When the air inside is bad

Parents have long known that the polluted, pollinated air outdoors can bring on asthma attacks in their children.

Now it turns out that many asthmatic inner-city kids are under assault inside their homes – where cigarette smoke, dust mites, mold and cooking smells can make them sicker than car exhaust or ragweed.

Researchers are finding a direct link between the air children breathe at home and the asthma attacks that are the source of hundreds of thousands of emergency-room visits in the United States every year.

The latest study, published last month by Johns Hopkins researchers, quantified the increase in asthma symptoms for every increase in air pollution particles inside Baltimore homes.

Such findings have begun a movement of health professionals going door to door to educate families about the potential dangers of indoor air and helping them clean up their homes. The goal is to reduce childhood asthma 50 percent by 2012.

“We tend to think of outside as being the polluted place and indoors being the sanctuary,” says Dr. Gregory B. Diette, a director of the Johns Hopkins Center for Childhood Asthma in the Urban Environment.

But in many of the Baltimore homes he surveyed, Diette found that inside air was a problem.

As many as 1 in 5 Baltimore children are believed to suffer from asthma, the most common chronic childhood disease but one that disproportionately affects inner-city black children.

Scientists don’t yet know exactly what causes asthma, a lung condition that temporarily narrows the airways and causes wheezing, coughing and difficulty breathing. The number of children with asthma has risen significantly over the past two decades.

“What is then responsible for this dramatic increase in asthma over the past 20 years? That’s the million-dollar question,” says Dr. Elizabeth Matsui, a pediatric allergist at the Johns Hopkins Children’s Center and, along with Diette, an author of the study.

Matsui says allergists have known for years that the home – where children spend most of their time – holds hidden dangers for those with asthma. But only recently, she says, have pollution scientists started to research the relationship between indoor air and asthma.

Syeadda Spears says she tried to do all she could to protect her children, two of whom suffer from asthma. She kept her sons inside their Northeast Baltimore home. She was constantly sweeping the floors. She even bought plug-in air fresheners to make everything smell nice.

Then she got a visit from Hopkins researchers doing another study – and learned she was doing a lot of things wrong.

She was kicking up dust that made her sons wheeze every time she swept. The air fresheners were triggering symptoms in 9-year-old Da’Shawn. She even made him sick when she tried to bake cookies because of her kitchen’s poor ventilation.

“I thought, ‘The house is clean. You’ve got wood floors. It smells fresh.’ But no,” she says.

Not every parent listens. Last spring, outreach workers from the Coalition to End Childhood Lead Poisoning began visiting the homes of 250 Baltimore children as part of a program aimed at keeping asthma in check.

Kevin Gummer and Gia Wilkerson arrive armed with special particle-removing vacuums, pest management advice and new windows – whatever a home needs. The idea is that a $100 HEPA vacuum might save $1,500 in doctor or emergency-room visits.

The workers say that showing a family how they can make changes is far more effective than handing out healthy-home pamphlets.

Sometimes, families trying to make things better only make them worse. For example, in trying to get rid of mice and cockroaches – which, among other ills, can trigger asthma attacks – families often use foggers or other chemical sprays. Gummer says those don’t solve the problem and they can aggravate asthma symptoms.

The childhood lead coalition moved into the realm of asthma as a complement to its successful efforts to reduce lead paint in city homes.

“When we were leaving homes in the late ’90s, cleaning up the lead, our guys were replacing windows … (but) the kids were still getting sick – not necessarily from lead but asthma and injuries,” Executive Director Ruth Ann Norton says. “In those families, about 50 percent of their kids had asthma.”

The problem of poor indoor air quality appears to be most serious in low-income city households. Reasons for that aren’t fully understood, but researchers say city homes tend to be smaller than those in the suburbs, so bad air has less chance to be diffused. And in older houses, there is more likely to be dust from old plaster and wood.

City children also tend to spend more time indoors, often because their parents fear the potential for violence outside.

While the home visits are intended to help families improve the air in their homes, health officials say, it can be intrusive to have someone come in and criticize your personal habits and your housekeeping.

“The issues are balancing privacy versus health,” says Dr. Peyton Eggleston, a pediatric allergist at the Johns Hopkins Children’s Center.

“With ambient-air-quality control and water-quality control and pollution control in general, there’s not really a question. We all share the air. We all share the water.

“But when you get to the conditions inside someone’s home … you get to the conflict between individual rights and the rights of the community.”

The Hopkins study, published in the journal Environmental Health Perspectives, looked at 150 asthmatic preschoolers in Baltimore over six months.

It found that for every 10-microgram-per-cubic-meter increase in coarse air particle pollution – such as that produced by dusting and cooking – there was a 6 percent increase in the number of days of coughing or wheezing or with chest tightness.

For every 10-microgram-per-cubic-meter increase in finer air particles indoors, there was a 7 percent increase in wheezing severe enough to limit speech, and a 4 percent increase in the number of days rescue medication was needed.

In many cases, the researchers found, the level of indoor fine particle pollution was twice as high as the outdoor-pollution standard established by the U.S. Environmental Protection Agency. There is no such standard for indoor air.

Diette points out that, sometimes in the summer, officials warn of bad-air-quality days and suggest children with asthma stay inside.

“Depending on where you’re staying inside,” he says, “it may not be a better environment.”