Asthma Slide Presentation Speakers Notes Page 19 of 25

mint tighets Because pets and people move around in a home, it can be difficult to contain
pet allergens in any home where there is a pet. If an asthmatic is allergic to
See, | Ee animals, it is best not to have a pet at all. Consider keeping the pet outdoors
~e ym senve nina or finding a new home for the pet.

ees pet to ‘ram ne nem hea
Searoom and eter tery tome nerughy
‘Sass at as arent tn

aieot eee

As we saw in the previous slide, pet allergens can remain long after a pet has
been removed. Therefore, if you remove a pet, be sure to clean very
thoroughly to remove the pet allergens. Clean the floors, walls, and especially
the carpets and upholstered furniture.

Some asthmatics may find that isolating the pet is sufficiently effective in
helping to keep their asthma under control. If so, be sure to keep the animal
out of sleeping areas at all times, and keep the animal away from upholstered
furniture, carpets, and stuffed toys.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 13 of 25

Asthma may be triggered by allergens and irritants which are common in our

som Indoor ererenmente! Magers own homes, schools, and daycare settings.

a The following slides show what you can do to help control five major indoor
triggers of asthma. Some of the most common indoor triggers include:
secondhand smoke, dust mites, pet dander, molds, and cockroaches.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 23 of 25

conte There are a number of ways to make your home attractive to humans but
ockroaches .
unattractive to pests.
Sommer” Sincpatiaican * Do not leave out any food or garbage
cece pepe mi * Store food in airtight containers

rambo tpiied tn ou apt and twp th penn
Senco nghtomay Taman ate fom

* Clean all food crumbs or spilled liquids right away

ponmnenns + Wash dishes when you are done using them, and do not leave dirty dishes in
the sink, especially overnight

+ Keep counters, sinks, and tables clean and clear of clutter
+ Fix plumbing leaks and other moisture problems

+ Remove piles of boxes, newspapers, and other items where cockroaches
may hide

* Make sure trash in your home is properly stored in containers with lids that
close securely, and remove trash daily

If pests still continue to be a problem, then try using poison baits, boric acid, or
traps first before using pesticide sprays. Keep in mind that pesticides are toxic
for people as well, so try to use the least toxic methods for pest control first. If
you must use sprays, do the following:

+ Limit the spray to the infested area

* Do not spray where you prepare or store food, or where young children play,
crawl, or sleep

* Carefully follow instructions on the label
+ Make sure there is plenty of fresh air when you spray, and keep the person
with asthma out of the room

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 4 of 25

‘asthma oplsode te? This exercise demonstrates how an asthma attack might feel.
+ som cnt aminane You will need one straw per person in the audience.

aceasta in our mov ane beste ty
‘Qreugh ne amy encing Yur nove Chee

Asthmatics or other persons with respiratory conditions should not participate
sone in this exercise, and anyone experiencing discomfort should discontinue the
exercise.

After handing out the straws, ask your participants to stand up and move in
place for 2 minutes by jogging, walking, or doing jumping jacks (depending on
fitness level).

Then ask people to breathe through their straws while pinching their noses
closed.

At the end of the exercise, ask your participants how they felt during the
exercise.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 20 of 25

Mold can also trigger asthma attacks. Molds can be found almost anywhere;
Molds .
une they can grow on virtually any substance when moisture is present.
aaa Molds produce tiny spores that reproduce, just as plants produce seeds. Mold
vinden spores waft through the indoor and outdoor air continually. When mold spores

land on a damp spot, they may begin growing and digesting whatever they are
growing on in order to survive. Molds can grow on wood, paper, carpet, and
food.

When excessive moisture or water accumulates indoors, mold growth will

often occur, particularly if the moisture problem remains undiscovered or
unaddressed.

There is no practical way to eliminate all mold and mold spores in the indoor
environment. Keeping that in mind, it is possible to control indoor mold
growth, and that is by controlling moisture. Remember that when tackling a
mold problem, you need to both clean up the mold and correct any problems
of excess moisture. Reducing moisture also has the benefit of helping to
reduce other asthma triggers, such as dust mites and cockroaches.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 22 of 25

Cockroaches, or, more accurately, their body parts and droppings, can trigger

Cocrroaches asthma symptoms.

‘Droppings body sant eoctrosches
ante ontona gps

Coctroaches ety conte eect
{eautee prottems mlnner cay ne

2 _— Because of higher cockroach populations in inner cities, cockroaches are
etic probably a more significant factor for asthmatics in inner city areas.

The key to controlling cockroaches is to keep them from entering your home,
and keep your home free of sources of food and water.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 17 of 25

*titet miteTiggers When avoiding dust mite triggers, try to both kill dust mites and clean to
remove mites and their droppings.

Wau eet and antes once oot ht water

{Choate maahable sted oye wath em ofan bat wet
‘ty nereughiy~ hep ted toy ft ba

ST eee neater eerie Wash bedding once a week in hot water, which has been shown to reduce
cen she rtf ress mites.

‘artam tow dot mami ee been 36-40%

Stuffed toys are often overlooked as a reservoir for mites. Choose washable
stuffed toys and wash them regularly. Keep them off beds to reduce the
exposure received during long hours of sleep.

Zippered mattresses and pillow covers which do not allow the mites to pass
through appear to be effective in reducing the amount of exposure

Vacuum floors and/or remove dust often, which may help reduce exposure to
dust mite allergens. Avoid vacuuming when the person with asthma is in the
room.

As you know, mites like to live in high humidity. Keeping humidity levels low,
between 30-50% relative humidity, can be effective in lowering mite
populations. Humidity levels can be measured by hygrometers which are
available at local hardware stores.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 9 of 25

About 5 million American children have asthma, or about 7.3% of children
under 18. Asthma is the leading chronic childhood illness and the leading
ome cause of school days missed due to chronic illness.

Who is “ts'Stiter trom asthma?

The most severe cases of asthma are found in urban areas. This is likely
caused by higher poverty rates, exposure to higher levels of some substances
which can trigger asthma, and limited access to information and medical care.

African-American children are four times more likely to die from asthma than
Caucasian children of the same age. The prevalence of asthma for some
Hispanic populations is much higher than for non-Hispanic Whites. (For
example, the prevalence of asthma is 11.2% among Puerto Ricans, as
opposed to 3.3% for non-Hispanic Whites.)

As mentioned earlier, the inherited tendency to have allergies is also a risk
factor for asthma.

Children with one asthmatic parent have a 25% greater chance of developing
asthma than children of non-asthmatics. The difference goes up to 50% when
both parents have asthma.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 6 of 25

Often, when we think of asthma, we think of a person who is coughing and
TW Batts soon wheezing. These are part of the noisy part of asthma.

Nis? Quig However, there is another part of asthma which is also very important, and that

is the quiet part of asthma. As we discussed in the previous slide, the lining of
the airways become inflamed during an asthma episode. The inflammation
can be present without a person having outward symptoms of asthma. The
inflammation also requires medical treatment.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 5 of 25

Airways are the passages that carry air to the lungs. As the airways progress

During an asthma episode?
through the lungs, they become smaller and smaller, like branches of a tree.

sot be

— When asthma is under control, as in the person on the left, the airways are
clear, and air flows easily in and out. When asthma is not under control, as in
the person on the right, the sides of the airways in the lungs become narrow,

and less air can pass in and out of the lungs.

‘neatng oth ne
ting ator

‘nororns nares
preanten

Asthma causes breathing difficulties because of three reasons. First, the
muscles around each air passage constricts or tightens, making the airways
smaller. Second, the lining of the lungs are irritated and get inflamed and
swollen, much like your skin would when you get a sunburn or a rash. Finally,
the airways produce more mucus than normal, and anyone who has had a
stuffy nose knows that mucus can also inhibit air passage.

Asthma can develop quickly, and it can range from being a mild discomfort to
a life-threatening attack if breathing stops completely. Asthma episodes are
often separated by symptom-free periods.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 18 of 25

Every one probably knows someone who is allergic to animals. Contrary to
Pets " . " :
popular belief, people are not allergic to the fur on pets, but to the animals’
skin flakes, saliva, and urine.

Sain aes wing and saben of warm
‘ooded anima an be anna nope

1+ Trgets can ema he nome for

=e Here, pets refers only to warm-blooded animals such as dogs and cats. For
most asthmatics, owning fish and turtles or other reptiles should not be a
problem for their asthma.

Most people don't realize that pet allergens can actually stay in a room long
after a pet has been removed.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 8 of 25

Facts Asthma is a significant health problem in this country, and it is on the rise.

‘Abou 7 etn mecca hae sno

‘Rete o arta ncresand 79% between 180 and 1904

Ask your audience: How many people know someone who has asthma?
(probably most people will raise their hands!)

Moet common crane heed snes stectng
‘oa bminonensoren

"4 prope cw ean day tom a

ey 2 pn room wats each yar

eee Children are particularly affected by asthma, and yes, asthma can and does
cause death.

Indoor Environments Divisior/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 24 of 25

There are quite a number of places you can go to to get additional information

Resources,
lnforreation about asthma Here are just a few.

[Provide your own sources here as well.]

Indoor Environments Division/Environmental Protection Agency


United States EPA/402-B-01-002
Environmental January 2001
Protection Agency

Asthma Speaker's Kit



Asthma Slide Presentation Speakers Notes Page 11 of 25

omstehmaTriqgers Asthma episodes can be caused by something that bothers or irritates your
ue lungs, which are called asthma triggers. Not all the asthma triggers affect
“Teena cone every person with asthma. Not all asthma triggers are listed here.
pilin There are many asthma triggers. Two major categories of asthma triggers are
— allergens and irritants.
Optional Exercise Allergens are substances that can trigger an allergic reaction in some people.

During an allergy attack, your body releases chemicals called mediators.

Before you show this slide, ask These mediators can trigger asthma episodes.

your audience to brainstorm
asthma triggers Record their
responses on a flipchart

Irritants can also trigger asthma, probably by stimulating irritant receptors in
the respiratory tract. These receptors, in turn, cause the muscles surrounding
the airway to constrict, resulting in an asthma episode.

How many of the allergens and irritants listed here are found inside homes,
schools, and childcare settings? [Answer: ALL]

Again, it is important that each asthmatic find out which triggers are a problem
for them.

Indoor Environments Division/Environmental Protection Agency



Asthma Slide Presentation Speakers Notes Page 10 of 25

Fortunately, asthma is a manageable disease. There are two parts to
sro Asthma managing asthma: preventing asthma attacks and treating asthma episodes
‘Stow sent pc cn when they do occur. Your doctor or health care provider is an important
sesctten person in helping you develop an effective asthma management plan. Have a
eee ee written asthma management plan, and make sure that the pian includes both
nares medical and environmental management. By following your plan, an asthmatic
emer ya ne piaaey
ee can lead a full and active life and significantly reduce, or even prevent, asthma

attacks.

In this presentation, we will not cover asthma medications, emergency plans,
or peak flow monitoring. Your doctor or health care provider can and should
assist you in these areas. This presentation will discuss the most common
indoor asthma triggers in detail, but will not cover how to identify which triggers
are problems for you. Again, your doctor or health care provider can provide
you assistance.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 7 of 25

*°S mpTOMS Here are some typical asthma symptoms. Which symptoms listed are part of
the noisy part of asthma? The quiet part of asthma? [ALL symptoms listed
— are part of the noisy part of asthma]
= Many of these symptoms can be caused by reasons other than asthma. On
__. the other hand, a person's asthma could also be asymptomatic, meaning that

the person is not experiencing any symptoms.

A person should consult a physician to accurately determine whether they
have asthma and to learn how to detect when their asthma requires treatment.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 21 of 25

smn tota T There are a number of common places in the home where moisture and mold
—r can be a problem, such as kitchens, bathrooms, and basements.
Saas Soros
ee ee Fix any plumbing leaks immediately. If water damage occurs, you should dry
er ccum  umameanennan water-damaged areas completely within 24 to 48 hours. In some cases,
Seema hima soaked materials such as carpeting may need to be replaced.

Check the various drip pans in your home and keep them clean and dry.
Optional Exercise

Before you show this slide, ask Use the exhaust fans in your bathrooms and kitchens when showering or

your audience to brainstorm a cooking.

list of common locations for

mold to grow in the home (such .

as shower curtains and window Make sure that your clothes dryer vents to the outside.

moldings) Record their
responses on a flipchart . says oe
Keep the relative humidity in your home between 30 and 50% to maximize

comfort and minimize asthma triggers. Using an air conditioner or
dehumidifier can help to lower humidity when it is high.

Avoid installing carpet directly on concrete floors in the lowest level of your
home.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes

atts Asthma?

‘Chrome tamer here o srw
‘nua evra But nat ot urate

‘Hot ae on ater

Asthma is a chronic inflammatory disorder of the airways.

Chronic means long-term or having recurring episodes.

Inflammatory disorder of the airways means that a person's capacity to
breathe is limited.

Asthma is a manageable disease. Asthma episodes, also called asthma

Page 3 of 25

attacks, are usually reversible either spontaneously or with medical treatment.

Asthma can be difficult to diagnose and differentiate from other respiratory
illnesses. Allergies and asthma are not the same, although they are both
diseases involving the immune system. Allergies can also trigger asthma
attacks or episodes. The inherited tendency to develop allergies (atopy) is a
tisk factor for asthma.

In case there is any doubt, asthma is not contagious!

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 14 of 25

secendhana Smoke Secondhand smoke is also known as Environmental Tobacco Smoke.
Secondhand smoke includes both exhaled mainstream smoke from smokers
and sidestream smoke from the end of a cigarette, cigar, or pipe. It contains
pene ta es more than 4,000 substances, including over 40 that are linked to cancer.
aoenteremuenmna Many of the compounds in tobacco smoke are released at higher rates in
eto umn ans nce sidestream smoke than in mainstream smoke.

Young children and babies are especially vulnerable to secondhand smoke,
and up to 1 million asthmatic children have their condition made worse by
exposure to secondhand smoke. Secondhand smoke can also cause young
children to develop asthma.

In addition, children exposed to secondhand smoke are more likely to suffer
from pneumonia, bronchitis, and other lung diseases, and be more likely to
have ear infections.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 16 of 25

bust Dust mites are tiny, spider-like animals which are too small to be seen.
— Dust mites feed on skin flakes and like to live in warm, humid places.
set nt te Therefore, ideal places for mites to live are mattresses, pillows, carpets, fabric-
tes covered furniture, bedcovers, clothes, and stuffed toys, where there is high
em" humidity and an ample food source.

Both the dust mites themselves, and their feces or droppings, are allergens
and can trigger asthma.

On average, a double-sized bed can easily contain 2,000,000 dust mites, with
each mite producing 10-20 waste particles (feces) per day.

As with secondhand smoke, dust mite exposure can also cause young
children to develop asthma.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 2 of 25

The presentation will include general information on asthma, as well as
Topics Coverea Pa . . .
more specific information about how our indoor environments relate to
vennneet asthma. The audience will come away with easy, effective ways for people
cena saner to avoid asthma triggers indoors.
smcoionenpencnseetonrnne none?
Note

This presentation does not
discuss medical interventions
for asthma (see page 10 of the
notes for more detailed
explanation) You can modify
and expand the information
presented to include the
medical aspects of managing
asthma

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 25 of 25

Getting Others To Take Action These are some things that you can do in your community to help spread the
word about asthma and asthma triggers.

Tete 0 recommended acon and encourage eter 1020 te,
‘smote tee Home Pledge 00) 811857
Inert Gushy Toot For Schoo (0 38-4318

SS ose EPA has a Smoke-Free Home program. You can take the pledge yourself and
(enna ang net semana call the hotline number to receive your kit. You can also encourage others to
join you in taking the pledge by ordering and passing out the informational
a brochure.

Launch a Secondhand Smoke campaign in your community. Order EPA's

End by encouraging your Secondhand Smoke Community Action Kit to get you started.

audience to take action

against asthma! First, take 5 hools to i their ind . ity. Call and ord

the actions recommended in Ncourage your schools to improve their indoor air quality. Call and order an
EPA's brochure "Clear Your IAQ Tools for Schools kit, or check out the kit on the EPA website.

Home of Asthma Triggers,”

then encourage thers to do Open Airways is an ALA program to help children with asthma manage their
so by using the many asthma better. Encourage your schools to implement this program. A is for

Asthma is a program that ALA has developed for younger children.

tesourees available to talk Encourage daycare centers in your area to implement this program.

with friends and family,
schools, child care providers, . . a
et The Asthma and Allergy Foundation of America offer a CEU-based training
c. : . .

course for licensed child care providers on appropriate asthma and allergy

management, including environmental controls, in their child care settings.

The program, Asthma and Allergy Essential for Child Care Providers, is co-

sponsored by the Indoor Environments Division of the Environmental

Protection Agency. Contact your local AAFA Chapter to co-sponsor a training

for child care providers in your area.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 1 of 25

Introduce yourself. . e
\tstin fe Ath Preparation Suggestions
a. Explain that the presentation is Materials Needed
We, about 1 hour in length and +Markers
Revetinrenetiqtiel indicate whether or not you are Flip Chart
__ open to receive questions “Slide Projector

during your presentation. Drinking Straws (one for each participant)

Handouts

Order the following handouts by calling EPA's National
Service Center for Environmental Publications at (800)
490-9198

Clear Your Home of Asthma Triggers: Your
Children Will Breathe Easier

EPA document number 402-F-99-005 Will also
become available in Spanish, Chinese, Korean, and
Vietnamese in 2001

Secondhand Smoke & Children

EPA document number 402-F-98-011(English) and 402-
F-98-011A(Spanish)

Indoor Air Quality Tools For Schools Kit
EPA document number 402-K-95-001

Indoor Environments Diviston/Environmental Protection Agency



Asthma Slide Presentation Speakers Notes Page 12 of 25

rdsoF environment, Asthma? Let's consider the fact that many allergens and irritants are found indoors.

=== Add to that the fact that Americans spend up to 90% of their time indoors.
sete common sete tigger tn ne Therefore, it is not surprising that exposure to indoor asthma triggers is a
Anereir ween 2 eee significant contributor to the asthma problem.

‘Resucing exposure todos abergena and leans can vecuce
Saha trmocome

‘Prevetion i an important etna management tot

ee Conversely, controlled studies show reducing exposure to indoor allergens can
reduce asthma symptoms

Therefore, avoiding indoor asthma triggers is important to helping avoid
asthma attacks. Also, when asthma episodes do happen, they could be less
severe. However, many people are still focusing only on treating asthma once
an episode has already started. Let's see if we can learn about how to keep
these asthma attacks from starting in the first place.

Indoor Environments Division/Environmental Protection Agency


Asthma Slide Presentation Speakers Notes Page 15 of 25

Given the adverse health effects of secondhand smoke, it is important to avoid
smoking in your home or car. Until you can quit smoking, you should smoke
outside.

Secondhand Smoke

Cheats nto mate your homeo at
‘indo not stow oters a Gove eet

Never smoke in the presence of asthmatics or children, who are particularly
susceptible to the effects of secondhand smoke.

Do not allow babysitters or others who work in your home to smoke in the
house or near your children.

Indoor Environments Division/Environmental Protection Agency