Category: Featured Stories and Interviews

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Family Asthma Day Is April 30 at All Children’s Hospital

ST. PETERSBURG – The Suncoast Pediatric Asthma Coalition wants to improve the quality of life for children and teens living with asthma in the Tampa Bay area.

The group is planning its 10th annual Asthma Family Day, which is at All Children’s Hospital in St. Petersburg on April 30.

“We’ll have great speakers, activities, and enthusiastic volunteers,” said Michiko Otsuki Clutter. Clutter is a coalition member and assistant professor of psychology at USF St. Petersburg.

She also heads the Suncoast Youth and Family Health Research Lab. Clutter does research to identify psycho-social factors that help young people manage their asthma care.

“Some kids are better at taking their medication than others. We want to learn why,” Clutter said.

FIRSTHAND KNOWLEDGE

Annmarie Colwell is a registered respiratory therapist who oversees the coalition’s outreach efforts. “I have two daughters, Natalie, age 13, who is a severe, persistent asthmatic and Caitlin, age 9, who is a mild, intermittent asthmatic,” Colwell said.

According to Colwell, her daughters and their asthma have shaped every aspect of her life including her career path and involvement in the coalition.

Colwell said she cannot forget the first time her infant daughter had trouble breathing and was hospitalized. “You deal with the fear, then the feeling of helplessness, loss of control, guilt and finally the relief that comes from having a child with asthma.”

Colwell shares the lessons she has learned combined with medical expertise. “I try to interact with the parents as well as the children and provide them with ‘real world’ answers on how to live day to day as a family with asthma.”

UNDERSTANDING ASTHMA

More than 7 million American children have asthma. The chronic respiratory disease is a major cause of childhood disability, according to the U.S. Centers for Disease Control (CDC).

There is no cure for asthma, but “knowing the warning signs of an attack, staying away from things that trigger an attack, and following the advice of your doctor or other medical professional” can reduce risks, the CDC reported.

Asthma accounts for more than 56 million school absences. Asthmatic children often spend their time away from school confined to bed.

Symptoms include: labored breathing; recurrent coughing; rapid, shallow breathing; wheezing, shortness of breath; and chest pain. In severe cases asthma can be deadly.

Treatments usually involve taking medication to prevent inflammation of lung tissue. With proper care, asthma attacks can be significantly reduced. But children with asthma do not always get the care they need or take their asthma medications as prescribed.

HELPFUL TIPS FOR FAMILIES

Colwell offered the following suggestions to parents of asthmatic children:

* Establish a relationship with a pediatric pulmonologist. Asthma can be a life-long disease and having a go-to person is imperative.

* Keep your child and her or his caregivers involved and informed. Make sure they know asthma can be life threatening and what to do if an attack is triggered.

* Keep a binder for questions and answers, get educated on the disease process and how your child reacts to triggers and medications.

“Always remember, you are your child’s best advocate,” Colwell stated.

FOR MORE INFORMATION

Asthma Family Day is for children ages 4 to 18 and their families and caregivers. Registration is recommended.

For more information, go to www.allkids.org/AsthmaDay or call (727) 767-4188

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Why Are Asthma Rates Soaring?

Why Are Asthma Rates Soaring? Researchers once blamed a cleaner world. Now they are not so sure

Research into varying causes of asthma may eventually lead to new ideas on how to manage the condition.

According to an article published in the Scientific American, Asthma rates have been surging around the globe over the past three decades, and for a long time researchers thought they had a good idea of what might be fueling the increase: the world we live in is just a little too clean. According to this notion—known as the hygiene hypothesis—exposure in early childhood to infectious agents programs the immune system to mount differing highly effective defenses against disease-causing viruses, bacteria and parasites. Better sanitary conditions deprive the immune system of this training, so that for reasons that are still unclear, the body pounces on harmless particles—such as dust and ragweed—as if they were deadly threats. The resulting allergic reaction leads to the classic signs of asthma: chronic inflammation or swelling of the airways and acute spasms of those passageways.

Or so the thinking went. Although a lot of data support the hygiene hypothesis for allergies, the same cannot be said for asthma. Contrary to expectations, asthma rates have skyrocketed in urban areas in the U.S. that are not particularly clean. Moreover, the big increase in asthma rates in developed countries did not kick off until the 1980s—well after general sanitary conditions in the richer parts of the world had improved. And some studies are beginning to show that far from protecting children from asthma, respiratory infections in early childhood may actually be a risk factor for it.

The collapse of the hygiene hypothesis as a general explanation for the startling jump in asthma rates has led physicians and scientists to a new realization: asthma is a much more complex condition than anyone had truly appreciated. Indeed, it may not be even be a single disease. Studies now suggest that only half of asthma cases have an allergic component.

The prevention and treatment implications are significant. If, for instance, it is true that allergy is not a fundamental cause of asthma in many people, then an alternative mix of treatments may be more effective for those individuals. To root out asthma’s cause (or causes) and properly treat the burgeoning number of people who are affected—300 million globally at last count—scientists will have to come to grips with the biology of its various forms.

Balancing Act
The hygiene hypothesis was first described in 1989 by David P. Strachan, a British epidemiologist who was studying hay fever. The more children in a family, he noticed, the lower the rates of hay fever and eczema, an allergic skin condition. Children in large families tend to swap colds and other infections more often than children with fewer siblings. Could it be that increased exposure to pathogens from their many siblings was protecting children from large families against allergies?

That same year Erika von Mutius, an epidemiologist at Munich University, was looking into the effect of air pollution on asthma in what was then East and West Germany. Children from dirtier East Germany, she was shocked to find, had dramatically less asthma than their West German counterparts living in cleaner, more modern circumstances. The East German children, unlike their Western counterparts, had spent more time in day care and thus had likely been exposed to many more viruses and bacteria. “That was astonishing,” she recalls, and led to “a major shift” in thinking.

These findings sparked intense debate among scientists. What is it about unhygienic living that might protect against asthma? One of the more popular explanations in the following decades entailed a balance between the immune cells that are involved in the body’s reaction to most viruses and bacteria and those that are involved in the reaction to most parasites and allergens. These two groups of cells produce chemicals that inhibit each other. Early-childhood exposure to bacteria and viruses would cause the infection-related cells to become active, keeping the allergy- and parasite-related cells in check. Without that interplay, the allergy-related cells would later become over­reactive, starting an allergic chain reaction that became chronic and ended in constricted airways, asthmatic spasms and labored breathing.

Inconvenient Facts
There was only one problem. As more data came in, they failed to tell the same story as the hygiene hypothesis. Children in Latin America with high rates of supposedly protective infection have even higher rates of asthma than children in western Europe. Inner-city children in Chicago and New York have quite high rates of asthma, despite unhygienic living. And the rates of asthma varied among countries with very similar histories of cleanliness—indicating that there was more to it than tidiness. For example, by 2004 Sweden’s asthma cases had increased to 10 percent, according to one international study, while the number of cases in the U.K. had soared to 20 percent.

In addition, research showed that the relation between asthma and allergy is not at all straightforward. Some cases of asthma are indeed triggered by allergies, although the consensus among researchers over the past decade is that the connection is probably not as clear-cut as the hygiene hypothesis would suggest. Still other layers of immune regulation must be involved. Maria Yazdanbakhsh, a parasitologist at Leiden University in the Netherlands, has shown that people infected with parasitic worms have very high levels of the allergy-related immune cells but very low rates of asthma, disproving a direct connection between allergy and asthma in these cases at least.

What is more, a landmark review of asthma studies in 1999 by Neil Pearce, now at the London School of Hygiene and Tropical Medicine, demonstrated that at least half of asthma cases in the general population have no connection to allergic reactions at all. These could never be explained by the hygiene hypothesis.

In fact, the same factors that the hygiene hypothesis suggests protect people from developing allergic asthma may cause them to develop nonallergic asthma. “We think that dirt protects against allergic asthma, as foretold by the hygiene hypothesis, but increases the risk of having a nonallergic form,” says Laura Rodrigues of the London School of Hygiene and Tropical Medicine, who studies asthma in Latin America. Pollutants in the air can irritate the airways and cause inflammation that leads to constricted breathing. Childhood colds, which the hygiene hypothesis suggested might help prevent development of asthma, can actually be a risk factor for asthma, especially if severe, says James E. Gern, a pediatrician who studies colds and asthma at the University of Wisconsin–Madison. “Early-life infections are an indicator of asthma risk rather than protective in any way,” he says.

Besides the hygiene hypothesis, what can explain the increase in asthma rates? Other suggested causes include a rise in sedentary lifestyle, which could affect lung strength, and the rise in obesity, which increases inflammation throughout the body. A reworking of the hygiene hypothesis that focuses on changes in the normal nondisease-causing bacteria that live inside and on the body (in the intestines or the airways or on the skin) has promise. Studies by von Mutius and others have shown that children who live on farms where cows or pigs are raised and where they drink raw milk almost never have asthma, allergic or otherwise. Presumably because the children drank unpasteurized milk and handled livestock, they have different strains of normal bacteria in their airways that are somehow more protective than those found in city kids.

But the short answer to the question of why asthma has increased, according to Pearce, von Mutius, Rodrigues and many others, is, “We don’t know.” Pearce, in particular, wonders whether modernization in general or westernization in particular may play a role. “There is something about westernization that means people’s immune systems function in a different way,” he says. “But we don’t know what the mechanism is.”

Getting at the true underlying cause of the climb will require better ways of distinguishing among various possible types of asthma. Major asthma research networks supported by the National Institutes of Health have begun recording the details of thousands of individuals’ symptoms and treatments. As the results are gathered and analyzed, researchers hope to identify clusters of asthma cases that have different causes and respond to different treatments. The hope is that “if you come in with these characteristics in asthma, we can anticipate what the prognosis is going to be and what the most effective treatment for you is going to be,” says William W. Busse of the University of Wisconsin School of Medicine and Public Health, who is part of one such network.
It will take years to understand fully whether microbial exposure, lifestyle changes or the obesity epidemic is more important in explaining the continuing increase in asthma rates. But one thing is clear: the hygiene hypothesis was just the beginning.

To subscribe to the Scientific American and for more information about the Asthma article visit http://www.scientificamerican.com/article.cfm?id=why-are-asthma-rates-soaring&page=3

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New Guidelines On Managing Childhood Asthma Released

Children aged five and under – particularly those with intermittent viral-induced wheezing – should be treated with oral corticosteroids for asthma only if their wheeze is severe enough to require hospital admission, according to new guidelines.

The Thoracic Society of Australia and New Zealand (TSANZ) updated its position statement on corticosteroid use in childhood asthma after reviewing recently published clinical research.

The understanding of childhood asthma and recognition of the need for separate management guidelines for children aged five and under has increased since the TSANZ published its previous position statement in 2002, Professor Peter Van Asperen, Head of the Department of Respiratory Medicine at The Children’s Hospital at Westmead said in an editorial published in the latest Medical Journal of Australia.

“If control is not achieved using initial preventer therapy, it is important to review the diagnosis of asthma – particularly in children aged five years or younger – as many children with recurrent cough are mislabelled as having asthma,” Prof Van Asperen said.

“Oral corticosteroids improve outcomes in children presenting to hospital with acute asthma, but the efficacy of oral corticosteroids for children aged five years or younger with acute, mild-moderate, viral-induced wheezing has been questioned.

“In children aged five years or younger (particularly those with intermittent, viral-induced wheezing) the use of oral corticosteroids should be limited to those with severe wheeze who require hospital admission.”

The revised position statement also provides updated recommendations on the roles of inhaled corticosteroids, leukotriene receptor antagonists and combination medications in childhood asthma management. It highlights the role of leukotriene receptor antagonists as an alternative to long-acting beta-agonists as add on therapy in children not adequately controlled on inhaled corticosteroids and also recommends that long-acting beta-agonists not be used in children aged five years or younger.

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Richmond is Top U.S. “Asthma Capital”

Richmond is Top U.S. “Asthma Capital” Again says Annual Report Names the 100 Most Challenging Places to Live with Asthma

For the second year in a row, Richmond, VA, has been ranked as the No.1 Asthma Capital – the most challenging place to live with asthma in the U.S. – according to the Asthma and Allergy Foundation of America (AAFA), which conducted the study. The ranking was determined based on an analysis and scoring of a variety of factors in the 100 largest U.S. metro areas.

For eight years, AAFA has scientifically researched and evaluated conditions in metropolitan areas in America and ranked them based on quality of life for people with asthma. The Foundation reviews 12 factors including: crude death rate for asthma; estimated prevalence of adult and pediatric asthma; risk factors, such as air pollution, pollen counts and public smoking bans; and medical factors, such as the number of asthma medications used per patient and the number of asthma specialists in the area. The full report showing all 100 metro areas is available for free at www.AsthmaCapitals.com.

Going South

Up from number fourteen in 2009, to number 1 in 2010, Richmond is again ranked as the top Asthma Capital in the 2011 report. The dubious honor for Richmond is due to a number of factors including a higher than average pollen score, continued poor air quality, a lack of public smoking bans, high poverty and uninsured rates, and other factors.

In fact, 14 cities in the top 25 of this year’s rankings are located in the south. The poor ranking of southern cities this year may be due in part to the slow adoption of “100% smoke-free” laws in southern tobacco-producing states and cities, as well as continued high levels of air pollution and ozone days, all considered major risk factors for people with asthma.

Don’t Move – Improve

More than 20 million children and adults live with asthma all over the U.S., making it one of the most common and costly diseases. Experts agree that people can’t move away from their asthma since every city in America has a variety of risk factors. Instead, people should work with an asthma specialist to improve their overall asthma management plan no matter where they live.

“Although Richmond is a particularly difficult place for people with asthma to live, asthma triggers are present in every American city,” says Mike Tringale, AAFA’s Vice President of External Affairs. “There is no way for asthma patients to escape their disease, but no matter where they live, patients can work with their physicians to find ways to control their symptoms better.”

This Year’s Top 10

The top 10 Asthma Capitals for 2011 are:

1. Richmond, VA
2. Knoxville, TN
3. Memphis, TN
4. Chattanooga, TN
5. Tulsa, OK
6. St. Louis, MO
7. Augusta, GA
8. Virginia Beach, VA
9. Philadelphia, PA
10. Nashville, TN

Find the full rankings and complete data for all 100 cities at www.AsthmaCapitals.com.

About Asthma

Asthma is a condition characterized by inflammation of airways in the lungs resulting in chronic wheezing, coughing and difficulty breathin

• More than 4,000 deaths annually

• More than 500,000 hospitalizations annually
• Over 12 million missed days of school for children each year
• Over 10 million missed days of work for adults each year
• 1.8 million emergency room visits each year
• $18 billion in medical expenses and indirect costs each year

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New Asthma Medicines Show Promise

New Asthma Medicines Show Promise Says Scientists

ANAHEIM, — In what they described as the opening of a new era in the development of potentially life-saving new drugs, scientists today reported discovery of a way to tone down an overactive gene involved in colon cancer and block a key protein involved in asthma attacks. Those targets long had ranked among hundreds of thousands that many scientists considered to be “undruggable,” meaning that efforts to reach them with conventional medicines were doomed to fail.

“These substances represent an entirely new class of potential drugs,” study leader Gregory Verdine, Ph.D., told the 241st National Meeting & Exposition of the American Chemical Society, being held here this week. “They herald a new era in the drug-discovery world.”

Verdine cited estimates that conventional medicines, most of which belong to a family termed “small molecules,” cannot have any effect on 80-90 percent of the proteins in the body known to be key players in disease. Throwing up their hands in frustration, scientists had even begun to term these prime targets for battling disease as “untouchables” and “undruggable.”

The new substances are not small molecules, but “stapled peptides,” named because they consist of protein fragments termed peptides outfitted with chemical braces or “staples.” The stapling gives peptides a stronger, more stable architecture and the ability to work in ways useful in fighting disease.

“Our new stapled peptides can overcome the shortcomings of drugs of the past and target proteins in the body that were once thought to be undruggable,” Verdine said. “They are a genuinely new frontier in medicine.”

In one advance, Verdine and colleagues at Harvard University described development of the first stapled peptides that target colon cancer and asthma attacks. The colon cancer stapled peptides inhibit activity of a protein called beta-catenin that, when present in a hyperactive form, causes cells to grow in an aggressive and uncontrolled way. That protein normally helps keep certain cells, including those lining the colon, in good health. But the abnormal protein has been directly linked with an increased risk of colon cancer and other types of cancer, including those of the skin, brain, and ovaries.

When added to human colon cancer cells growing in laboratory cultures, the stapled peptides reduced the activity of beta-catenin by 50 percent. In patients, that level of reduction could be sufficient to have a beneficial impact on the disease, Verdine suggested.

Verdine also reported development of the first stapled cytokines, which show promise for fighting asthma. Cytokines are hormone-like proteins secreted by cells of the immune system and other body systems that help orchestrate the exchange of signals between cells. The stapled cytokines moderate the activity of a cytokine called interleukin-13, which asthma patients produce in abnormally large amounts that contribute to asthma attacks.

Current asthma drugs, he noted, tend to treat the underlying symptoms of asthma, particularly inflammation. By contrast, stapled cytokines could treat the underlying causes of the disease. Verdine’s team is collaborating with a pharmaceutical firm on efforts to further develop the stapled peptides.

The American Chemical Society is a nonprofit organization chartered by the U.S. Congress. With more than 163,000 members, ACS is the world’s largest scientific society and a global leader in providing access to chemistry-related research through its multiple databases, peer-reviewed journals and scientific conferences. Its main offices are in Washington, D.C., and Columbus, Ohio.M

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Asthma diagnosis breakthrough

Simple blood test to detect respiratory disease says news study

In a world-first study, Hunter researchers have found that respiratory diseases could soon be diagnosed through a simple blood test.

Currently, people suspected of suffering asthma or chronic obstructive pulmonary disease (COPD), are diagnosed by undertaking a series of clinical tests to assess their lung function and response to medication.

The study, to be published in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine, has identified four novel blood-based biomarkers that can tell whether a person is suffering asthma, COPD or if they have a healthy lung function.

Lead researcher Professor Peter Gibson said that correct diagnosis of asthma or COPD was vital in managing and treating the conditions.

“Asthma and COPD have similar characteristics such as coughing and wheezing, but they are two very different conditions in terms of disease onset, frequency of symptoms and treatment.

“To date, some studies have attempted to identify biomarkers of COPD or asthma, but no one had investigated whether blood-based diagnosis was possible.”

Professor Peter Gibson and his team relied on the proteomics approach – an emerging field of science that focuses on the structure and functions of an organism’s proteins.

Using clinical trials they found that when used in combination, four blood-based biomarkers were able to discriminate between a clinical diagnosis of asthma, COPD and a control group.

Professor Gibson said that identifying the biomarker involved in the development of airway diseases may allow clinicians to diagnose the diseases in their earlier, more treatable stages.

“Since these biomarkers can be detected in blood, which is readily obtainable from patients, this panel of biomarkers has the potential to become an extremely useful addition to the clinical diagnosis and management of respiratory disease.

“Combined with well-defined clinical groups and advanced statistical analyses, we have shown that proteomics is a powerful tool for the identification of novel disease biomarkers. The study is a good example of how high-quality biological science can be translated effectively to a useful result for people with asthma and COPD.”

Professor Peter Gibson is a senior staff specialist at Hunter New England Local Health Network and a Conjoint Professor at the University of Newcastle.

The study was funded by the Australian government as part of its Cooperative Research Centre for Asthma and Airways program. The findings were published online ahead of the print edition of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

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Researchers claim asthma breathrough

Researchers in South Australia are claiming a breakthrough in the understanding of asthma say news sources.

They have found a protein which stops the absorption of the essential mineral, zinc, which may help control symptoms.

According to researchers, zinc can protect humans against any pollutants that are inhaled.

However, experts have found that in asthmatics zinc does not have the same effect because the molecules that usually carry it through the body are missing.

Work has begun to find a way to correct the deficiency.

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Asthma and Fungai

Anti-Fungal Drug Offers Great Benefits to Some with Severe Asthma

January 1, 2009 — Some patients with severe asthma who also have allergic sensitivity to certain fungi enjoy great improvements in their quality of life and on other measures after taking an antifungal drug, according to new research from The University of Manchester in England.

The findings were reported in the first issue for January of the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

“We knew that many people with severe asthma are sensitized to several airborne fungi which can worsen asthma without overt clinical signs. The question was: does antifungal therapy provide any clinical benefit,” said David Denning, F.R.C.P., F.R.C.Path., professor of medicine and medical mycology at The University of Manchester and lead investigator of the study.

In 2006, the most recent year for which official statistics are available, there were more than 16 million adults with self-reported asthma in the U.S.; about 20 percent of them have severe asthma.

A small number of severe asthmatics—about one percent— are known to have a syndrome called allergic bronchopulmonary aspergillosis, an extreme allergy to Aspergillus fumigatus fungus that is associated with the long-term colonization of their respiratory tracts with the fungus. But many more — 20 to 50 percent— are sensitized to a variety of fungi without showing overt clinical signs or demonstrable colonization. It is these patients with severe asthma with fungal sensitization, or “SAFS”, as the researchers named the syndrome, who are most likely to enjoy marked improvement with the antifungal therapy.

In the prospective double-blind study, 58 patients with severe asthma and allergic sensitivity to at least one of seven different common fungi (confirmed by a skin-prick test and/or an IgE blood test for the study) were randomized to receive either an oral dose of itraconazole (200mg twice a day) or a placebo.

After 32 weeks of treatment, 18 of the 29 patients (62 percent) who were randomized to receive the drug experienced significant improvements on their Asthma Quality of Life Questionnaires, and in runny nose and morning lung function. However, 11 of the patients who received the drug left the trial before completion, some citing side effects that included nausea, breathlessness and muscle weakness. Unfortunately, four months after stopping antifungal treatment, symptoms had returned.

“This study indicates that fungal allergy is important in some patients with severe asthma, and that oral antifungal therapy is worth trying in difficult-to-treat patients. Clearly itraconazole will not suit everyone and is not always helpful, but when it is the effect is dramatic,” said Dr. Denning. “These findings open the door to a new means of helping patients with severe asthma, and raise intriguing questions related to fungal allergy and asthma.”

John Heffner, M.D., past president of the ATS, reflected that the recent Severe Asthma Research Program report describes severe asthma as a entirely different form of the disease. “Patients with severe asthma may have unique triggers for bronchospasm, which remain unidentified. This study suggests that colonization with fungal species may generate immunologic responses in patients with asthma that perpetuate airway inflammation and blunt the effectiveness of drug therapy. One can’t help but wonder if antifungal therapy would benefit all severe asthmatics regardless of sensitivity to fungi.”

A press release provided by the American Thoracic Society — the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine.

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Asthma Vs. Heart Disease

Asthma Vs. Heart Disease

How Can I Tell The Difference Between A Heart Condition And Asthma?

Bruce Bochner, M.D., Chief, Division of Allergy and Clinical Immunology, The Johns Hopkins School of Medicine on ABC frames it this way:

Question:How can I tell the difference between a heart condition and asthma?
Dr. Bochner answers the question: ‘Do I Have A Heart Condition Or Asthma?’

Answer: So, people with asthma have symptoms of chest tightness, shortness of breath, wheezing; it can happen at rest, but it is particularly worse when people exert themselves. And it’s that latter point that often makes it a little bit confusing between distinguishing asthma from heart conditions that also lead to things like shortness of breath, especially with exertion.

So, things that make you think of asthma are shortness of breath symptoms that are relieved with asthma-like inhalers, usually those don’t work at all in heart conditions. With respect to heart conditions, they’re often associated with additional symptoms that people might be waking up in the middle of the night short of breath and that needs to be distinguished between asthma and heart disease. Asthma rarely, if ever, causes any swelling in the legs. That’s almost always a condition other than asthma. And then the typical symptoms of angina, the sort of really chest, a heavy chest pressure that you get with exertion that gets relieved with things like nitroglycerine. That medicine doesn’t work at all in asthma.

So sometimes it’s a little bit tricky in someone who shows up in the office for the first time with shortness of breath as their main symptom, you can’t always jump to immediate conclusions and assume that it is or it isn’t asthma, is or isn’t a heart condition. Lots of conditions can present with shortness of breath and that’s often one of the most important reasons why you should see a doctor and let them help you figure out exactly what the main problems are.

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Asthma and Molds

<'h2>Asthma and Molds – Potential health effects and symptoms associated with mold exposures include allergic reactions, asthma, and other respiratory complaints.

Mold Resources

The publication, “A Brief Guide to Mold, Moisture, and Your Home”, is available in HTML and PDF (PDF, 20 pp, 278KB About PDF) [EPA 402-K-02-003]

Una Breve Guía para el Moho, la Humedad y su Hogar está disponible en el formato PDF (PDF, 20 pp, 796KB About PDF). [Documento de la agencia EPA número 402-K-03-008]

The publication, “Mold Remediation in Schools and Commercial Buildings”, is available in HTML and PDF (PDF, 54 pp, 5MB About PDF) [EPA 402-K-01-001, March 2001]

Resource: WHO Guidelines for Indoor Air Quality: Dampness and Mould (PDF) (248 pp., 2.65 M) exiting epa World Health Organization, 2009

EPA’s Office of Research and Development Fact Sheet: The Environmental Relative Moldiness Index

Order publications from EPA’s NSCEP. Use the EPA Document Number when ordering.

Contents

* Introduction to Molds
* Basic Mold Cleanup
* Ten Things You Should Know About Mold
* Asthma and Mold
* Floods/Flooding
* Health and Mold
* Homes and Mold
* Indoor Air Regulations and Mold
* Large Buildings and Mold
* Schools and Mold and Indoor Air Quality
* How to Order Publications

Introduction to Molds

Molds produce tiny spores to reproduce. Mold spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may begin growing and digesting whatever they are growing on in order to survive. There are molds that can grow on wood, paper, carpet, and foods. When excessive moisture or water accumulates indoors, mold growth will often occur, particularly if the moisture problem remains undiscovered or un-addressed. There is no practical way to eliminate all mold and mold spores in the indoor environment; the way to control indoor mold growth is to control moisture.

* See also: An Introduction to Molds and Related Links

Basic Mold Cleanup

The key to mold control is moisture control. It is important to dry water damaged areas and items within 24-48 hours to prevent mold growth. If mold is a problem in your home, clean up the mold and get rid of the excess water or moisture. Fix leaky plumbing or other sources of water. Wash mold off hard surfaces with detergent and water, and dry completely. Absorbent materials (such as ceiling tiles & carpet) that become moldy may have to be replaced.

Ten Things You Should Know About Mold

1. Potential health effects and symptoms associated with mold exposures include allergic reactions, asthma, and other respiratory complaints.
2. There is no practical way to eliminate all mold and mold spores in the indoor environment; the way to control indoor mold growth is to control moisture.
3. If mold is a problem in your home or school, you must clean up the mold and eliminate sources of moisture.
4. Fix the source of the water problem or leak to prevent mold growth.
5. Reduce indoor humidity (to 30-60% ) to decrease mold growth by: venting bathrooms, dryers, and other moisture-generating sources to the outside; using air conditioners and de-humidifiers; increasing ventilation; and using exhaust fans whenever cooking, dishwashing, and cleaning.
6. Clean and dry any damp or wet building materials and furnishings within 24-48 hours to prevent mold growth.
7. Clean mold off hard surfaces with water and detergent, and dry completely. Absorbent materials such as ceiling tiles, that are moldy, may need to be replaced.
8. Prevent condensation: Reduce the potential for condensation on cold surfaces (i.e., windows, piping, exterior walls, roof, or floors) by adding insulation.
9. In areas where there is a perpetual moisture problem, do not install carpeting (i.e., by drinking fountains, by classroom sinks, or on concrete floors with leaks or frequent condensation).
10. Molds can be found almost anywhere; they can grow on virtually any substance, providing moisture is present. There are molds that can grow on wood, paper, carpet, and foods.

If you have IAQ and mold issues in your school, you should get a copy of the IAQ Tools for Schools Action Kit. Mold is covered in the IAQ Reference Guide under Appendix H – Mold and Moisture.

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Asthma and Mold

Molds can trigger asthma episodes in sensitive individuals with asthma. People with asthma should avoid contact with or exposure to molds.

EPA’s Asthma Website

Additional Resources:

* Allergy & Asthma Network/Mothers of Asthmatics (AAN/MA): (800) 878-4403 begin_of_the_skype_highlighting (800) 878-4403 end_of_the_skype_highlighting; www.aanma.org exiting EPA
* American Academy of Allergy, Asthma & Immunology (AAAAI): www.aaaai.org exiting EPA
* American Lung Association: 1-800-LUNG-USA begin_of_the_skype_highlighting 1-800-LUNG-USA end_of_the_skype_highlighting (1-800-586-4872 begin_of_the_skype_highlighting 1-800-586-4872 end_of_the_skype_highlighting); www.lungusa.org exiting EPA
* Asthma & Allergy Foundation of America: (800) 7ASTHMA begin_of_the_skype_highlighting (800) 7ASTHMA end_of_the_skype_highlighting; www.aafa.org exiting EPA
* Canada Mortgage & Housing Corporation “Fighting Mold – The Homeowner’s Guide” www.cmhc-schl.gc.ca/en/co/maho/yohoyohe/momo/momo_005.cfm exiting EPA
* National Institute of Allergy and Infectious Diseases: www.niaid.nih.gov
* National Jewish Medical and Research Center: (800) 222-LUNG begin_of_the_skype_highlighting (800) 222-LUNG end_of_the_skype_highlighting (5864); www.njc.org exiting EPA

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Floods/Flooding

Mold growth may be a problem after flooding. EPA’s Fact Sheet: Flood Cleanup: Avoiding Indoor Air Quality Problems – discusses steps to take when cleaning and repairing a home after flooding. Excess moisture in the home is cause for concern about indoor air quality primarily because it provides breeding conditions for microorganisms. This fact sheet provides tips to avoid creating indoor air quality problems during cleanup. U.S. EPA, EPA Document Number 402-F-93-005, August 1993.

Additional Resources:

* Federal Emergency Management Agency (FEMA): (800) 480-2520 begin_of_the_skype_highlighting (800) 480-2520 end_of_the_skype_highlighting; www.fema.gov Flood information – www.fema.gov/hazard/flood/index.shtm

* U.S. Department of Health and Human Services (HHS), Centers for Disease Control and Prevention’s (CDC) Emergency Preparedness and Response page on “Protect Yourself from Mold” – www.bt.cdc.gov/disasters/mold/protect.asp and Key Facts About Hurricane Recovery – www.bt.cdc.gov/hurricanes/index.asp

* University of Minnesota, Department of Environmental Health and Safety – www.dehs.umn.edu/iaq.htm exiting EPA Flood Information – www.dehs.umn.edu/iaq_fi.htm exiting EPA

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Health and Mold

How do molds affect people?

Some people are sensitive to molds. For these people, exposure to molds can cause symptoms such as nasal stuffiness, eye irritation, wheezing, or skin irritation. Some people, such as those with serious allergies to molds, may have more severe reactions. Severe reactions may occur among workers exposed to large amounts of molds in occupational settings, such as farmers working around moldy hay. Severe reactions may include fever and shortness of breath. Some people with chronic lung illnesses, such as obstructive lung disease, may develop mold infections in their lungs.

EPA’s publication, Indoor Air Pollution: An Introduction for Health Professionals, assists health professionals (especially the primary care physician) in diagnosis of patient symptoms that could be related to an indoor air pollution problem. It addresses the health problems that may be caused by contaminants encountered daily in the home and office. Organized according to pollutant or pollutant groups such as environmental tobacco smoke, VOCs, biological pollutants, and sick building syndrome, this booklet lists key signs and symptoms from exposure to these pollutants, provides a diagnostic checklist and quick reference summary, and includes suggestions for remedial action. Also includes references for information contained in each section. This booklet was developed by the American Lung Association, the American Medical Association, the U.S. Consumer Product Safety Commission, and the EPA. EPA Document Reference Number 402-R-94-007, 1994.

Allergic Reactions – excerpted from Indoor Air Pollution: An Introduction for Health Professionals section on: Animal Dander, Molds, Dust Mites, Other Biologicals.

“A major concern associated with exposure to biological pollutants is allergic reactions, which range from rhinitis, nasal congestion, conjunctival inflammation, and urticaria to asthma. Notable triggers for these diseases are allergens derived from house dust mites; other arthropods, including cockroaches; pets (cats, dogs, birds, rodents); molds; and protein-containing furnishings, including feathers, kapok, etc. In occupational settings, more unusual allergens (e.g., bacterial enzymes, algae) have caused asthma epidemics. Probably most proteins of non-human origin can cause asthma in a subset of any appropriately exposed population.”

Damp Buildings and Health

For information on damp buildings and health effects, see the 2004 Institute of Medicine Report, Damp Indoor Spaces and Health, published by The National Academies Press in Washington, DC. You can read a description of the report and purchase a copy at http://fermat.nap.edu/catalog/11011.html exiting EPA

The Center for Disease Control and Prevention (CDC’s) National Center for Environmental Health (NCEH) has a toll-free telephone number for information and FAXs, including a list of publications: NCEH Health Line 1-888-232-6789 begin_of_the_skype_highlighting 1-888-232-6789 end_of_the_skype_highlighting.

* CDC’s “Molds in the Environment” Factsheet – www.cdc.gov/mold/faqs.htm
* Stachybotrys or Stachybotrys atra (chartarum) and health effects – www.cdc.gov/mold/stachy.htm

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Homes and Molds

The EPA publication, “A Brief Guide to Mold, Moisture, and Your Home”, is available here in HTML and PDF formats in English (PDF, 20 pp, 257KB About PDF) and Spanish (PDF, 20 pp, 796KB About PDF). This Guide provides information and guidance for homeowners and renters on how to clean up residential mold problems and how to prevent mold growth.

Biological Pollutants in Your Home – This document explains indoor biological pollution, health effects of biological pollutants, and how to control their growth and buildup. One third to one half of all structures have damp conditions that may encourage development of pollutants such as molds and bacteria, which can cause allergic reactions — including asthma — and spread infectious diseases. Describes corrective measures for achieving moisture control and cleanliness. This brochure was prepared by the American Lung Association and the U.S. Consumer Product Safety Commission. The publication was updated by CPSC in 1997 www.cpsc.gov/cpscpub/pubs/425.html

Moisture control is the key to mold control, the Moisture Control Section from Biological Pollutants in Your Home follows:

Moisture Control

Water in your home can come from many sources. Water can enter your home by leaking or by seeping through basement floors. Showers or even cooking can add moisture to the air in your home. The amount of moisture that the air in your home can hold depends on the temperature of the air. As the temperature goes down, the air is able to hold less moisture. This is why, in cold weather, moisture condenses on cold surfaces (for example, drops of water form on the inside of a window). This moisture can encourage biological pollutants to grow.

There are many ways to control moisture in your home:

* Fix leaks and seepage. If water is entering the house from the outside, your options range from simple landscaping to extensive excavation and waterproofing. (The ground should slope away from the house.) Water in the basement can result from the lack of gutters or a water flow toward the house. Water leaks in pipes or around tubs and sinks can provide a place for biological pollutants to grow.
* Put a plastic cover over dirt in crawlspaces to prevent moisture from coming in from the ground. Be sure crawlspaces are well-ventilated.
* Use exhaust fans in bathrooms and kitchens to remove moisture to the outside (not into the attic). Vent your clothes dryer to the outside.
* Turn off certain appliances (such as humidifiers or kerosene heaters) if you notice moisture on windows and other surfaces.
* Use dehumidifiers and air conditioners, especially in hot, humid climates, to reduce moisture in the air, but be sure that the appliances themselves don’t become sources of biological pollutants.
* Raise the temperature of cold surfaces where moisture condenses. Use insulation or storm windows. (A storm window installed on the inside works better than one installed on the outside.) Open doors between rooms (especially doors to closets which may be colder than the rooms) to increase circulation. Circulation carries heat to the cold surfaces. Increase air circulation by using fans and by moving furniture from wall corners to promote air and heat circulation. Be sure that your house has a source of fresh air and can expel excessive moisture from the home.
* Pay special attention to carpet on concrete floors. Carpet can absorb moisture and serve as a place for biological pollutants to grow. Use area rugs which can be taken up and washed often. In certain climates, if carpet is to be installed over a concrete floor, it may be necessary to use a vapor barrier (plastic sheeting) over the concrete and cover that with sub-flooring (insulation covered with plywood) to prevent a moisture problem.
* Moisture problems and their solutions differ from one climate to another. The Northeast is cold and wet; the Southwest is hot and dry; the South is hot and wet; and the Western Mountain states are cold and dry. All of these regions can have moisture problems. For example, evaporative coolers used in the Southwest can encourage the growth of biological pollutants. In other hot regions, the use of air conditioners which cool the air too quickly may prevent the air conditioners from running long enough to remove excess moisture from the air. The types of construction and weatherization for the different climates can lead to different problems and solutions.

Moisture On Windows

Your humidistat is set too high if excessive moisture collects on windows and other cold surfaces. Excess humidity for a prolonged time can damage walls especially when outdoor air temperatures are very low. Excess moisture condenses on window glass because the glass is cold. Other sources of excess moisture besides overuse of a humidifier may be long showers, running water for other uses, boiling or steaming in cooking, plants, and drying clothes indoors. A tight, energy efficient house holds more moisture inside; you may need to run a kitchen or bath ventilating fan sometimes, or open a window briefly. Storm windows and caulking around windows keep the interior glass warmer and reduce condensation of moisture there.

Humidifiers are not recommended for use in buildings without proper vapor barriers because of potential damage from moisture buildup. Consult a building contractor to determine the adequacy of the vapor barrier in your house. Use a humidity indicator to measure the relative humidity in your house. The American Society of Heating and Air Conditioning Engineers (ASHRAE) recommends these maximum indoor humidity levels.

Outdoor Recommended Indoor Temperature Relative Humidity
+20o F. 35%
+10o F. 30%
0o F. 25%
-10o F. 20%
-20o F. 15%

Source: Anne Field, Extension Specialist, Emeritus, with reference from the Association for Home Appliance Manufacturers (www.aham.orgexiting EPA).

How to Identify the Cause of a Mold and Mildew Problem

Mold and mildew are commonly found on the exterior wall surfaces of corner rooms in heating climate locations. An exposed corner room is likely to be significantly colder than adjoining rooms, so that it has a higher relative humidity (RH) than other rooms at the same water vapor pressure. If mold and mildew growth are found in a corner room, then relative humidity next to the room surfaces is above 70%. However, is the RH above 70% at the surfaces because the room is too cold or because there is too much moisture present (high water vapor pressure)?

The amount of moisture in the room can be estimated by measuring both temperature and RH at the same location and at the same time. Suppose there are two cases. In the first case, assume that the RH is 30% and the temperature is 70oF in the middle of the room. The low RH at that temperature indicates that the water vapor pressure (or absolute humidity) is low. The high surface RH is probably due to room surfaces that are “too cold.” Temperature is the dominating factor, and control strategies should involve increasing the temperature at cold room surfaces.

In the second case, assume that the RH is 50% and the temperature is 70oF in the middle of the room. The higher RH at that temperature indicates that the water vapor pressure is high and there is a relatively large amount of moisture in the air. The high surface RH is probably due to air that is “too moist.” Humidity is the dominating factor, and control strategies should involve decreasing the moisture content of the indoor air.

Should You Have the Air Ducts in Your Home Cleaned? – excerpt on duct cleaning and mold follows, please review the entire document for additional information on duct cleaning and mold.

You should consider having the air ducts in your home cleaned if:

There is substantial visible mold growth inside hard surface (e.g., sheet metal) ducts or on other components of your heating and cooling system. There are several important points to understand concerning mold detection in heating and cooling systems:

* Many sections of your heating and cooling system may not be accessible for a visible inspection, so ask the service provider to show you any mold they say exists.
* You should be aware that although a substance may look like mold, a positive determination of whether it is mold or not can be made only by an expert and may require laboratory analysis for final confirmation. For about $50, some microbiology laboratories can tell you whether a sample sent to them on a clear strip of sticky household tape is mold or simply a substance that resembles it.
* If you have insulated air ducts and the insulation gets wet or moldy it cannot be effectively cleaned and should be removed and replaced.
* If the conditions causing the mold growth in the first place are not corrected, mold growth will recur.

Additional Resource

* U.S. Dept. of Agriculture, Food Safety and Inspection Service fact sheet – Safe Food Handling- Molds on Foods: Are They Dangerous? www.fsis.usda.gov/FactSheets/Molds_On_Food/index.asp September 2005

* A Brief Guide to Mold in the Workplace, U.S. Dept. of Labor, Occupational, Safety and Health Administration, Safety and Health Bulletin 03-10-10

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Indoor Air Regulations and Mold

Standards or Threshold Limit Values (TLVs) for airborne concentrations of mold, or mold spores, have not been set. Currently, there are no EPA regulations or standards for airborne mold contaminants.

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Large Buildings and Mold

EPA has a number of resources available, you can start with the Indoor Air Quality Building Evaluation and Assessment Model (I-BEAM). I-BEAM updates and expands EPA’s existing Building Air Quality guidance and is designed to be comprehensive state-of-the-art guidance for managing IAQ in commercial buildings. This guidance was designed to be used by building professionals and others interested in indoor air quality in commercial buildings. I-BEAM contains text, animation/visual, and interactive/calculation components that can be used to perform a number of diverse tasks. See www.epa.gov/iaq/largebldgs/i-beam/index.html

See also “Building Air Quality: A Guide for Building Owners and Facility Managers”.

Excerpt from the Building Air Quality: A Guide for Building Owners and Facility Managers, Appendix C – Moisture, Mold and Mildew:

How to Identify the Cause of a Mold and Mildew Problem.

Mold and mildew are commonly found on the exterior wall surfaces of corner rooms in heating climate locations. An exposed corner room is likely to be significantly colder than adjoining rooms, so that it has a higher relative humidity (RH) than other rooms at the same water vapor pressure. If mold and mildew growth are found in a corner room, then relative humidity next to the room surfaces is above 70%. However, is the RH above 70% at the surfaces because the room is too cold or because there is too much moisture present (high water vapor pressure)?

The amount of moisture in the room can be estimated by measuring both temperature and RH at the same location and at the same time. Suppose there are two cases. In the first case, assume that the RH is 30% and the temperature is 70oF in the middle of the room. The low RH at that temperature indicates that the water vapor pressure (or absolute humidity) is low. The high surface RH is probably due to room surfaces that are “too cold.” Temperature is the dominating factor, and control strategies should involve increasing the temperature at cold room surfaces.

In the second case, assume that the RH is 50% and the temperature is 70oF in the middle of the room. The higher RH at that temperature indicates that the water vapor pressure is high and there is a relatively large amount of moisture in the air. The high surface RH is probably due to air that is “too moist.” Humidity is the dominating factor, and control strategies should involve decreasing the moisture content of the indoor air.

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Schools and Mold and Indoor Air Quality

The Agency’s premier resource on this issue is the Indoor Air Quality Tools for Schools kit. Our schools-related resources on the web start at: www.epa.gov/iaq/schools.

The asthma companion piece for the IAQ Tools for Schools Action kit, is Managing Asthma in the School Environment – www.epa.gov/iaq/schools/managingasthma.html. This publication has a section entitled Clean Up Mold and Moisture Control: An excerpt follows:

Common Moisture Sources Found in Schools

Moisture problems in school buildings can be caused by a variety of conditions, including roof and plumbing leaks, condensation, and excess humidity. Some moisture problems in schools have been linked to changes in building construction practices during the past twenty to thirty years. These changes have resulted in more tightly sealed buildings that may not allow moisture to escape easily. Moisture problems in schools are also associated with delayed maintenance or insufficient maintenance, due to budget and other constraints. Temporary structures in schools, such as trailers and portable classrooms, have frequently been associated with moisture and mold problems.

Suggestions for Reducing Mold Growth in Schools

Reduce Indoor Humidity

* Vent showers and other moisture-generating sources to the outside.
* Control humidity levels and dampness by using air conditioners and de-humidifiers.
* Provide adequate ventilation to maintain indoor humidity levels between 30-60%.
* Use exhaust fans whenever cooking, dishwashing, and cleaning in food service areas.

Inspect the building for signs of mold, moisture, leaks, or spills

* Check for moldy odors.
* Look for water stains or discoloration on the ceiling, walls, floors, and window sills.
* Look around and under sinks for standing water, water stains, or mold.
* Inspect bathrooms for standing water, water stains, or mold.
* Do not let water stand in air conditioning or refrigerator drip pans.

Respond promptly when you see signs of moisture and/or mold, or when leaks or spills occur

* Clean and dry any damp or wet building materials and furnishings within 24-48 hours of occurrence to prevent mold growth.
* Fix the source of the water problem or leak to prevent mold growth.
* Clean mold off hard surfaces with water and detergent, and dry completely.
* Absorbent materials such as ceiling tiles, that are moldy, may need to be replaced.
* Check the mechanical room and roof for unsanitary conditions, leaks, or spills.

Prevent moisture condensation

* Reduce the potential for condensation on cold surfaces (i.e., windows, piping, exterior walls, roof, or floors) by adding insulation.

Floor and carpet cleaning

* Remove spots and stains immediately, using the flooring manufacturer’s recommended techniques.
* Use care to prevent excess moisture or cleaning residue accumulation and ensure that cleaned areas are dried quickly.
* In areas where there is a perpetual moisture problem, do not install carpeting (i.e., by drinking fountains, by classroom sinks, or on concrete floors with leaks or frequent condensation).

How to Order Publications

You can order Indoor Air Quality publications from EPA’s National Service Center for Environmental Publications (NSCEP):

U.S. Environmental Protection Agency
National Service Center for Environmental Publications (NSCEP)
P.O. Box 42419
Cincinnati, OH 45242-0419
Website: www.epa.gov/nscep
Fax: (301) 604-3408
E-mail: nscep@bps-lmit.com

NSCEP operates a Toll-free phone service for EPA Publication Assistance with live customer service representative assistance Monday through Friday from 9:00am-5:30pm eastern time. Voice Mail is available after operating hours. You can fax or e-mail your publication requests. For technical assistance with NSCEP web pages, write to: nscep_nepis.tech@epa.gov

Please use the EPA Document Number, which is usually bolded or highlighted, when ordering from NSCEP.