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This podcast forum is brought to you to share expertise and insights within our integrated delivery system to help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights. Here's your host, Melanie Cole.

Melanie: Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole, and I invite you to listen as we examine the impact of home environments on asthma, healthy homes and asthma triggers, part of this series from the Asthma Symposium.

Joining me is Paul Francisco. He's a research engineer at Indoor Climate Research and Training at the University of Illinois at Champaign-Urbana. Paul, it's a pleasure to have you join us today as we get into this really important topic. Tell us a little bit about how the environment affects asthma.

Paul Francisco: Well, thank you very much for having me, Melanie. I really appreciate the opportunity for this. So the indoor environment has a potential to have a really significant impact on respiratory issues and especially asthma. There are a lot of contaminants that have a relationship with asthma. It's difficult to say specifically any particular contaminants associated with any particular person's asthma without a doctor doing the evaluation, but there are associations with a number of indoor contaminants.

One of the issues is we generate a lot of contaminants indoors. And then because it's a confined space, those contaminants will stay indoors for some amount of time. We can reduce that amount of time significantly by using ventilation. There are also the potential for having outdoor contaminants that are associated with asthma coming indoors. And so there's also management of outdoor air, especially when we have some bad outdoor air quality events. There are certainly a lot of issues with wildfires in the west last year, for example. But really a lot of the issue is maintaining a good indoor environment and keeping contaminant levels low.

Melanie: When someone is suffering with asthma and maybe they've had it for a very, very long long time, they're never quite sure whether to be outside or inside and air filters and windows closed, air conditioning on or outside if the air is fresh. Does staying indoors make asthma worse? Speak a little bit about some of the common household triggers and some different triggers for that inflammatory syndrome.

Paul Francisco: For indoor-generated contaminants, there really are quite a number of them that are associated with asthma. There are, for example, formaldehyde, which comes from carpets, pressed wood products, things like that. It will dissipate over time, but typically when you bring in a new pressed wood product or new carpet, you will dose the house with formaldehyde. They're volatile organic compounds. Some of which are associated with asthma.

There are hundreds of these compounds and not all of them are necessarily an issue, but many of them are associated with asthma and that'll appear in many products. Basically, if you are smelling something, you're often smelling a volatile organic compound. The lemony fresh scent, the pine scent, the smell of nail polish, the smell of perfumes, all of those are volatile organic compounds that you're smelling. Some of which are associated with asthma.

There's evidence that just having a damp indoor space, even without the presence of mold, that the dampness is associated with asthma. Then we have triggers from, say, cooking such as nitrogen dioxide, which is a product of natural gas combustion or propane combustion. So if you're using gas for cooking, you'll produce nitrogen dioxide that's associated with asthma.

And then one of the most significant indoor contaminants is particles, very, very small particles. If you can see it, that's not what we're talking about. We're talking about extremely small particles. Those can get into the deep lung and trigger symptoms as well.

Now, one of the problems is that you can also get things like the particles from outdoors. And so there's a balance. Are you generating a bunch indoors or are they coming in from outdoors? So that's a number of the triggers that we see indoors that we know are associated with asthma.

Melanie: Well, thank you for that. So tell us some common household triggers for asthma. Give us some indoor-generated contaminants that you would like people to know about.

Paul Francisco: So one of the things that I do is train healthy home evaluators. Now a healthy home evaluator is somebody who starts with a baseline of knowledge about buildings. They are typically have been trained previously to look at buildings from an energy perspective. But one of the things that means is that they understand how buildings work and how they're put together. And they can do things that kind of look behind the walls and above the ceiling.

And so what we do is we do a walkthrough through the house to identify what we can see that could be potential triggers. You know, we will identify things like is there a vented range hood above the stove that would allow for contaminants from cooking to be removed to the outdoors? Do we see candles? Do we see air fresheners? What do we see for cleaning products? We'll also look for pests because pests can also trigger asthma.

But we will also do some diagnostic testing. We will do evaluations to try to identify air leaks. Some of those air leaks in homes might be connections to attics or crawl spaces, places where there could be some additional sources of contaminants. And so the goal that we have is to combine these measurements. We will also potentially, depending on what we find, we may measure certain indoor contaminants as well. We can measure formaldehyde, nitrogen dioxide, particles, all of those things that I mentioned. So we'll do a combination of visual observations and measurements to really try to understand what is in the home and where it is coming from. And that where it is coming from is so key, because you might know that there's something in the home, but if you don't know where it's coming from, you don't have any way to know what to do about it, to make it so that it is no longer an issue.

So we'll look in every room. We may go into the crawl space. We may go into the attic, go down in the basement. We may leave some measurement devices behind to measure for several days so that we can try to get a longer pattern than just what we might see when we're there for a few hours. Then we'll take all that information back. We'll review it and then put together a report, "This is kind of what we've found." And these are the types of measures that we think could help to reduce the triggers for asthma.

Melanie: Before we talk about management. Paul, how is a family referred for this type of assessment?

Paul Francisco: To be quite honest, the healthy home evaluator is relatively new. We've only been trying to build up some capacity in the last few years. And one of the things that I've been spending a lot of my time working on is to develop partnerships between people who had been trained as healthy home evaluators with practitioners, such as Carle Hospital.

So what would happen in the program that we're piloting with Carle Foundation Hospital is the nurses are going to be identifying in homes that they're going into families that they believe based on what they're seeing could benefit from healthy home evaluation. And then they will be referred to us.

In general, like I say, this is a relatively new field. And so at this point it's still sort of a you have to know to go look for it. But I'm hoping that that will change over time as we demonstrate the potential for partnerships and the value that this can provide.

Melanie: So discuss for us some interventions that people can do on their own, versus when you've done that walkthrough, what must be completed by a professional. You mentioned allergens such as dust mites and pests and cooking all of these different things. So what can people do on their own versus what really needs a professional?

Paul Francisco: That's a great question. And obviously, if everything needs an expensive professional, that's not empowering people to take control of their environments and improve their health. So one of the things I think is so important is that we identify things that people can do themselves along with things that might need a professional.

Some examples of things people can do themselves, if they have a vented range hood above the stove to outside, you know, it actually is vented all the way to outside, not just re-circulating, use it whenever you cook. It's there, it's simple. It makes some noise. It uses a little bit of energy, but one of the things it's doing is removing contaminants that you can't otherwise sense. You can't smell them. You can't see them. So use your range hood.

Another thing that can be really helpful is a lot of people use cleaning products that have these scents added to them. And these scents, as I said those are volatile organic compounds. Well, there are very, very good cleaners that we can just make with less expensive materials, such as you can have a multipurpose cleaner that is simply a combination of soap like flakes or powder, water, and vinegar. It doesn't have those chemicals added. It does just as good a job of cleaning, yet it doesn't leave behind that odor that people associate with cleanliness. But that odor is a chemical, that's a contaminant in the air that could for some people trigger symptoms. So those are some sorts of things.

And other things that people can do if they have nail polish or perfumes, keep them in sealed containers. Only open up the containers when they're going to be using those products and ventilate the room when they're going to be doing that. Turn on ventilation fan or open a window, just like people are supposed to do when they paint.

Another thing they can do if they're worried about pests, if they have foods sitting out, use sealed plastic containers so that pests can't get to the food. Pests need food, shelter and water, just like we do. Keep them from getting one of those things and the pests are not going to want to be there. And so that's a way to reduce many of the pests that we deal with. Not all pests are looking for the food that we would eat. Some of them are really most interested in us. So those are some of the things that can be done by people themselves. And if you see bypasses, you see leaks, seal them up.

Now, some things do need a professional. If you don't have a vented range hood, you probably need a professional to install one if you wanted to do that. One of the things that we find in way too many homes are big leaks in the duct system. That's the system that's moving the warm air or cold air around the house when you're heating or cooling. If there are big leaks in that system, that's one of the things a healthy home evaluator should be able to identify. If there are those leaks, a contractor's probably going to be necessary to really seal those up properly. And if you don't seal them up, they can be a way to move contaminants from say a crawlspace or a basement up into the main living space. So that's some examples of the types of things people can do to take control of their own environments versus what might need a contractor.

Melanie: Certainly things like mold and, you know, that's really important information for homeowners to hear and people suffering with asthma. Where do you stand, Paul, on some lifestyle types of things that we might do in our home, whether it's neti pots or nasal lavage, air filters, pillow cases, vacuum cleaners, all of those kinds of things. Can you just briefly touch on those for us?

Paul Francisco: So I like to not introduce chemicals into my home. I like to use these cleaners that don't have the scents in them. So that's one thing. I don't like to have plug-in air fresheners or humidifiers. I don't like to add water to the air even sometimes it does feel dry, but I still tend to try to avoid intentionally adding water to the air.

So for air filters, I think air filters can be great. They can be a really big improvement on indoor air quality. They have to be good quality filters and not every system can handle a good quality filter, but most systems can. So one of the things you can do is use a good quality air filter and then make sure to change it. That is really key. If you don't change it, it will just get clogged and it will impact your system. So really making sure that, not only you use good filters, but you do change them on a regular basis like every month or two. If you have a thicker filter, like a four-inch filter, you can usually get away for like three to six months with one of those.

Melanie: Well, you are certainly very handy, I'm sure, to have around when it comes to all of these things, Paul. So wrap it up for us. What would you like other providers to know about the impact of the home environment on asthma as part of the asthma symposium and healthy homes and asthma triggers?

Paul Francisco: I would like people to recognize that people spend most of their time indoors and they spend most of their indoor time at home. We also have plenty of evidence that asthma triggers are in the home, but most people are not seen by medical providers in the home. And so what I would really like people to know is that, one, the home environment can have a really significant impact on people's health. And second, that there are people out there that they can work with, that they can partner with, who can go into homes and really understand the home environment to be able to give actionable recommendations, including things that residents can do themselves. This is not something where we just have to always resort to rescue medication. There are things we can do upfront on a preventive basis. We just need to know that these people are out there and there are ways to do some of these interventions.

Melanie: That's great information. Absolutely great information, Paul. Thank you so much for joining us today. That concludes this episode of Expert Insights with the Carl Foundation Hospital. For a listing of Carle Providers and to view Carle's sponsored educational activities, please visit our website at carlconnect.com for more information.

I'm Melanie Cole. Thank you so much for listening.