Vol. 15 •Issue 10 • Page 16
Home Makeover: Asthma Edition
Where science is lacking, use common sense to control common asthma triggers.
The Peter family suffered a devastating fire that all but destroyed their home in Jamaica, N.Y., and left them penniless. They were forced to continue living in the charred house without heat, hot water, or most of the electricity. The sooty conditions were most harmful to their youngest child, Ashley, who has asthma.
Enter the television series “Extreme Makeover: Home Edition,” which radically transforms the homes of families dealing with hardships. The team not only gave the Peter family a new structure, they also incorporated indoor allergen control measures to help Ashley breathe better. Her bedroom came equipped with natural bedding, dust mite encasings, a latex organic mattress, non-toxic bedroom furniture, and air purification products.
The episode, which aired in May, opens the door to the question: Will encouraging your patients to take dramatic steps to control allergens in their homes make a big difference in the frequency and severity of their asthma exacerbations?
Little data
Peyton Eggleston, MD, professor of pediatrics, Johns Hopkins University, Baltimore, considers two factors when evaluating an intervention: Does it reduce allergens or particles? And does it reduce them enough to have a health effect?
We don’t have the answers for most allergen reduction strategies. “They are very difficult, big, expensive studies to do,” he said. “There’s relatively little data.”
Dr. Eggleston and colleagues have taken on the challenge. One of their studies looked at an intervention that included visits by a home health educator, cockroach and mouse extermination, provision of sealed food containers, allergen-proof bedding encasings, a HEPA air cleaner in the child’s bedroom, and smoking cessation education for parents.
The amount of particulates in the air significantly decreased in the treatment group, and their daily asthma symptoms decreased from 58 percent to 35 percent. Still, Dr. Eggleston said, it’s only one study. And the value of each intervention isn’t known because they weren’t studied separately.
The best bet when effectiveness hasn’t been proven, Dr. Eggleston advised, is to go with logic.
Moisture control
For example, excessive moisture in a home is widely known to promote the growth of mold, a significant asthma trigger. Moisture can appear any place in the home, but bathrooms, kitchens, and basements are prime suspects.
“It’s very important to keep basements dry,” said Norman Edelman, MD, chief medical officer of the American Lung Association (ALA). “Basements harbor a lot of mold, and even if the asthmatic doesn’t go down there, the mold will affect the entire home environment.”
“Extreme Makeover” provided Ashley with a dehumidifier to eliminate excess moisture in her bedroom. On the other hand, some intervention programs recommend humidifiers to prevent an overly dry environment that can irritate the respiratory tract.
Balance is the key when it comes to moisture. The ALA recommends keeping room air humidity levels between 40 percent and 50 percent. One way to measure humidity is with a hygrometer, which is like a thermostat for humidity.
If the patient lives in a particularly dry area and requires a humidifier to maintain this comfort zone, the family must be warned about the potential harm a humidifier can cause. Most humidifiers have water reservoirs that are hotbeds for mold. The mold grows inside the unit and is sprayed into the house.
“Mold is a dangerous contaminant that produces more health problems than dryness does,” Dr. Eggleston warned. The unit must be scrupulously cleaned to prevent mold build-up.
Dust mites
Another common asthma irritant is dust mites. “Mattresses and pillows get heavily infested with these little organisms, and they produce their own allergen in the bedding,” Dr. Eggleston said.
“Extreme Makeover” gave Ashley dust mite covers that encase the infested mattress, box spring, and pillows so the allergen won’t trigger an attack.
Simply washing bed linens once a week knocks out the accumulated allergen in sheets and pillowcases, and washing them in water hotter than 130 degrees Fahrenheit can kill the mites. Hypoallergenic sheets also are available for people with asthma. “Extreme Makeover” even gave Ashley an organic latex mattress that’s supposed to be dust mite, mold, and mildew resistant.
Dust mites also infest carpets, so when the financial situation allows, bare floors are preferable. If not, Dr. Eggleston said, it’s not such a big deal. “The allergen doesn’t get in the air very much, and unless you sleep on your carpet, you aren’t exposed that much.” Plus, removing carpet delivers nowhere near the bang of using mattress covers and hypoallergenic, washable bedding.
No matter what kind of flooring an asthmatic has, vacuuming is essential. Lots of dust settles in even the best-kept house, and frequent vacuuming is an efficient way to remove it. “Extreme Makeover” provided the Peter family with vacuum cleaners that have HEPA filters, which are extremely effective at removing dust mites, pet dander, and other particles from carpets and furniture, according to manufacturers.
“The HEPA filter vacuum cleaner is a good idea that hasn’t really been proven or documented,” Dr. Eggleston said. However, he takes issue with how expensive these vacuums are, without having a clear benefit. Only a few are on the market priced similarly to standard vacuum cleaners. “It’s not a bad thing,” he noted, “but don’t spend a grand on it.”
Particulates
HEPA filters also are being used in indoor air purifiers, which are meant to remove particulates resulting from cigarette smoke, dust mites, mold spores, pet dander, and bacteria. Homes with smokers routinely have particulate levels that exceed the Environmental Protection Agency’s danger levels for particulates outside.
One word of caution: People with asthma must be careful not to use an air purifier that generates ozone, which is an airway irritant.
The jury is out on the effectiveness of air purifiers because, as with the other interventions, the scientific evidence isn’t strong. In Dr. Eggleston’s opinion, air purifiers in general aren’t worth the money.
“Filters aren’t bad, but unless they’re accompanied by some understanding of how to cut down on the generation of particulates, they won’t be that effective,” he said. Air purifiers can reduce airborne particle levels by maybe 20 percent to 40 percent, he said, whereas changing behaviors can cut levels in half (at virtually no cost).
A case in point is pet allergens. The only solution that really works is to find the furred pet a new home. “Pet allergen gets carried to work, carried to school, and appears in levels there that are high enough to be associated with disease,” Dr. Eggleston said. “Just having the pet makes it almost impossible to keep allergen out of the house.”
Making recommendations
Health care practitioners need to address home environmental triggers with asthma patients, but the lack of data makes this a challenging task. Before giving any recommendations, the most important thing you can do is ask patients about their home environments and educate them about potential asthma triggers.
Be sure to follow up at their next appointment. Ask the patient, “How’s the water proofing in the basement coming along? Have you found a new home for your cat?”
“There’s a lot of demand placed on our health care practitioners, and we continually ask them to do more than they have time to do,” Dr. Edelman said. “But it’s part of optimum health care to check in with your patient periodically.” n
Lauren Constance Everingham is a former staff writer for ADVANCE.
The Little Things
Robin Hyman, RRT, AE-C, asthma educator, Children’s Healthcare of Atlanta, made the following recommendations for some little things asthma patients and family members can do to clear the air in a big way:
