Note: This Instructional Module information comes from our Training Manual.  However, due to periodic website updating, some of the information found here, may not be found in the manual. The complete Training Manual can be ordered from our Program and comes with a video, transparency masters, module publications, and many other educational resources. 

Module Learning Objectives

• Identify environmental triggers of asthma
• Describe steps to take to reduce exposures to indoor asthma triggers in the home 

Support Publications

• Back to School with Allergies and Asthma, A Bill of Rights for Children with Allergies and Asthma, Allergy and Asthma Network - Mothers of Asthmatics, Inc., 1998. http://www.lungusa.org
• Clear Your Home of Asthma Triggers - Your Children Will Breathe Easier, EPA 402-F-99-005, July 1999. http://www.epa.gov/asthma/pdfs/asthma_eng.trifold.pdf
• See Home IAQ Overview Module for Indoor Air Hazards Every Homeowner Should Know About... Booklet

Additional Resources

• Guidelines for the Diagnosis and Management of Asthma, Available separately from the National Asthma Education and Prevention Program (NAEPP), 1997. Call 301-592-8573 for more information.
• Sesame Street - A is for Asthma Video, Children’s Television Workshop (English and Spanish versions on same cassette. Available separately from the Children’s Television Workshop, or for loan from the Healthy Indoor Air for America’s Homes Program at 406-994-3451. For more information, contact CES-Asthma Project, Children’s Television Workshop, 1633 Broadway, 40th Floor, New York, New York, 10019.)

Notes to the Program Leader:

The format is to provide a series of masters for making overhead transparencies (or slides) and a script to accompany each visual. The script is presented in outline form to encourage you to present information in a conversational style and to avoid reading an exact script during the program presentation.

In preparation, read the reference materials. Also, because information on indoor environmental asthma triggers is most often found interspersed in longer documents that address all factors contributing to asthma, it is recommended that you read through the presentation script to familiarize yourself with more detailed information about these triggers in case you get questions from your audience.

Script for Transparency #1

Facts About Asthma

Asthma is a serious lung disease. During an asthma attack, the body’s airways constrict, making it difficult to breathe. Symptoms of asthma include wheezing, shortness of breath, and coughing. Asthma can even cause death. The number of people with asthma increased by more than 150% from 1980 to 1998. It affects an estimated 17 million Americans, including nearly 5 million children. 

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What is Asthma?

Asthma is a chronic "reactive airway disease". This means that airways narrow, and breathing becomes difficult. The smaller breathing tubes (bronchioles) in the lungs react to an individual's "triggers" by narrowing: muscles in the bronchioles tighten, tissue becomes inflamed, and there is excessive mucus production. These factors combine to make breathing difficult. For a demonstration, try breathing through a drinking straw.

Asthma CAN be controlled. With proper care and treatment, most people with asthma can engage in nearly all activities and lead normal lives. While we are not sure why people have asthma, we do know what sorts of things cause asthma episodes.

Asthma...

• Cannot be "caught" from someone else
• Cannot be cured (but it sometimes becomes less serious)
• Can be controlled; the cause of asthma is not known, but we do know what triggers asthma episodes.

Asthma is especially worrisome because it is more prevalent among low income and minority groups. The national health and economic consequences of asthma are substantial, including: 

• 5,500 deaths per year
• 500,000 hospitalizations
• 1.5 million emergency department visits
• $11.3 billion a year in direct and indirect costs
• 14 million missed school days per year 

• management of environmental asthma triggers
• proper selection and use of medications 

"Almost all asthma patients can become free of symptoms with proper treatment. Patients and their families should expect nothing less." (cited in the NIH/NHLBI booklet: Your Asthma Can be Controlled: Expect Nothing Less)

Asthma is different from most other illnesses. There are many medications to treat this disease. (More about this later.) The important thing is that there is no one "best" medication. Different medications work better for some people than for others. This means that it is important for the patient to work with the doctor, telling him or her how helpful - or unhelpful - a particular medication is. In most cases, the doctor and patient must work together to find which medicine works the best.  Likewise, the patient must become an "asthma detective", keeping track of the conditions and situations that are present when an attack occurs.  Identifying common patterns will point to asthma "triggers" that will allow the patient additional control over this disease.

Asthma Triggers:

• What are triggers?
• How do I find out about my triggers?

The best way to find out what your triggers are is to keep a diary. Write down what was going on before each asthma episode.  List such things as indoors/outdoors, home (particular room), activity, time of day, season, presence of pets, dust, etc. This will show what the most common circumstances are when asthma episodes occur. Working together, you and your doctor should be able to determine common things, events or locations associated with asthma episodes.

The main goal of this presentation is to talk about common allergy-type triggers and ways to control them.

Note to instructor:  The doctor-patient partnership is of critical importance in developing an optimum treatment plan. Since patient-doctor communication is often less than it should be, in terms of the doctor's education of the patient, the patient's understanding and the patient's willingness to ask questions, this need requires special emphasis in managing asthma. Each asthma patient should receive a written "Asthma Treatment Plan" that describes medications and when they should be taken, and other aspects of asthma management. The doctor or medical personnel should explain any parts of this that are not understood. The emergency room is not the place for asthma education!
     Moreover, recent research shows that only a very small percentage of family practitioners fully conform to the most recent National Heart, Lung and Blood Institute guidelines for asthma treatment.  This means that if a patient is not getting adequate control of asthma, the patient should ask for a second opinion or referral to a specialist.  Patient knowledge, patient education, and persistence are all critical in taking control of asthma. Patient compliance - taking prescribed medications as directed - is also important.
     Patient compliance is important as well. Some types of asthma medication must taken regularly, even when there are no symptoms (these are discussed below). These medications will lessen the severity and frequency of asthma episodes; but some patients stop taking them because they feel better. The doctor should always be consulted before changing or discontinuing medication.

Script for Transparency #3

Major Indoor Asthma Triggers

Asthma may be triggered by allergens and irritants that are common in homes. The following overheads in this presentation show what you can do to help control five major indoor triggers of asthma: secondhand smoke, dust mites, pet dander, molds, and pests. 

Not all the asthma triggers shown here affect every person with asthma. Not all asthma triggers are listed here. You should see your doctor or health care provider for more information about the most effective way you can manage your child's or your own asthma.

Script for Transparency #4

Secondhand Smoke

Asthma can be triggered by the smoke from the burning end of a cigarette, pipe, or cigar, or the smoke exhaled by a smoker. 

Children are especially vulnerable to secondhand tobacco smoke, and up to 1 million children with asthma have had their condition worsened by exposure to secondhand smoke. It is also a risk factor for new cases of asthma in children who have not previously displayed asthma symptoms.

In addition, children exposed to secondhand smoke are more likely to suffer from pneumonia, bronchitis, and other lung diseases, as well as ear infections. 

Note to the Program Leader: For more information about secondhand smoke, see the "Secondhand Smoke" module.

Script for Transparency #5

Controlling Secondhand Smoke

Given the adverse health effects of secondhand smoke, it is important to avoid smoking in your home or car. Until you can quit smoking, you should smoke outside.

Script for Transparency #6

Dust Mites

Dust mites are tiny creatures that cannot be seen without magnification. They live in warm, humid places such as mattresses, pillows, carpets, fabric-covered furniture, bedcovers, clothes, and stuffed toys. Bedding provides an ideal environment for dust mites: warmth, moisture and an abundant supply of food (flaked-off skin).

Exposure to house dust mites and their droppings can trigger asthma attacks.

Note to instructor:  Dust mites are not insects, but members of the class Arachnida and are related to spiders. They differ from insects in that they have eight legs. Sooner or later you will have a young kid in the audience who will know/ask about this.

Script for Transparency #7

Controlling Dust Mites

Washing bedding in hot water has been shown to reduce dust mites. Since stuffed toys are a breeding ground for dust mites, choose toys that can be washed and thoroughly dried, and keep them off beds to reduce the exposure received during long hours of sleep. It may also help to put stuffed toys in the freezer for a day or so.

Zippered mattress and pillow covers that do not allow the mites to pass through appear to be effective in reducing the amount of exposure. While special "allergy" mattress covers are available, these are expensive. A less expensive alternative is to use a plastic mattress cover and a mattress pad. Launder all bedding in hot water (at least 130 degrees Fahrenheit).

Script for Transparency #8

Pets

Dander, urine, or saliva of warm-blooded animals (such as cats, dogs, mice, rats, gerbils, birds, etc.) can cause allergic reactions or trigger asthma. The most effective way to control exposure to triggers from animals is to keep your home pet-free. 

Script for Transparency #9

Controlling Pet Problems

You might consider trying to find a new home for your pets, if necessary. If you do remove an animal from the home, do a thorough cleaning including floors, walls, and especially carpets and upholstered furniture. Also, be aware that triggers from pets can stay in the home for several months after the pet is removed even with cleaning. Some individuals may reduce their exposure by:

 
• Keeping pets in only one area of the home
• Keeping pets out of the bedroom and other sleeping areas at all times, and keeping the door closed
• Keeping pets away from fabric-covered furniture, carpets, and stuffed toys
• Keeping pets outside
• Ensuring individuals with asthma stay away from the pet

Script for Transparency #10

Molds

Some people's asthma can be triggered by mold. Molds can be found almost anywhere; they can grow on virtually any substance, provided moisture is present. There are molds that can grow on wood, paper, carpet, and foods. When excessive moisture accumulates in buildings or on building materials, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed. 

There is no practical way to eliminate all mold and mold spores in the indoor environment. The best way to control indoor mold growth is to control moisture. Clean up the mold and get rid of excess water or moisture. Lowering moisture also helps reduce other triggers, such as dust mites and cockroaches. 

Note to the Program Leader: For more information about molds, see the "Bugs, Mold, and Rot (Biologicals)" module.

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Controlling Molds

To fix a mold problem, you should do two things: 

1. Fix the water or humidity problem 
2. Completely clean up the mold

 
• Repairing a plumbing leak or raising the temperature of cold surfaces where moisture condenses by adding insulation
• If a leak or other water damage occurs, drying all water-damaged areas completely within 24 to 48 hours
• Washing mold off hard surfaces and drying completely - absorbent materials (ceiling tiles and carpet) may need to be replaced. Beware of mold spores when cleaning. Let a helper, without asthma, do the cleanup. A good quality dust mask or respirator may be necessary. Wet down dry mold before scrubbing.
• Keeping drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry
• Using exhaust fans or opening windows in kitchens and bathrooms when showering, cooking, or using the dishwasher
• Venting clothes dryers to the outside
• Maintaining low indoor humidity (between 35-55% relative humidity)

Script for Transparency #12

Pests

Exposure to household pests (such as cockroaches and rodents) can trigger asthma symptoms in some individuals.

An important key to pest control is to keep them from entering your home and to keep them away from food and water. Pesticides are toxic for people as well as pests, so try to use the least toxic methods for pest control.

Script for Transparency #13

Controlling Pests

Some steps to manage pest problems include:

 
• Do not leave food or garbage out 
• Store food in airtight containers
• Clean all food crumbs or spilled liquids right away
• Wash dishes when you are done using them, and do not leave dirty dishes in the sink, especially overnight
• Keep counters, sinks, and tables clean and clear of clutter
• Fix plumbing leaks and other moisture problems
• Take piles of boxes, newspapers, and other items where cockroaches may hide out of your home
• Make sure trash in your home is properly stored in containers with lids that close securely, and remove trash daily
• Try using poison bait, boric acid (for cockroaches), or traps before using pesticide sprays

Script for Transparency #14

Housekeeping/Housecleaning:

• Avoid clutter, dust catchers
• Reduce or eliminate carpeting
• Use a high-performance vacuum cleaner 

(Let a helper without asthma do the vacuuming.)

Asthma Medications:
Two types:

• Rescue meds (also known as bronchodilators)
• Maintenance meds (also known as Preventers) 

We are not health care providers and can not be recommending medications. However, there is some general information about medications that is very important to convey:

• Bronchodilator medications open the airways and are taken to relieve the symptoms of an acute asthma episode.
• Maintenance medications (anti-inflammatory meds; corticosteroids) reduce the inflammation and sensitivity. If you think of the sensitive lung tissues of a person with asthma as being similar to sensitive skin after a sunburn, you can think of maintenance medication as protection for the lungs, much like sun blocker protects the skin from sunburn. Rescue medications are like treatments applied after the sunburn has happened.
• Sometimes patients get these two mixed up, and take the wrong ones. Sometimes people stop taking the maintenance medication because they feel better. This a mistake. (Consult your doctor before stopping or changing your medication.)
• Some people do not want to take steroids because of harmful effects they have heard of in athletes who take "steroids". This is also a mistake: a) steroids for asthma are different types of steroids and have very little harmful side effects; b) most steroids for asthmatics are taken by inhaler, directly into the lungs, so dosages are very small compared to pills or tablets.
• Medications to reduce lung mucus can also be prescribed.

If pesticide sprays are used to control pests:

 
• Limit the spray to the infested area
• Do not spray where you prepare or store food, or where young children play, crawl, or sleep
• Carefully follow instructions on the label
• Make sure there is plenty of fresh air when you spray, and keep people with asthma out of the room

Script for Transparency #15

Bill of Rights for Children with Allergies and Asthma

The Allergy and Asthma Network - Mothers of Asthmatics, Inc. (AAN-MA) is an organization dedicated to helping all people affected by allergies and asthma. The AAN-MA has released a Bill of Rights for Children with Allergies and Asthma (full text fact sheet included in this module). According to AAN-MA, a child with allergies and asthma and his/her family have the right to:

 
1. Be presented with the proven scientific facts of asthma and allergies in a manner that raises appropriate concerns and avoids needless anxiety
2. Be cared for by a supportive physician who provides preventive management of asthma and allergies as well as treatment for acute episodes
3. Live in a smoke-free environment where reasonable attempts at eliminating relevant allergens are made

Script for Transparency #16

Bill of Rights for Children with Allergies and Asthma (Continued)

 
4. Have full and personal access to appropriate medications and devices so that potential scholastic, athletic, and social achievements are not limited by otherwise uncontrolled asthma or allergies
5. Learn self-management skills to minimize dependence on medical personnel, emergency clinics, and hospitalizations
6. Expect teachers, school nurses, coaches, camp counselors, and other adults entrusted with their care to understand the enlightened handling of children with asthma and allergies

Prepared by: 

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“www.healthyindoorair.org” is a partnership program of the Montana State University Extension Service - Housing Program, U.S. Department of Agriculture - Cooperative State Research, Education, and Extension Service, the Healthy Homes Partnership - Alabama Cooperative Extension System @ Auburn University, U.S. Dept. of Housing & Urban Development, , and the U.S. Environmental Protection Agency - Indoor Environments Division.

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