asthma in New England

Nearly 1 in 5 households with a child has at least one child with asthma *

* Analysis conducted by ARC, 2001

12.3% of children in New England have been diagnosed with asthma *

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12.7% adults in New England have been diagnosed with asthma, giving this region the highest asthma rate of any region in the U. S.*

1 in 8 adults in New England has asthma.** Analysis conducted by ARC, 2001

Adult Asthma Rates more Severe in New England

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Asthma in Public Housing

Baseline asthma rates across the country under 10% 40% of adults and 56% of children surveyed reported asthma in a Boston Public Housing development*

*Brugge D et al New Solutions Summer 2001

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Adults Children

Public HousingDevelopment inBoston

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General Population

BaselineAsthma Rates

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Concentrated Areas of Asthma and Housing Issues

State AverageRoxbury

4/1000

19/1000

Roxbury 19/1,000 children * State average of 4/1,000*

* Boston Public Health Commission, Health of Boston 2000; Boston, MA

Many inner city neighborhoods report high rates of hospitalizations

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Prevalence data suggests large pockets of asthma in poor inner city and rural areas:

6 Hartford Clinics showed that 40% of treated children have asthma symptoms**

Highest prevalence of asthma appears in children living in the rural counties of CT***

There are mostly public and subsidized housing in the Hartford and rural areas of CT

** J Pediatr 2001; 139:267-72*** www.ehhi.org/pubs/asthma_schools.htm

Concentrated Areas of Asthma and Housing Issues

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Courtesy of theEnvironmental HealthOffice at the Boston Public Health Commission

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Commonly Asked Questions

There has always been distressed housing, why is it a problem now?- Housing has always been a problem- Every action has an equal reaction

Why is this problem getting bigger?- Changes in housing design- Worldwide problem

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Commonly Asked Questions

How can we be sure these fixes work?- Individual studies support changes- New studies of integrated approaches to come soon

Won’t this cost a lot of money?- Many changes are at no additional cost- Energy savings can offset many costs

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What is the Disease?

Poorly maintained or designed housing is the disease - Asthma is the symptom

A “disease free” or “healthy” environment is dry, clean, pest-free, and well-ventilated

An unhealthy environment has been connected to children developing asthma and allergies

A healthy house can make a healthy child

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Reduce Asthma Triggers by Keeping the House:

Dry Clean Pest freeWell ventilated Comfortable

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Water is a Precondition For:

Molds Insects Rodents Mites

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Stop Enemies at the Gate

At the roof, ceilings, walls, foundations and entryways

RainwaterAirborne particles CondensationAnimals Cold or hot air Tracked in particles

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Stop Enemies at the Gate

Roofing, flashing, siding, site drainage, damp proofing, and capillary breaks all keep rainwater out

Airtight envelope reduces: - ice dams- airborne particles- humidity migration- pest infestation

Well designed track-off entry reduces tracked in dirt by two thirds

Complete insulation barrier reduces - condensation- thermal comfort problems

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Exorcise the Demons Within

Dust mites Humidity Condos for critters

(food, water, cockroach dating bars and beds)

Smoke

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Exhaust vent sources of humidity and particles Use finishes that are easy to clean and do not provide a place for creatures to live Supply 130º F water to the washer; 120º F to the sinks Use pest resistant materials

Reduce Asthma Triggers

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Ways to a Healthy Home There is a clear connection between asthma

and housing Pay attention to what you can do to reduce

asthma triggers in your home, and

Keep your home a Healthy Home