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AAP Clears the Air on Role of Indoor Environmental Exposure in Childhood Asthma

​A new clinical report from the American Academy of Pediatrics (AAP) says reducing the exposure a child with asthma has to indoor allergens and pollutants, such as dust mites and second-hand cigarette smoke, can be as effective as medications to control the disease.

The report, "Indoor Environmental Control Practices and Asthma Management," in the November 2016 Pediatrics (online Oct. 31), urges individually tailored recommendations to reduce and control these exposures as a cornerstone of asthma management.

Asthma is one of the most common chronic childhood illnesses, affecting as many as 10 percent of children across the United States. Rates are as high as 25 percent in some U.S. communities, according to the report, and studies have identified poverty among major risk factors for the disease. Children may be especially vulnerable to environmental allergens and pollutants, the report says, because of the unique characteristics of their airways and because they may spend more time on the floor where substances can collect.

As part of developing tailored recommendations for children with asthma, the report urges pediatricians to ask families about exposure to common triggers such as:

  • Dust mites and mold, both of which are more common in environments where humidity is high. An estimated 30-62 percent of children with persistent asthma are allergic to dust mites, microscopic members of the spider family, and roughly half are sensitive and exposed to mold.
  • Furry pets. Up to 65 percent of children with persistent asthma are allergic to cats and dogs, according to the report.
  • Presence or evidence of pests such as cockroaches and rodents. Roughly 75-80 percent of U.S. homes contain detectable amounts of mouse allergen, the report says, and concentrations in homes in urban neighborhoods with high poverty rates are as much as 1,000-fold higher than those found in suburban homes.
  • Sources of indoor air pollution, including smokers who live in the home or care for the child and use of gas stoves and appliances.
  • Household chemicals, such as those found in air fresheners and cleaning agents, which can be respiratory irritants and trigger asthma symptoms.

The report also recommends allergen-specific blood antibody tests or referral to allergists for skin testing in order to identify indoor allergens likely to contribute to a child's asthma. Once triggers are known, the report says, environmental control strategies are tailored to the triggers and can include removing and controlling the source of allergens in the air, dust, bedding, clothing, carpeting, stuffed toys and other places, using high-efficiency particulate air (HEPA) filters and allergen-proof mattress, box spring and pillow encasements.

Lead author Elizabeth C. Matsui, MD, MHS, FAAP, said a comprehensive approach to environmental exposures in the new report is the most effective. "We know that targeting all exposures that can trigger a child's asthma," she said, "is more likely to be successful and result in significant improvement than targeting only one or two of them, and can help reduce asthma attacks and the need for medication."

Talk with your pediatrician

If you have questions about indoor air quality, talk with your pediatrician. Your regional Pediatric Environmental Health Specialty Unit (PEHSU) have staff who can also talk with parents about concerns over environmental toxins.

10/31/2016 12:00 AM
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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