Asthma Home Environment Checklis

&EPA
United States
Environmental Protection
Agency
ASTHMA HOME ENVIRONMENT
0CHECKLIST
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
     BUILDING   INFORMATION
     (This information may be helpful to determine reasonable mitigations.)
     What type of building does the patient
     live in?
     Notes:
D  House
D  Duplex
D  Apartment
D  Mobile home
D  Other	
     Does the patient own or rent?
     Notes:
D  Own
D  Rent
     Questions
     HOME   INTERIOR
                                           Answers
                                Action Steps
                                A MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES.
     Secondhand Smoke

     Does anyone smoke in the home or      D Y
     car?                                  D N
                                  Keep the home and car smoke-free.
                                  Do not allow visitors to smoke in the home.
                                  Take the smoke-free home pledge and post a smoke-
                                  free 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
     around warm-blooded pets?
     Notes:
D Y
D N
If possible, remove the pet from the home or keep the
pet outside.
If this is not possible, keep the pet out of the patient's
sleeping area and off of the furniture.
     Consumer Products

     Is the patient's asthma worse when
     around chemicals or products with
     strong odors (such as cleaners, paints,
     adhesives, pesticides, air fresheners,
     or cosmetics)?

     Notes:
D Y
D N
Limit patient's exposure as much as possible by
minimizing product use, using products only when
patient is not present, or trying alternative products.
If products are used, carefully follow manufacturer's
instructions on the label and make sure the area is well
ventilated.
     Heating and Cooling Systems

     Does the heating and cooling system
     use filters?
     Notes:
D Y
D N
If so, replace the filters quarterly.
Use filters with higher efficiency than standard furnace
filters, such as upgraded pleated filters, if heating or
cooling system manufacturer's specifications allow.

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ASTHMA HOME ENVIRONMENT CHECKLIST
Questions
Answers
Action Steps
HOME INTERIOR (continued)
MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES.
Does the heating system use a fuel-
burning appliance (such as an oil or
gas furnace)?

Notes:
D Y
D N
Have the heating system - including furnaces, flues and
chimneys - professionally inspected annually.
Promptly repair cracks or damaged parts.
Are supplemental heating sources
used? (Check all that apply)
D Fireplace
D Wood-burning stove
D Unvented kerosene or gas
space heater
D Other
Properly ventilate the room where a fuel-burning
appliance is used. Consider using appliances that vent
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
units?

Notes:
D Y
D N
Run window air conditioner with the vent control open to
increase the outdoor ventilation rate during the cooling
season.
ROOM INTERIOR
Bedding and Sleeping Arrangements

What does the patient sleep on?
(Check all that apply)
D Mattress with box springs
D Sofa
D Other
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
patient use? (Check all that apply)
D Bedspread (e.g., comforter,
quilt)
D Blankets
D Pillows
D Sheets
D Other (e.g., sleeping bag)
Choose washable bedding.
Wash bedding regularly in hot water and dry completely.
Cover patient's pillow in a dust-proof (allergen imperme-
able) zippered cover. Clean cover according to
manufacturer's instructions.
Notes:

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ASTHMA HOME ENVIRONMENT CHECKLIST
     Questions
                                            Answers
                                Action Steps
    ROOM    INTERIOR (continued)
                                A MAY REQUIRE ADDITIONAL TIME AND/OR RESOURCES.
     Flooring

     What type of floor covering is present?    D Carpeting
     (Check all that apply)
D  Hardwood floor, tile, or vinyl
   flooring
D  Throw rugs
D  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?
D Y
D N
     Notes:
Cover upholstered furniture with washable slipcovers or
sheets.
Vacuum upholstered furniture regularly, including
removing cushions and vacuuming in cracks and
crevices.
If replacing furniture, consider purchasing a  non-
upholstered furniture - such as vinyl, wood,  or leather -
that can be easily wiped down.
     Are stuffed toys present?
     Notes:
D Y
D N
Choose washable stuffed toys, and wash frequently in
hot water. Dry completely.
Limit the number of stuffed toys in patient's bed and
sleeping area.
     Window Treatments

     What window coverings are present?
     (Check all that apply)
     Notes:
D  Curtains or drapes
D  Blinds
D  Shades
D  Other	
Vacuum drapes regularly.
Wash and dry curtains regularly.
Dust window sills, blinds, and shades regularly using a
damp cloth with warm, soapy water. Dry completely.
If possible,  replace curtains or drapes with plastic, vinyl,
wood, or aluminum blinds.
     Cooking Appliances

     Are gas cooking appliances used?
D  Y
D  N
When cooking with a gas appliance, turn on an exhaust
fan or open a window.
Avoid misuse of the appliance by following the
manufacturer's instructions for operation.
     Notes:

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ASTHMA HOME ENVIRONMENT CHECKLIST
Questions
Answers
ROOM INTERIOR (continued)
Action Steps
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)?
D Y
D N
Notes:
• Dry damp or wet items within 24-48 hours to avoid
mold growth.
A Fix water leaks (such as leaky plumbing) as soon as
possible.
A Replace absorbent materials, such as ceiling tiles and
carpet, if mold is present.
A Use air conditioner or dehumidifier to maintain low
indoor humidity. If possible, keep indoor humidity
below 60% (ideally between 30-50%) relative humidity.
Do you see or smell mold or mildew
(such as in the bathroom on tub,
shower, walls, or windows)?
D Y
D N
Notes:
Open a window or turn on an exhaust fan when there is
excessive moisture in the room, such as when shower-
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.
Replace absorbent materials, such as ceiling tiles and
carpet, if mold is present.
Is standing water present (such as in
refrigerator drip pans, air conditioner
drip pans, or house plants)?

Notes:
D Y
D N
Empty and clean refrigerator and air conditioner drip
pans regularly.
Avoid standing water in plant containers.
Are humidifiers used in the patient's D Y
house? D N
Notes:
Use humidifier only when conditions require it, use the
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, mainte-
nance, and replacement of any materials supplied with
the humidifier.
Are rooms and moisture-producing
appliances—such as stoves, clothes
dryers, or dishwashers—properly
vented (including venting to the
outside if specified by the manufac-
turer)?
D Y
D N
Increase ventilation or air movement by opening doors
and/or windows when practical. Use fans as needed.
Run the bathroom exhaust fan or open the window
when showering.
Use exhaust fans or open windows whenever cooking
or washing dishes.
Vent appliances properly according to manufacturer's
specifications.
Notes:

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ASTHMA HOME ENVIRONMENT CHECKLIST
Questions
Answers
ROOM INTERIOR (continued)
Action Steps
A 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)?
Notes:
D Y
D 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.
Are there food crumbs or open or D Y
unsealed food? D N
Clean all food crumbs or spilled liquids right away.
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
construction materials and pipes that
could allow pests to enter the house?

Notes:
D Y
D N
Seal holes or gaps between construction materials
and pipes, or ask the owner to do so.
Is there evidence of standing water or
leaks?
Notes:
D Y
D N
Dry damp or wet items within 24-48 hours to avoid
mold growth.
Avoid standing water in house plant containers and
drip pans.
Fix water leaks (such as leaky plumbing) as soon as
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:
Limit physical exertion outdoors.

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.

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:
^  Asthma and steps you can take to remove environmental triggers from the home, visit www.epa.gov/asthma.
^  Secondhand smoke and how to make your home and car smoke-free, visit www.epa.gov/smokefree or call the smoke-
   free home pledge number at 1-866-SMOKE-FREE (1-866-766-5337).
^  Household pest management and how to apply integrated pest management at home, visit www. ep a. gov/p es ticides/
   controlling/home.htm.
   Order publications via EPA's Asthma website at www.epa.gov/asthma
 SU MMARY
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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