EPR 3 (2007) Measures of Assessment and Monitoring Education Control of Environmental Factors Medication

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Imogen Reed
5 years ago
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2 EPR 3 (2007) Component 1: Measures of Assessment and Monitoring Component 2: Education Component 3: Control of Environmental Factors Component 4: Medication

3 KEY DIFFERENCES FROM 1997 EXPERT PANEL REPORT Evidence strengthens recommendations that reducing exposure to inhalant indoor allergens can improve asthma control and notes that a multifaceted approach is required; single steps to reduce exposure are generally ineffective. This suggests the need for holistic environmental investigation.

4 EPR 3 Recommendations for Management to Reduce Exposure 1. The first and most important step in controlling allergen induced asthma is to advise patients to reduce exposure to relevant indoor and outdoor allergens to which the patient is sensitive.

5 EPR 3 Recommendations for Management to Reduce Exposure 2. Effective allergen avoidance requires a multifaceted, comprehensive approach; individual steps alone are generally ineffective.

6 EPR 3 Recommendations for Management to Reduce Exposure 3. Consider multifaceted allergen control education interventions provided in the home setting that have been proven effective for reducing exposures to cockroach, dust mite, and rodent allergens for patients sensitive to those allergens. Further research to evaluate the feasibility of widespread implementation of such programs will be helpful.

7 EPR 3 Points to Numerous Indoor Allergens to be Controlled House dust mite Animal dander (not just pets!) Cockroach Indoor fungi and molds (IOM report also points to moisture) ETS Formaldehyde and VOCs (including fragrances) Fuel burning appliances Outdoor allergens that come into the house, mostly pollens

8 Today, housing and health care are both in a state of crisis, particularly for families with limited means. A scientific examination of the efficacy of healthy housing interventions can help to improve both health and housing, reducing the cost of health care services.

10 Of these interventions, three are ready for implementation and have been shown to be effective, five need more field testing but are promising, three need formative research, and four are ineffective. 1. Multi faceted in home interventions for asthma tailored to the individual, as exemplified by the National Cooperative Inner City Asthma Study, are effective in controlling asthma symptoms and reducing other measures of asthma morbidity. These interventions include home environmental assessment; education; use of mattress and pillow covers; use of HEPA vacuums and HEPA air filters; smoking cessation and reduction in environmental tobacco smoke exposure; cockroach and rodent management; minor repairs, and intensive household cleaning.

11 2. Cockroach control through Integrated Pest Management (IPM) was found to be an effective intervention in reducing exposures to pests, as well as reducing exposures to pesticides. IPM includes household cleaning and tool dispensing, professional cleaning, education of residents, baits and structural repairs and when necessary, intensive application of low toxicity, non spray pesticides. 3. When implemented together, eliminating moisture intrusion and leaks and removal of moldy items were found to be effective in reducing asthma triggers and reducing exposures.

12 How does the Healthy Homes Coalition do Assessments? 1. Test the hypothesis. If you know triggers, go straight at them. 2. Focus on the locations where the child spends the most time. 3. Basements are very important. 4. Most of the work is done through visual assessment (nose too!). 5. Key instruments include flashlight, moisture meter and sticky traps.

13 What is the Healthy Homes Coalition typically looking for? 1. Pests (cockroaches, mice, rats) 2. Moisture Water stains on walls, ceilings Damp basements Unvented baths and kitchens Leaking plumbing Humidity control 3. Over use of fragrances, lack of green cleaning 4. Dust sinks (carpet, window treatments, etc.)

14 What is the Healthy Homes Coalition typically looking for? Yes, we also know about 1. Smokers 2. Pets 3. Housekeeping You can deal with a house objectively, but you have to deal with people subjectively.

15 What Form do You Use? 1. Start with People. 2. Remember, you are testing a hypothesis, so don t use a form that asks too many questions. 3. Focus on the most common triggers and their sources, not the unique. 4. Room by room forms work best for us. 5. Be thinking about practical, affordable solutions as you assess.

16 Additional Recommendations 1. Don t just make recommendations, discuss them. Talk specifically about priorities and first steps. 2. Provide low cost solutions. 3. Have a firm process for referral and accountability. 4. If you can offer environmental controls, ROI is greatest when fixes are < $2, Body science vs. Building science Partner!

17 Paul Haan Executive Director 742 Franklin Street SE Grand Rapids, Michigan (616)

B.R.E.A.T.H.E. Bringing Reduction and Education of Asthma Triggers to the Home Environment

B.R.E.A.T.H.E. Bringing Reduction and Education of Asthma Triggers to the Home Environment A collaborative project of HDHHS and the EPA Bureau of Community and Children s Environmental Health Acknowledgements