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Research ArticleConference Proceedings

Environmental Issues in Managing Asthma

Gregory B Diette, Meredith C McCormack, Nadia N Hansel, Patrick N Breysse and Elizabeth C Matsui
Respiratory Care May 2008, 53 (5) 602-617;
Gregory B Diette
Division of Pulmonary and Critical Care
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Meredith C McCormack
Division of Pulmonary and Critical Care
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Nadia N Hansel
Division of Pulmonary and Critical Care
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Patrick N Breysse
Bloomberg School of Public Health
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Elizabeth C Matsui
Division of Pediatric Immunology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Abstract

Management of asthma requires attention to environmental exposures both indoors and outdoors. Americans spend most of their time indoors, where they have a greater ability to modify their environment. The indoor environment contains both pollutants (eg, particulate matter, nitrogen dioxide, secondhand smoke, and ozone) and allergens from furred pets, dust mites, cockroaches, rodents, and molds. Indoor particulate matter consists of particles generated from indoor sources such as cooking and cleaning activities, and particles that penetrate from the outdoors. Nitrogen dioxide sources include gas stoves, furnaces, and fireplaces. Indoor particulate matter and nitrogen dioxide are linked to asthma morbidity. The indoor ozone concentration is mainly influenced by the outdoor ozone concentration. The health effects of indoor ozone exposure have not been well studied. In contrast, there is substantial evidence of detrimental health effects from secondhand smoke. Guideline recommendations are not specific for optimizing indoor air quality. The 2007 National Asthma Education and Prevention Program asthma guidelines recommend eliminating indoor smoking and improving the ventilation. Though the guidelines state that there is insufficient evidence to recommend air cleaners, air cleaners and reducing activities that generate indoor pollutants may be sound practical approaches for improving the health of individuals with asthma. The guidelines are more specific about allergen avoidance; they recommend identifying allergens to which the individual is immunoglobin E sensitized and employing a multifaceted, comprehensive strategy to reduce exposure. Outdoor air pollutants that impact asthma include particulate matter, ozone, nitrogen dioxide, and sulfur dioxide, and guidelines recommend that individuals with asthma avoid exertion outdoors when these pollutants are elevated. Outdoor allergens include tree, grass, and weed pollens, which vary in concentration by season. Recommendations to reduce exposure include staying indoors, keeping windows and doors closed, using air conditioning and perhaps high-efficiency particulate arrestor (HEPA) air filters, and thorough daily washing to remove allergens from one's person.

  • asthma
  • pollutants
  • particulate matter
  • nitrogen dioxide
  • sulfur dioxide
  • secondhand smoke
  • ozone
  • allergens

Footnotes

  • Correspondence: Gregory B Diette MD MHS, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, 1830 E Monument Street, 5th Floor, Baltimore MD 21205. E-mail: gdiette{at}jhmi.edu.
  • Dr Diette presented a version of this paper at the 41st Respiratory Care Journal Conference, “Meeting the Challenges of Asthma,” held September 28–30, 2007, in Scottsdale, Arizona.

  • Copyright © 2008 by Daedalus Enterprises Inc.
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Respiratory Care: 53 (5)
Respiratory Care
Vol. 53, Issue 5
1 May 2008
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Environmental Issues in Managing Asthma
Gregory B Diette, Meredith C McCormack, Nadia N Hansel, Patrick N Breysse, Elizabeth C Matsui
Respiratory Care May 2008, 53 (5) 602-617;

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Environmental Issues in Managing Asthma
Gregory B Diette, Meredith C McCormack, Nadia N Hansel, Patrick N Breysse, Elizabeth C Matsui
Respiratory Care May 2008, 53 (5) 602-617;
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Keywords

  • Asthma
  • pollutants
  • particulate matter
  • nitrogen dioxide
  • sulfur dioxide
  • secondhand smoke
  • ozone
  • allergens

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