United States 

Environmental Protection 

Agency 

ASTHMA HOME ENVIRONMENT


5 CHECKLIST

Home visits provide an opportunity to educate and equip asthma patients with the tools to effectively manage their disease in concert with a physician’s care. This checklist—designed for home care visitors—provides a list of 

questions and action steps to assist in the identification and mitigation of environmental asthma triggers commonly found 

in and around the home. The checklist is organized into three sections—building information, home interior and room 

interior. The room interior is further subdivided by categories (such as bedding and sleeping arrangements, flooring, 

window treatments, and moisture control). This will allow the home care visitor to focus on the specific activities or things 

in a room—in particular the asthma patient’s sleeping area—that might produce or harbor environmental triggers. The 

activities recommended in this checklist are generally simple and low cost. Information on outdoor air pollution follows 

the checklist. The last page includes information on U.S. Environmental Protection Agency (EPA) resources and an area 

for the home care visitor to record a home visit summary. 

If the patient’s sensitivities to allergens (such as dust mites, pests, warm-blooded pets and mold) and irritants (such as 

secondhand smoke and nitrogen dioxide) are known, the home care visitor should begin by focusing on relevant areas. 

This checklist covers the following allergens and irritants, which are commonly found in homes. Information is also 

provided on chemical irritants—found in some scented and unscented consumer products—which may worsen asthma 

symptoms. 

Dust Mites 

Triggers:	 Body parts and droppings. 

Where Found:	 Highest levels found in mattresses and 

bedding. Also found in carpeting, 

curtains and draperies, upholstered 

furniture, and stuffed toys. Dust mites 

are too small to be seen with the naked 

eye and are found in almost every home. 

Pests (such as cockroaches and rodents) 

Triggers:	 Cockroaches – Body parts, secretions, 

and droppings. 

Rodents – Hair, skin flakes, urine, and 

saliva. 

Where Found:	 Often found in areas with food and water 

such as kitchens, bathrooms, and 

basements. 

Warm-Blooded Pets (such as cats and dogs) 

Triggers:	 Skin flakes, urine, and saliva. 

Where Found:	 Throughout entire house, if allowed 

inside. 

Mold 

Triggers: Mold and mold spores which may begin 

growing indoors when they land on damp 

or wet surfaces. 

Where Found:	 Often found in areas with excess moisture 

such as kitchens, bathrooms, and 

basements. There are many types of mold 

and they can be found in any climate. 

Secondhand Smoke 

Trigger:	 Secondhand smoke – Mixture of smoke 

from the burning end of a cigarette, pipe 

or cigar and the smoke exhaled by a 

smoker. 

Where Found: Home or car where smoking is allowed. 

Nitrogen Dioxide (combustion by-product) 

Trigger:	 Nitrogen dioxide – An odorless gas that 

can irritate your eyes, nose, and throat and 

may cause shortness of breath. 

Where Found:	 Associated with gas cooking appliances, 

fireplaces, woodstoves, and unvented 

kerosene and gas space heaters. 

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ASTHMA HOME ENVIRONMENT CHECKLIST 

B U I L D I N G I N F O R M A T I O N 

(This information may be helpful to determine reasonable mitigations.) 

What type of building does the patient  House 

live in?  Duplex 

 Apartment 

 Mobile home 

 Other_____________________ 

Notes: 

Does the patient own or rent?  Own 

 Rent 

Notes: 

Questions Answers Action Steps 

HOME INTERIOR S MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES. 

Secondhand Smoke 

Does anyone smoke in the home or  Y  Keep the home and car smoke-free. 

car?  N  Do not allow visitors to smoke in the home. 

 Take the smoke-free home pledge and post a smokefree home decal or magnet to show that the house is a 

“smoke-free” zone. 

Notes: 

Warm-blooded Pets (such as cats and dogs) 

Is the patient’s asthma worse when  Y  If possible, remove the pet from the home or keep the 

around warm-blooded pets?  N pet outside. 

 If this is not possible, keep the pet out of the patient’s 

sleeping area and off of the furniture. 

Notes: 

Consumer Products 

Is the patient’s asthma worse when  Y  Limit patient’s exposure as much as possible by 

around chemicals or products with  N minimizing product use, using products only when 

strong odors (such as cleaners, paints, patient is not present, or trying alternative products. 

adhesives, pesticides, air fresheners,  If products are used, carefully follow manufacturer’s 

or cosmetics)? instructions on the label and make sure the area is well 

Notes: ventilated. 

Heating and Cooling Systems 

Does the heating and cooling system  Y S If so, replace the filters quarterly. 

use filters?  N S Use filters with higher efficiency than standard furnace 

filters, such as upgraded pleated filters, if heating or 

cooling system manufacturer’s specifications allow. 

Notes: 

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_____________________________ 

ASTHMA HOME ENVIRONMENT CHECKLIST 

Questions Questions Answers Action Steps 

HOME INTERIOR (continued) S MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES. 

Does the heating system use a fuel-  Y S Have the heating system - including furnaces, flues and 

burning appliance (such as an oil or  N chimneys - professionally inspected annually. 

gas furnace)? S Promptly repair cracks or damaged parts. 

Notes: 

Are supplemental heating sources  Fireplace  Properly ventilate the room where a fuel-burning 

used? (Check all that apply)  Wood-burning stove appliance is used. Consider using appliances that vent 





Unvented kerosene or gas 

space heater 

Other_____________________ 

to the outside whenever possible. 

 Never use a gas-cooking appliance as a heating source. 

 If using a fireplace, make sure it is properly vented to 

help ensure smoke escapes through the chimney. 

 If using a wood-burning stove, make sure that doors are 

tight-fitting. Use aged or cured wood only and follow 

the manufacturer’s instructions for starting, stoking, and 

putting out the fire. 

 If using an unvented kerosene or gas space heater, 

follow the manufacturer’s instructions for proper fuel to 

use and keep the heater properly adjusted. 

Notes: 

Are there air conditioning window  Y  Run window air conditioner with the vent control open to 

units?  N increase the outdoor ventilation rate during the cooling 

season. 

Notes: 

ROOM INTERIOR


Bedding and Sleeping Arrangements 

What does the patient sleep on? 

(Check all that apply) 







Mattress with box springs 

Sofa 

Other_____________________ 

S Cover patient’s mattress in a dust-proof (allergen 

impermeable) zippered cover. Clean cover according to 

manufacturer’s instructions. 

 If it is necessary for the patient to sleep on upholstered 

furniture such as a sofa, then cover furniture with 

washable slipcovers or sheets and vacuum furniture 

regularly (including removing cushions and vacuuming in 

cracks and crevices). 

Notes: 

What types of bedding does the  Bedspread (e.g., comforter,  Choose washable bedding. 

patient use? (Check all that apply) quilt)  Wash bedding regularly in hot water and dry completely. 

 Blankets S Cover patient’s pillow in a dust-proof (allergen imperme-

 Pillows able) zippered cover. Clean cover according to 

 Sheets manufacturer’s instructions. 

 Other (e.g., sleeping bag) 

Notes: 

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ASTHMA HOME ENVIRONMENT CHECKLIST 

Questions Answers Action Steps 

ROOM INTERIOR (continued) S MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES. 

Flooring 

What type of floor covering is present? 

(Check all that apply) 









Carpeting 

Hardwood floor, tile, or vinyl 

flooring 

Throw rugs 

Other_____________________ 

 If carpeting is present, vacuum carpets, area rugs, and 

floors regularly. 

 If possible, use a vacuum cleaner with a high efficiency 

filter. 

 Mop hard surface floors regularly. 

 Wash throw rugs regularly in hot water. Dry completely. 

 Clean baseboards regularly using a damp cloth with 

warm, soapy water. 

 Someone besides the patient should vacuum, sweep, 

empty the dust canister and change the vacuum bag. 

 If possible, the patient should stay out of rooms when 

they are being vacuumed or swept. 

 If the patient vacuums, sweeps, empties the dust 

canister, or changes the vacuum bag, he or she should 

wear a dust mask. 

Notes: 

Upholstered Furniture and Stuffed Toys

Is there upholstered furniture present?  Y  Cover upholstered furniture with washable slipcovers or 

 N sheets. 

 Vacuum upholstered furniture regularly, including 

removing cushions and vacuuming in cracks and 

crevices. 

S If replacing furniture, consider purchasing a nonupholstered furniture - such as vinyl, wood, or leather -

Notes: that can be easily wiped down. 

 Y  Choose washable stuffed toys, and wash frequently in 

 N hot water. Dry completely. 

 Limit the number of stuffed toys in patient’s bed and 

sleeping area. 

Window Treatments 

Are stuffed toys present? 

Notes: 

What window coverings are present? 

(Check all that apply) 

Notes: 

Cooking Appliances 

Are gas cooking appliances used?  Y  When cooking with a gas appliance, turn on an exhaust 

 N fan or open a window. 

 Avoid misuse of the appliance by following the 

manufacturer’s instructions for operation. 

Notes: 

 Curtains or drapes  Vacuum drapes regularly. 

 Blinds  Wash and dry curtains regularly. 

 Shades  Dust window sills, blinds, and shades regularly using a 

 Other_____________________ damp cloth with warm, soapy water. Dry completely. 

S If possible, replace curtains or drapes with plastic, vinyl, 

wood, or aluminum blinds. 

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ASTHMA HOME ENVIRONMENT CHECKLIST 

Questions Answers Action Steps 

ROOM INTERIOR (continued) S MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES. 

Moisture Control 

Is there evidence of water damage, 

moisture, or leaks (such as damp 

carpet or leaky plumbing)? 

 Y 

 N 

 Dry damp or wet items within 24-48 hours to avoid 

mold growth. 

S Fix water leaks (such as leaky plumbing) as soon as 

possible. 

S Replace absorbent materials, such as ceiling tiles and 

carpet, if mold is present. 

S Use air conditioner or dehumidifier to maintain low 

indoor humidity. If possible, keep indoor humidity 

below 60% (ideally between 30-50%) relative humidity. 

Notes: 

Do you see or smell mold or mildew 

(such as in the bathroom on tub, 

 Y 

 N 

 Open a window or turn on an exhaust fan when there is 

excessive moisture in the room, such as when showershower, walls, or windows)? ing or cooking. 

 Scrub mold off hard surfaces with detergent and water. 

Dry completely. 

 Clean up mold and dry surfaces completely before 

painting or caulking. 

S Replace absorbent materials, such as ceiling tiles and 

Notes: carpet, if mold is present. 

Is standing water present (such as in  Y  Empty and clean refrigerator and air conditioner drip 

refrigerator drip pans, air conditioner  N pans regularly. 

drip pans, or house plants)?  Avoid standing water in plant containers. 

Notes: 

Are humidifiers used in the patient’s  Y  Use humidifier only when conditions require it, use the 

house?  N correct setting to maintain indoor relative humidity 

between 30-50 percent, and clean humidifier reservoirs 

regularly. 

 Use low mineral content water to prevent the build-up 

of scale and dispersal of minerals into the air. 

 Follow manufacturer’s instructions for use, maintenance, and replacement of any materials supplied with 

Notes: the humidifier. 

Are rooms and moisture-producing  Y  Increase ventilation or air movement by opening doors 

appliances—such as stoves, clothes  N and/or windows when practical. Use fans as needed. 

dryers, or dishwashers—properly  Run the bathroom exhaust fan or open the window 

vented (including venting to the when showering. 

outside if specified by the manufac-  Use exhaust fans or open windows whenever cooking 

turer)? or washing dishes. 

 Vent appliances properly according to manufacturer’s 

specifications. 

Notes: 

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ASTHMA HOME ENVIRONMENT CHECKLIST 

Questions Answers Action Steps 

ROOM INTERIOR (continued) S MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES. 

Pest Control 

Is there evidence of cockroaches and/ 

or rodents (such as droppings or dead 

specimens in traps)? 

 Y 

 N 

 Clean all surfaces where you have seen pests. 

 Use poison baits, boric acid, or traps to kill pests. 

Minimize use of sprays. If sprays are used: limit the 

spray to the infested area, carefully follow the 

instructions on the label, make sure there is plenty of 

fresh air where the spray is being used and, if 

possible, keep patient out of the room. 

Notes: 

Are there food crumbs or open or  Y  Clean all food crumbs or spilled liquids right away. 

unsealed food?  N  Store food in sealed containers. 

 Remove food, bags, newspapers, and empty boxes, 

cans, and bottles from the sleeping area. 

 Put all garbage in plastic trash bags. Seal trash bags 

and put them into garbage cans with fitted lids every 

day. 

Notes: 

Are there holes or gaps between  Y  Seal holes or gaps between construction materials 

construction materials and pipes that  N and pipes, or ask the owner to do so. 

could allow pests to enter the house? 

Notes: 

Is there evidence of standing water or  Y  Dry damp or wet items within 24-48 hours to avoid 

leaks?  N mold growth. 

 Avoid standing water in house plant containers and 

drip pans. 

S Fix water leaks (such as leaky plumbing) as soon as 

Notes: possible. 

OUTDOOR AIR POLLUTION 

Exposure to air pollution (mainly ozone and particle pollution) can trigger asthma attacks. The Air Quality Index 

(AQI) is a tool to provide the public with clear and timely information on local air quality and whether air pollution 

levels pose a possible health concern. The AQI is reported and forecasted every day in many areas throughout the U.S. 

on local weather reports and through national media. Asthma attacks are most likely to occur the day after outdoor 

pollution levels are high. 

People can take simple steps to reduce their exposure to outdoor air pollution. When the AQI reports unhealthy levels: 

X Limit physical exertion outdoors. 

X Consider changing the time of day of strenuous outdoor activity to avoid the period when air pollution levels are 

high or consider postponing sports activities to another time. 

X Reduce the intensity of the activity, or spend less time engaged in strenuous activities. For example, coaches can 

rotate players more frequently in strenuous sports, like soccer. Resting players reduces their exposure to air 

pollution. 

To learn more about and access the AQI, visit www.epa.gov/airnow. 

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ASTHMA HOME ENVIRONMENT CHECKLIST 

Educational Resources: 

To learn more about EPA’s programs on: 

X Asthma and steps you can take to remove environmental triggers from the home, visit www.epa.gov/asthma. 

X Secondhand smoke and how to make your home and car smoke-free, visit www.epa.gov/smokefree or call the smokefree home pledge number at 1-866-SMOKE-FREE (1-866-766-5337). 

X Household pest management and how to apply integrated pest management at home, visit www.epa.gov/pesticides/ 

controlling/home.htm. 

To order materials at no cost on: 

X Asthma and secondhand smoke, call EPA’s Indoor Air Quality Information Line at 1-800-438-4318.


X Household pest management, call EPA’s National Center for Environmental Publications at 1-800-490-9198.


SUMMARY


Use this space to record triggers identified and mitigations recommended. You are encouraged to provide this information 

to the patient’s health care provider. 

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G-35 

EPA Postage and Fees Paid 

United States EPA 402-F-03-030 Environmental Protection Agency February 2004 Penalty for Private Use $300. Official Business Washington, DC 20460 (6609-J)