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Children’s Asthma and Environmental

Triggers Susan Buchanan, MD, MPH

University of Illinois at Chicago School of Public Health

Chicago, Illinois

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Disclosures/Acknowledgements

I have no commercial, financial, or other conflicts of interest to disclose.

This material was developed by the Great Lakes Center for Children’sEnvironmental Health and funded under the cooperative agreement awardnumber 1U61TS000118-01 from the Agency for Toxic Substances and DiseaseRegistry (ATSDR).

Acknowledgement: The U.S. Environmental Protection Agency (EPA) supports thePEHSU by providing funds to ATSDR under Inter-Agency Agreement number DW75-92301301-0. Neither EPA nor ATSDR endorse the purchase of any commercialproducts or services mentioned in PEHSU publications.

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What is asthma?National Heart Lung BIood Institute 2003:

• Asthma is a chronic inflammatory disorder of the airways … causes wheezing, breathlessness, chest tightness, and coughing, particularly at night or in early morning.

• Airway inflammation also causes bronchial

hyperresponsiveness to stimuli.

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National Heart, Blood and Lung Institute

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Source: Global Initiative for Asthma

Trends in asthma prevalence by age

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Factors that contribute to asthma

• Viral infections• Allergens: dust mites,

cockroaches, animal dander, molds

• Irritants: ETS, chemical fumes, air pollution

• Misc: exercise, food allergies, GI reflux, aspirin and ibuprofen sensitivity, other sensitivities

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Allergens

• Allergens – proteins in the environment that cause an immunological response

• By age 10-12, 90% of asthmatics will have allergies that trigger their asthma attacks

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How do environmental exposures cause an asthma attack?

• Act as a trigger in individuals with hyperresponsiveness

• Worsen airway inflammation• Increase the immune response to inhaled

allergen

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Environmental asthma triggers

• Indoor Pollutants

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Indoor pollutants may be more important than outdoor pollutants!

*Americans spend more than 90% of their time indoors (home, work, school, daycare)

• Allergens– Dust mites– Cockroaches– Pets– Mold

• ETS• Irritant chemicals (cleaners)• Particulate matter (combustion: gas stove, wood stove,

kerosene heaters)• Ozone

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Indoor Allergens: Dust mites

• Thrive in warm, humid environments• Grow in cloth-covered objects such as

toys, bedding, furniture, carpets

*Dust mite exposure in susceptible individuals may lead to the development of asthma

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Indoor Allergens: Cockroaches

• 36% cockroach sensitization rate in inner-city asthmatic children

• Patients/parents may not feel comfortable admitting to infestation

• Dust mite exposure in susceptible individuals may lead to the development of asthma

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Indoor Allergens: Cats

• 6 million Americans have allergies to cats

• Cat and dog allergens can be found in all homes, regardless of pet ownership

• Cat allergens may be transferred at school from children who have pets at home

• Dust mite exposure in susceptible individuals may lead to the development of asthma

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Indoor Allergens: Mold

• 60 species of molds are allergenic• Common allergenic species: penicillium,

aspergillus, cladosporium, alternaria

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Environmental Tobacco Smoke

• The combustion of tobacco, paper, and additives

• CLEAR evidence of link between ETS exposure and asthma attacks and more severe symptoms

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Chemicals

• Off-gassing of formaldehyde from furniture and building materials

• Cleaning products (chlorine, ammonia)

• No clear association with asthma

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Combustion devices• Gas ranges used for home heating• Improperly vented fireplaces• Malfunctioning furnaces• Wood-burning stoves• Poorly-ventilated kerosene or gas

space heaters

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Outdoor air pollution

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Outdoor air pollution

• Organic dusts– Soybeans, grains

• Industrial releases• Hazardous air pollutants from combustion

• All have shown to trigger asthma attacks or exacerbate symptoms

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Criteria Air Pollutants

• Ozone (ground level)• Carbon Monoxide• Sulfur dioxide• Particulate matter• Nitrogen dioxide• Lead

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Criteria Air Pollutants: Ozone (Smog)VOC + NOx + Heat + Sunlight = Ozone

Increases airway inflammation and hyperresponsiveness

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Criteria Air Pollutants: Sulfur Dioxide

• Upper airway irritant

• Deep lung penetration during exercise

• Causes bronchoconstriction

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Criteria Air Pollutants: Particulate Matter

Leads to more hospitalizations due to asthma

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Criteria Air Pollutants: Nitrogen Oxides

• Increases bronchial responsiveness during exercise

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Traffic-related pollutants and diesel exhaust

• Children living near heavily traveled roadways have higher rates of asthma and wheezing

• School bus diesel exhaust exposes children riding on the bus

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Resources

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Pediatric Environmental Health Specialty Units (PEHSU)

• Funded by federal EPA, ATSDR

• Staffed by:– Occupational/Environ-

mental Med physician– Peds or Family Med

physician– Medical toxicologist– Pediatric health nurse– Industrial hygienist

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PEHSU Services

• Clinical consultations– Telephone consults to health care providers and families– Clinic visits at UIC, Stroger Hospital, Cincinnati Children’s

Hospital, Lurie Children’s Memorial Hospital

• Public Health Consultations to health departments and environmental agencies, media

• Training for physicians, nurses, and other health professionals in children’s environmental health

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Great Lakes Center for Children’sEnvironmental Health

Region 5 Pediatric Environmental Health Specialty Unit (PEHSU)(312) 636-0081 or (866) 967-7337

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Questions?