ASTHMA
This bulletin is the second in a series that provides an overview of U.S. Environmental Protection Agency (EPA) program
activities and highlights resources designed for health care providers. We invite you to share this information with your colleagues
and encourage them to integrate these resources into their standards of care for asthma.
EPA's Asthma Program Can Help Your
Asthma Patients
While asthma cannot be cured, it is most effectively controlled
with comprehensive care that includes medical and
environmental management techniques. The National Institutes
of Health (NIH) acknowledge that the indoor environment is an
important factor in the growing asthma problem. For successful
long-term asthma management, NIH recommends a
comprehensive program of assessment and monitoring,
medication, patient education, and control of factors that
contribute to the severity of asthma.1 EPA has joined with NIH
in the national public health effort to address asthma.
EPA keeps the public and the asthma community aware of the
very latest information about indoor and outdoor environmental
asthma triggers and simple ways to reduce exposure to these
triggers, especially at home. Along with proper medical
treatment, effective management of environmental triggers in
patients' homes can reduce the number and severity of their
asthma episodes.
To learn more about EPA's asthma program, resources, and how
to control environmental asthma triggers visit EPA's asthma Web
site at www.epa.gov/asthma.
EPA Announces New Awards
Program
EPA is announcing a new awards program for health plans and
health care providers. The National Environmental
Leadership Award in Asthma Management will recognize
health plans and health care providers who have demonstrated
leadership in managing environmental triggers as part of a
comprehensive asthma management program. If you have a
comprehensive asthma program, we encourage you to consider
applying for this award. The deadline is February 15, 2005. For
more information, see page 4.
Environmental Triggers
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,
wood stoves, and unvented kerosene and gas space heaters.
OUTDOOR AIR POLLUTION
Triggers: Small particles and ozone that come from things like
exhaust from cars and factories, smoke, and road dust.
Where to Look: Watch for the Air Quality Index (AQI) during
the local weather report or visit www.airnow.gov.
1 National Heart, Lung and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. NIH
publication number 97-4051. (www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf)
This bulletin is only available electronically.
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ASTHMA BULLETIN
Asthma Resources and Action Steps
All EPA resources may be downloaded from the EPA Web site and are available at no cost by contacting the Indoor Air Quality
Info Clearinghouse (lAQInfo) at 1-800-438-4318 or iaqinfo@aol.com. To view a complete list of resources, visit www.epa.gov/
asthma/publications.html.
Play an Asthma Video in Your
Waiting Room
Controlando los Factores delAsma, a Spanish language video,
describes common environmental asthma triggers found
indoors and out. In the video, doctors talk about asthma and
its effects on children, and families describe their experience
with asthma and identify simple steps they took to manage
asthma triggers. To order copies, use publication # EPA 402-
V-02-002. An English language version, currently under
development, should be available by fall 2005.
Conduct In-Home Assessments
Incorporate environmental controls into home visit programs
with EPA's Asthma Home Environment Checklist. This
checklist helps home visitors recognize and address common
asthma triggers. To download the checklist, visit EPA's asthma
Web site (www.epa.gov/asthma/pdfs/home_environment_
checklist.pdf). To order copies, use publication # EPA 402-F-
03-030.
S.EPA
Help Your Pediatric Patients
Learn About Asthma and Have
Fun
Check out Dusty The
Asthma Goldfish and
His Asthma Triggers
Funbook, a great
display for patient
waiting rooms. The
Funbook—available
in English or
Spanish—includes
children's games to
teach children and
their parents about
asthma triggers and
how to avoid them.
To download the
Funbook visit EPA's asthma Web site for English
(www.epa.gov/asthma/pdfs/dustythegoldfish_en.pdf) or
Spanish (www.epa.gov/asthma/pdfs/
dustythegoldfish_sp.pdf). You may also order the
English Funbook (publication # EPA 402-F-04-008) or
the Spanish Funbook (publication # EPA 402-F-04-
009) from IAQ info.
protest lour C
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Prot«ja i w
Teach Parents and Caregivers to
Manage Asthma at Home
Use EPA's brochure, Help Your Child Gain Control Over
Asthma, to discuss comprehensive asthma care with your
patients. This interactive brochure, designed for parents and
caregivers with limited reading skills, encourages the use of an
asthma action plan and provides simple steps to minimize
exposure to environmental triggers. To download this
brochure, visit www.epa.gov/asthma/pdfs/
ll_asthma__brochure.pdf. To order copies beginning in March
2005, use publication # EPA 402-F-04-021.
Encourage Parents and Caregivers
to Smoke Outside Until They Can
Quit
Support your patients in
taking the smoke-free
home pledge today with
EPA's brochure, Protect
Your Children: Take the
Smoke-Free Home Pledge.
This bilingual resource is
designed to teach parents
and caregivers about the
harmful risks to children
of secondhand smoke. To order copies, use publication # EPA
402-P-04-002.
Answer Your Patients' Questions
About How Air Pollution Can Affect
Their Asthma
EPA's AlPJSfow Web site (www.airnow.gov/health-prof) can
help you help your patients protect their health by reducing
their exposure to air pollution.
The Web site includes
information about the
cardiovascular and respiratory
health effects associated with
outdoor air pollution exposure
and educational materials for
your patients. It features a
medical poster, a downloadable
fact sheet on asthma and
outdoor air pollution, and a
new Web-based training
course, Ozone and Your
Patients' Health.
Effects of .
Common Air Pollutants
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ASTHMA BULLETIN
Learn More About Mold and Its
Health Effects
A new publication, Guidance for Clinicians on the Recognition
and Management of Health Effects Related to Mold Exposure and
Moisture Indoors, was recently published by the Center for
Indoor Environments and Health at the University of
Connecticut Health Center,
under a grant from EPA. The
guide is available at no cost
online (http://oehc.uchc.edu/
clinser/mold%20guide.pdf). It
is designed to help the
healthcare provider address
patients with illnesses related to
mold in the indoor
environment by providing a
background understanding of
how mold may be affecting
patients. With an appreciation
of the time pressures in the
clinical medical setting today, the book presents tools to help
the provider evaluate the patient and help the practitioner
explore environmental relationships to illness.
Locate Physician Education
Materials on Pediatric Asthma
The Pediatric Asthma Speaker's Kit was recently developed by
the American Academy of Pediatrics (AAP) under a
cooperative agreement with EPA. The Kit educates primary
health care providers about asthma and, in particular, the
environmental triggers of asthma. It also provides guidelines
on key educational points for patients, and patient handouts.
For more information, visit the AAP s Web site at
www.aap.org/sections/allergy/pe.cfm.
Be Active During Asthma Awareness Month
Each year, in the month of May, EPA joins international, national, and local Asthma Awareness Month activities to increase
public understanding of asthma. Throughout the month, EPA organizes events, conducts media outreach, releases new materials
and supports local Asthma Awareness Month efforts. Download an Event Planning Kit (www.epa.gov/asthma/pdfs/
asthmakit_09_04.pdf) for ideas and materials to support Asthma Awareness Month activities in your local hospital or clinic or for
activities a health insurer or managed care organization can sponsor in the community. To post your event on EPAs Web site, visit
http://www.cadmusonline.net/asthmaevents.
Encourage Older Adults and Caregivers to Reduce Exposure to
Asthma Triggers
People over 65 have much higher rates of mortality from asthma than any other age group,
and more than two million adults age 65 and older are living with asthma. Use EPAs Age
Healthier, Breathe Easier fact sheet to inform older patients on how to reduce their risk of
triggering asthma and Chronic Obstructive Pulmonary Disease (COPD)-related
symptoms. This resource discusses the main indoor and outdoor air hazards and
encourages older adults afflicted with COPD and asthma and their caregivers to reduce
exposure to these triggers. This fact sheet is available in English, Spanish, Vietnamese, and
Chinese. A poster highlighting simple steps older adults can take to reduce the frequency
of symptoms has also been disseminated widely to local agencies on aging. The poster is
available in English, Spanish, and Chinese with Vietnamese and Russian versions coming
soon. To download these materials or to find more information on asthma triggers for
older adults, visit http://www.epa.gov/aging/resources/epareports.htm#facts.
For more information about EPAs efforts to protect the environmental health of older persons, visit the Agency's
Aging Initiative Web site at http://www.epa.gov/aging/index.htm.
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ASTHMA BULLETIN
Asthma Research Update
EPA's Office of Research and Development (ORD) has developed an asthma research
program. Researchers in EPA labs as well as EPA-funded investigators at universities and
other organizations are currently conducting studies to address the "how" and "why" of
asthma induction (development of new cases) and exacerbation (worsening of existing
asthma) in order to develop better methods of prevention. This section provides you with
information on current asthma research program activities. To learn more about ORD's
asthma research program, visit www.epa.gov/ord/htm/researchstrategies.htmttrs02.
Relationship Between Mold and
Asthma
Stachybotrys chartarum is a black mold that grows on wet
wall board. This mold is often associated in the popular
press with a variety of adverse health effects. Researchers in
ORD's National Health and Environmental Effects
Research Laboratory (NHEERL) are conducting studies to
understand the relationship of Stachybotrys and asthma. In
one series of experiments, scientists exposed mice to
samples of Stachybotrys taken from homes and looked for
responses typical of allergies and asthma in the study
animals. The results showed that the mold can indeed
cause a disease similar to allergic asthma, and this suggests
that Stachybotrys contamination in homes could pose a risk
of developing allergic responses.
Environmental Influences on the
Induction and Incidence of
Asthma
In October 2004, asthma experts from around the world
gathered at the EPA facility in Research Triangle Park,
North Carolina, to address two questions: 1) What does
the science suggest that regulatory and public health
agencies could do now to reduce or prevent the induction
of new cases of asthma, and 2) What research is needed to
improve our understanding of the factors that contribute
to the induction of asthma. Conference participants
unanimously agreed that maternal smoking and exposure
to environmental tobacco smoke during gestation and the
first year of life greatly increase the risk of developing
asthma. Participants also agreed that while indoor
allergens and outdoor air pollutants are known to
exacerbate existing asthma, more research is needed to
better understand the potential influence of indoor
allergens and outdoor air pollutants on the incidence of
asthma. There was also a consensus at the meeting that
more research is needed to better understand the
relationship between obesity and asthma.
To learn more about EPA's asthma program, resources, and how to control environmental asthma triggers
visit EPA's asthma Web site at www.epa.gov/asthma or contact the Indoor Air Quality Clearinghouse (IAQ
Info) at 1-800-438-4318 or iaqinfo@aol.com.
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EPA 402-F-05-002
February 2005
ASTHMA BULLETIN
ATTENTION HEALTH
PLANS AND HEALTH
CARE PROVIDERS
ce to Apply,
CA1 FOR ENTRIES
National
ivironmental
.eadership
ward in
Asthma
Management
The Awards Program
The U.S. Environmental Protection
Agency (EPA) is pleased to
announce a new awards program
that recognizes leadership in
addressing environmental triggers
as part of comprehensive asthma
care programs.This award will
celebrate health plans and health
care providers who are offering
comprehensive tools to help people
with asthma lead healthy, active
lives. If you have demonstrated
leadership in environmental asthma
care, EPA urges you or your
organization to apply for an award
http://www.asthmaawards.info
Are you a health plan or health care provider with
a comprehensive asthma care program? EPA
encourages you to seek recognition for your
important work by applying for the 2005 awards.
Deadline for Applications:
February 15,2005
To learn more about the program and to download an application, visit the National Environmental
Leadership Award in Asthma Management's website at http://www.asthmaawards.info. EPA is accepting
applications until February 15,2005.
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