Indoor AIRepair at Home, School, and Play

Indoor AIRepair at Home, School, and Play
at Home, School and Play
5th Edition
8229 Boone Blvd., Suite 260
Vienna, VA 22182
Phone: 800.878.4403
Indoor AIRepair at Home, School and Play is
published by Allergy & Asthma Network
Mothers of Asthmatics (AANMA),
Copyright 2003. Revised 2014.
All rights reserved.
AANMA Mission: Founded in 1985, AANMA is the leading nonprofit patientcentered organization dedicated to eliminating needless death and suffering
due to asthma, allergies and related conditions through education, advocacy,
outreach and research.
Funded by the U.S. Environmental Protection Agency (EPA) under cooperative agreement XA-83466701.
The contents of this document do not necessarily reflect the views and policies of EPA, nor does
mention of trade names or commercial products constitute endorsement or recommendation for use.
2 • AANMA Indoor AIRepair
Indoor AIRepair™
4 Asthma – What’s It All About?
at Home, School and Play
Every breath we take contains millions of
particles of dust, allergens, chemicals, pollutants and other tiny molecules. And
while pollen and outdoor air pollution get
most of the attention, Environmental
Protection Agency (EPA) studies show that
pollutant levels inside homes and buildings
are two to five times higher than outside!
Indoor AIRepair at Home
7 Room-by-Room
11 Recipes for Success: Nontoxic cleaning
14 The Importance of a Smoke-Free Home
15 Asthma At A Glance
When you have asthma and allergies, that
puts clean indoor air at the top of your
must-have list.
16 AIRepair Friends and Neighbors:
Organizations, government agencies and
websites that can help you repair your air
Welcome to Indoor AIRepair at Home,
School and Play, a family-friendly magazine developed by Allergy & Asthma
Network Mothers of Asthmatics.
18 Indoor AIRepair Checklist
Indoor AIRepair at School: Helping
Parents, Students and Teachers Breathe Easier
20 Indoor Air Pollutants -- Finding the source:
Mold, Pests, Animals, Secondhand Smoke,
Dust Mites
25 Managing Medications at School
26 Common Medication Myths
27 Advice for Parents
28 Advice for Teachers
Indoor AIRepair at Play: The Business
of Being a Kid
32 Asthma and Allergy Fun Busters: Keep playtime safe for little airways by watching out
for these symptom-starters
33 AIRepair Tips: Play dates and birthday
parties; slumber parties and overnights;
community center classes; travel
35 Fun-tastic Activities for Kids
AANMA Indoor AIRepair • 3
Asthma – What’s it all about?
Take a Deep Cleansing Breath
Breathe in. Oxygen just passed
through your nose, sinuses and
throat. It branched into a system of
smaller and smaller air tubes in your
lungs, then entered your blood
through tiny air sacs – billions of
them! Circulating red blood cells
picked up the oxygen and carried it
to your brain, heart, kidneys, muscles
and skin – every organ of your body.
Now breathe out. Used oxygen,
which has become carbon dioxide,
just left your blood, reentered
those air sacs and traveled back
through your airways into the
room where you sit.
That breath contained more than
just oxygen – mixed in were 25 million tiny pieces of dust, allergens,
irritants and other air pollutants. If
you could see these tiny molecules
floating in the air, the air would be
so thick with them they would hide
your hand. So where did they go
when you inhaled them?
Many stuck to the hairs inside your
nose and sinuses. Others got trapped
in mucus inside your airways. Each
time you swallow, cough, sneeze or
blow your nose you get rid of a few
million. It’s nature’s filter system.
But for people with asthma, some
inhaled particles go too far. As they
hit the airways, they signal the body
to make more mucus and release
fluids. Breathing tubes and nasal
passages swell and clog. Muscles that
usually keep the airways open begin
to twitch and squeeze, trying to
make room for the air.
This is what some people call an
asthma attack or episode. In the early
stages, aside from a slight cough or
sniffle, the person’s breathing may
look normal. But within minutes or
hours, the picture changes, as used
air gets trapped inside the air sacs
and fresh air can’t get in.
4 • AANMA Indoor AIRepair at School
Signs that an asthma episode is underway and needs treatment:
coughing – with or without throat clearing, sniffling. The cough may come
every few minutes or within seconds.
wheezing – this whistling sound can sometimes be heard as the person
breathes out. Wheezing is a sign the asthma episode is becoming dangerous. However, not all people with asthma wheeze during an asthma
episode. Others may always sound wheezy – not a good thing.
breathing – becomes rapid and difficult.
talking – may be difficult, but the person with asthma will usually use full
sentences when symptoms first show up. As the episode gets worse, he or
she will use fewer and fewer words.
energy level – may decrease slowly or suddenly. If the person has been
running, he may stop, lean forward and place his hands on his knees
while trying to catch his breath.
Each person responds to asthma differently and may display any or all
of these symptoms during an asthma episode.
Steps to take if a person shows the above symptoms:
take the person away from any obvious irritants that are making it
difficult to breathe (such as animals, smoke or chemical smells).
use the prescribed inhaled bronchodilator immediately. This medication
relaxes twitchy airways so the patient can breathe more easily.
help the patient drink water to keep airways hydrated.
allow him or her to rest long enough to recover.
It is important for the patient to use the prescribed bronchodilator (albuterol
or levalbuterol) at the first sign of symptoms. Most often, people will recover
quickly as the medication takes effect. However, the longer the symptoms
continue without medication, the more dangerous the episode becomes.
Signs the person needs emergency medical assistance:
breathing doesn’t become easier within 5 minutes after inhaling the
bronchodilator medication. The skin around the person’s neck, collarbone and ribs may appear to suck in with each breath or the stomach
may contract.
skin color – may become pale or dusky. Lips may lose color or fingernails
may look slightly blue. Dark circles may form around the eyes.
talking – the person may become very agitated, talking in single words only.
wheezing – is louder and longer. Sometimes, wheezing may disappear
altogether, if the airways are so clogged with mucus that airflow is not
strong enough to produce wheezes.
Steps to take if you notice any one of these symptoms:
call 911 for emergency assistance
call the parents, if the patient is a child
Helping Others
Breathe Easier
Get ready to roll up your sleeves
and pinch the dust mask tight on
your face because we’re going in –
into your home, that is – hunting for
airborne invaders that can make you
sneeze, wheeze, itch and drip!
That’s right – AANMA’s Indoor
AIRepairTM guide will help you find
and remove allergens and irritants
that can trigger asthma, allergies and
other health conditions. Every home
has them, whether tent, mansion or
anything in between, but we don’t
always recognize them.
The point is, even if you think the air
inside your home is clean, it may not
be as healthy as you’d like. So use this
Indoor AIRepair guide as a starting
point. Shine your flashlight in every
nook and cranny, searching for the
clues we list room-by-room, then fill
in your Checklist and use our
AIRepair tips to clean things up. Need
outside help? Consult the Friends and
Neighbors resource list and don’t
despair! As intimidating as the
process can seem, there’s always help.
Visit AANMA’s website, www.aanma.
org, to find additional resources and
help and to join our network of families, caregivers, consumer advocates,
and healthcare professionals.
Share your AIRepair stories and tips -write to [email protected] or
AANMA, 8229 Boone Blvd., Suite 260,
Vienna, VA 22182.
Join us on or
follow us on
Your opinions are important!
Let’s stay in touch!
AANMA Indoor AIRepair at Home • 5
Calling All
Neat Freaks
and Messies
Your home is your castle, be it an
apartment, mobile home, singlefamily dwelling or townhouse in the
bustling city, suburbs or rural countryside. And whether you consider
yourself a neat freak or a creatively
cluttered person, if you or someone
in your family has asthma or allergies,
the air inside your home may be
making you sick.
Americans spend nearly 90 percent of our time inside – and often
take indoor air quality for granted.
But Environmental Protection
Agency (EPA) studies show air
pollutant levels may be two to
five times higher indoors than
If we could color the tiny air specks
and chemicals we breathe each
day, we’d be amazed at all the particles that constantly bombard our
airways. Allergens such as animal
how your
self-tour went, what you did
dander, dust mites, cockroaches
and mold; irritants such as smoke,
chemical odors and dust; and biological pollutants such as viruses
and bacteria swirl in, often causing
headaches, stuffy nose, tickly
throat, nagging cough, wheezing,
shortness of breath, itchy eyes and
more. And while medications can
sometimes relieve these symptoms,
6 • AANMA Indoor AIRepair at Home
Asthma and allergies are the most
common health conditions linked
with indoor pollutants. Others
include rhinitis, chronic sinusitis,
eczema, skin rashes, fungal infections, headaches and eye irritations.
How healthy is the air inside your
home? Let’s find out. Grab a dust
mask, a pair of gloves, a flashlight,
a pencil and this Indoor AIRepair at
Home guide. Start at the kitchen
sink (or any other convenient point
in your home) and take the Roomby-Room tour to look for indoor
allergens, irritants and pollutants.
Record your findings on the handy
Checklist on page 18.
Find it Fix it
How good is your home’s indoor air quality?
Even the cleanest homes have room for improvement.
Take this quick quiz – the answers may surprise you!
Friends and/or family use
lighted tobacco products in
my home.
My family and I have taken Yes
the EPA Smoke-Free Home
It has been more than one
month since I cleaned or
replaced the air filter on
our heating/cooling unit.
I’ve marked the calendar
to check the filters once
a month.
We use bleach indoors and
other scented cleaners in
our home.
We use only unscented
or nontoxic cleaning
My shower enclosure
seems impossible to keep
free from mold.
I’ve reminded my family
members to run the
exhaust fan during and
after their showers, and
I’m now using a mildewfree shower curtain.
I often wake up with an
itchy nose and eyes.
I’ve put dust-mite-proof
covers on my mattress,
box springs and pillows.
and the results you expect.
[email protected]
the best way to prevent them is to
remove the offending elements
from our home, school and play
Indoor AIRepair Room-by-Room
Getting Started
ike a detective, you will be looking
and sniffing for clues pointing to
indoor allergens, irritants and
pollutants. Some things to look for:
Tobacco smoke
Accumulated house dust
Rodent droppings
Leaky pipes
Cleaning products
Start your investigation in the room
where symptoms happen most often
or where you know a problem exists.
For example, if your child coughs at
night or you are congested every
morning when you wake up, tackle
the bedrooms first. Your problem
could be dust mites, feather pillows
or mold.
But don’t stop there – continue on
through each room of the house,
spreading the hunt over several days,
if necessary. Tackle one project or
room one day, week or month at a
time. And do yourself a favor: Give up
the impossible dream of a germ-free,
sterile home. You’ll wear yourself out
and drive your family crazy if you try
to create it.
Common allergens and irritants: Mold, cockroaches, rodent droppings, cleaning supplies
Clues that there may be an
indoor air problem:
Water puddles or leaks around or near the faucet or
Loose or missing grout where the sink meets the countertop
Black or brown mold on the backsplash or countertop or
around the drain
Dirty dishes
Scum or discoloration under the dish drain mat
Odors coming from the garbage disposal
Damp or wet plumbing pipes or flooring under sink
Musty or damp smell inside cabinet
Black, brown or rust-colored areas on back wall, pipes or
flooring under sink
Gaps between pipes and wallboard
Warped or rotting wallboard or flooring
Black or brown rodent droppings (about the size of rice)
Dust clumps containing insect parts (cockroach nests)
Open or overflowing trash bin
Pet food, bird seed
Cleaning products, particularly those containing perfumes
or other strong smells
Repair leaking faucets (a simple “o” ring or washer
may do the trick) and pipes to discourage mold
growth, rodents and other pests.
Wash dishes immediately after use; dry and replace in
Place thin lemon slices in the garbage disposal and
turn it on while running cold water into the sink to
keep it smelling fresh and clean.
Limit clutter under the sink; wipe the area clean
monthly to discourage pests and mold growth.
Never store wet sponges or dishrags under the sink.
Stuff steel wool in gaps left around plumbing pipes to
prevent rodents from entering the kitchen from behind
the wall.
Use nontoxic, childproof insect and rodent traps or
baits to reduce pests.
Use a lid on your trash bin. Empty trash daily. Clean
the inside and outside of trash bin weekly.
Store pet food and bird seed in airtight containers.
Wash and put away pet food dishes each night.
Replace odor-masking, fragranced and expensive
cleaners with nontoxic, fragrance-free and inexpensive
alternatives using ingredients you probably already
have in your kitchen! (page 11)
AANMA Indoor AIRepair at Home • 7
at a Glance
Allergies are the 6th leading
cause of chronic disease in the
U.S. and each year more than
50 million Americans experience
symptoms of allergic diseases,
including rhinitis, sinusitis,
dermatitis, asthma, and food
Allergic rhinitis, often called hay
fever, causes symptoms such as
itchy eyes, nose, throat or ears;
watery eyes; runny nose and
congestion; wheezing; sneezing; headache; and fatigue.
Perennial (year-round) allergic
rhinitis is generally caused by
sensitivity to indoor allergens
such as house dust mites, animal
dander, cockroaches and/or
mold spores. Seasonal allergic
rhinitis occurs in spring, summer
and/or early fall, usually caused
by tree, grass or weed pollens
or airborne mold spores.2
Common allergens and irritants:
House dust, mold, cockroaches, rodent droppings
Clues that there may be
an indoor air problem:
Allergic asthma is the most
common form of asthma.
Indoor environmental factors
that can trigger symptoms
include dust mites, molds,
cockroaches, pet dander, and
secondhand smoke.3
8 • AANMA Indoor AIRepair at Home
Dust or slimy dark spots on top of or
beneath the refrigerator
Mold, dust and water in the drip
pan (if you have one, the drip pan is
usually beneath the refrigerator a
few inches off the floor behind a kick
Sticky substance left from liquid
spills underneath the refrigerator
Dusty backside of the refrigerator
and wall
Black or brown rodent droppings
(about the size of rice) on the floor
Moisture on refrigerator surfaces
Black growth on the door or door
seal (the flexible rubber gasket)
Keep the refrigerator top clutterfree to make dusting an easy
part of your cleaning routine.
Sprinkle salt in the drip pan to
inhibit mold growth.
Pull the refrigerator out from
the wall. (You may want to
wear a dust mask if it’s been a
while since you did this!)
Vacuum dust off refrigerator
coils and fan; it will help reduce
energy costs, too!
Damp mop the floor under the
refrigerator each season.
Place nontoxic, childproof
rodent bait or traps behind the
refrigerator. Check them often!
Some allergies can trigger
anaphylaxis, a life-threatening
reaction that can cause swelling
of the throat and/or tongue and
a severe drop in blood pressure.
1. The Allergy Report, American
Academy of Allergy, Asthma &
Immunology, 2000
2. Allergy Facts, American College of
Allergy, Asthma & Immunology
3. Asthma Facts, Environmental
Protection Agency,
Common allergens and irritants:
Dust, mold, cockroaches, rodent droppings
Clues that there may be
an indoor air problem:
Dust, dust clumps containing
cockroach eggs and decaying
insects, decaying food and
rodent droppings found on the
floor or in the drawer
Sticky, greasy filters on oven
exhaust fan
Roaches appear when oven is
turned on
Periodically remove and clean the
drawer at the base of the oven and
vacuum or mop the floor area
underneath the oven.
Use nontoxic, childproof cockroach
and/or rodent traps or bait.
Use an exhaust fan when cooking to
reduce moisture and odors.
Clean exhaust fan filter or screen to
remove cooking grease build-up.
Common allergens and irritants:
Mold, cockroaches, rodent droppings
Clues that there
may be an indoor
air problem:
Food clinging to waste
can, compactor or
recycle bin surfaces
Black or brown rodent
droppings in or near
waste can, compactor
or recycle bin
Common allergens and irritants:
Mold, fragranced cleaners,
personal care products
Remove kitchen waste daily.
Do not use odor-masking
products. Odor alerts you to
an allergen or irritant, rotting
food and/or moisture.
Keep waste can, compactor
and recycle bin surfaces and
areas clean.
Wash or rinse out bottles
and cans before placing in
recycle bins.
Clues that there may
be an indoor air problem:
Common allergens and irritants:
Mold, cockroaches, rodent droppings
Clues that there
may be an indoor
air problem:
Green, gray, brown
fuzzy growth on bread
or yeast-containing
Spilled food or
Cockroaches, silverfish
Black or brown
rodent droppings on
shelving or in drawers
Paper grocery bags
Discard bread and other bakery
foods when no longer fresh.
Never allow anyone to smoke
in your home. (See page 14.)
Store all food in airtight containers or bags when not in use.
Keep countertops clean and
free of crumbs or spills.
Place childproof, nontoxic
cockroach and/or rodent baits
in your kitchen. Follow package
directions carefully.
Throw away stacks of old paper
bags. (They’re perfect hiding
places for cockroaches!)
Black or brown growth on grout or surfaces,
particularly in corners (check around shower,
tub enclosure, floor near shower, tub or
sink, under sink or on backsplash, behind
toilet tank or on floor at base of toilet)
Missing grout in bath, shower or sink areas
Musty smell
Dust/mold clinging to the exhaust fan vent
Fragranced or strong-smelling cleansers,
personal hair and body care products
Remove obvious signs of mold growth. (See
page 11 for cleaning solution suggestions.)
Mold stains may be difficult or impossible to
remove from white grout or caulking. While
they can be unsightly, stains do not pose a
health problem.
Replace missing grout. Repair or replace
leaky faucets and pipes immediately. Your
local home hardware expert can help do-ityourselfers or this may require plumbing skills.
Use an exhaust fan or open a window while
showering to remove excess humidity.
Vacuum or wash exhaust fan vent covers to
remove accumulated dust which may also
contain mold.
Wipe the shower walls and tub toys dry
after use.
Use a mold-proof shower curtain. Keep
enclosure doors and tracking clean and free
of mold build-up.
Dry your feet and legs before stepping onto
the bathmat. Use a towel-style bathmat
instead of a plush carpet. It is easier to clean
and does not retain moisture as much as
thicker or rubber-backed mats.
AANMA Indoor AIRepair at Home • 9
Clues that there may
be an indoor air problem:
Humidity levels above 50 percent
Upholstered furniture or carpet in
Moldy smell from clothes hamper or
dark spots on inside surfaces
Moisture or dark areas on window
glass and/or window frame
White powdery coating on shoes in
Empty food containers, crumbs
Hobby products
Stacked books and magazines
Deodorant sprays, room deodorizers,
talc powders, perfumes, hairspray
Purchase an inexpensive humidity
gauge to measure indoor air humidity.
Keep humidity levels between 30 and
50 percent to minimize mold growth
and dust mite populations.
Limit upholstered furniture, which
becomes a breeding ground for dust
Choose washable
stuffed toys; wash
with bedding in hot
water. Dry completely.
Keep stuffed toys off
the bed.
Use washable throw
rugs and curtains (or use
window shades or blinds instead).
Put pillows and mattress inside
specially designed dust-mite-proof
Wash bedding weekly in hot (130°F)
You can purchase a HEPA vacuum
cleaner or use replaceable filter
bags designed to trap allergens
as small as .03 microns.
Vacuum and dust the bedroom
once each week. Use a HEPA (high
efficiency particulate air) filtered
Vacuum mattress dust-mite covers
when changing sheets or cleaning
10 • AANMA Indoor AIRepair at Home
house vary greatly. There are
numerous ways to fix the
problem – some are
very inexpensive. See
your local home
hardware experts
for suggestions.
Find and stop the
source of humidity in the closet causing powdery mold
to form on shoes. Leave light on in
Never let anyone smoke
in your home. (See page 14.)
Common allergens
and irritants: Dust
mites, mold, cockroaches, pet dander,
chemical fragrances
Many factors affect indoor air
humidity. For more, visit: www.
Avoid carpeting in bedroom if
possible. Existing carpet should be
in good condition with no signs of
mold or dust accumulation. Padding
should be in good condition – no
signs of crumbling or rotting. Simply
walking across a carpeted floor sends
tiny allergens into the air.
Empty clothes hamper daily. Never
store wet items inside.
Do not allow clothing to pile on the
floor or in corners.
Water droplets form on windows
and window frames when air temperatures inside and outside the
Keep food out of the bedroom.
If allergic to pets, keep them out of
the bedroom. (Pets usually adjust to
this change faster than their owners!)
Avoid using the bedroom for hobby
projects as these increase exposure
to allergens, irritants and pollutants.
Limit bedroom reading material;
stacked books and magazines retain
humidity and encourage mold
Whenever possible, use unscented
personal hygiene and hair care
products. Do not use scented candles
and odor-masking room deodorizers.
Keep potted plants (a source of
mold growth) out of the bedroom.
Use paints or wallpaper treated
with mold inhibitors when redecorating.
ust mites look like ferocious monsters, but thousands could sit on a pinhead.
They thrive in pillows, mattresses, upholstered furniture, stuffed toys and carpets:
wherever they have a steady supply of human dander (shed flakes of skin).
When inhaled, tiny dust-mite droppings trigger coughing, stuffy nose, itchy eyes
or wheezing. Keep dust mites at bay by reducing room humidity levels below 50
percent; washing bedding frequently; and using dust-miteproof encasings on your mattress, box spring and pillows.
More information:
Photograph courtesy of Precision Fabrics Group, Inc. maker of Pristine®
Recipes for
Clean mold and mildew with:
l 1 tablespoon baking soda
+ 2 tablespoons white vinegar
+ 1 quart water
Common allergens and irritants:
Dust mites, pet allergens, mold, secondhand smoke,
firewood, coal dust, kerosene
Disinfect with:
l 1/2 cup borax + 1 gallon hot water
1/4 cup baking soda + 1/2 cup
white vinegar + 1 gallon warm
water (for toilet bowls)
Remove rust from countertops
l A paste of cream of tartar and
lemon juice (allow paste to sit on
rust spot for 15-30 minutes, scrub
with sponge, rinse)
Clean shower soap scum with:
l Undiluted, heated white vinegar
(put in spray bottle, spray on, let
soak for 15 minutes, apply dry
borax, scrub)
Clean dirty shower grout with:
l 2 cups baking soda + 1 cup borax
+ 1 cup hot water
Clean glass and mirrors with:
l 3 tablespoons white vinegar
+ 3/4 cup water
Deodorize and freshen musty
areas with:
l Baking soda in an open container
l White vinegar in an open container
Clean drains monthly with:
l Baking soda and vinegar (pour 1/2
cup baking soda into drain followed
by 1/2 cup white vinegar; let sit 30
minutes, then flush with cool water)
Cleaning recipes from 101 Ways to
Reduce Allergens in Your Home by
Jayne Ruppenkamp
Clues that there may be
an indoor air problem:
Fabric upholstered furniture
Carpeting and padding
Food crumbs on carpet and underneath couch cushions
Stacked firewood or kindling, ashes
or burned wood smell in the fireplace
Kerosene heaters, wood stoves,
coal stoves
Never permit any person to smoke
inside your home. (See page 14.)
Secondhand, upholstered furniture
or antiques may contain mold,
dust, dust mites and pet allergens.
Replacement alternatives to consider
include vinyl, leather or other
washable-surface furniture.
Keep pets off the furniture and out
of the family room.
If family members are diagnosed
with pet allergies, consider finding a
new home for your pet or create safe
and weather-protected living space
outside the home for your animal.
Vacuum underneath and behind
furniture and underneath couch and
chair cushions at least once a month.
Vinyl beanbag chairs provide
kid-friendly seating for watching
television and playing games.
Replace moldy carpet and padding
(check in front of doors leading to
the outside of your home, in corners,
etc.), preferably with hardwood or
other hard-surface flooring. Avoid
products requiring toxic glues or
fumes when possible.
If the floor beneath the carpet is
concrete, make certain the concrete
was sealed or a moisture barrier or
wood planking was placed between
the padding and floor before the
carpet was installed. If the basement
has ever flooded, don’t install carpet
or wood flooring.
Use paints or wallpaper treated with
mold inhibitors when redecorating.
Eat meals in the kitchen/dining area.
Enjoy snacking while watching
television, but remember to clean
under couch, chairs, and cushions
after eating.
Use water-filled radiant electric
heaters as a supplemental heat
source in place of wood or coal
stoves, fireplaces and kerosene
space heaters.
Keep Indoor Humidity Low
If possible, keep indoor humidity between 30 and 50 percent relative
humidity. Relative humidity can be measured with a moisture or humidity
monitor, a small, inexpensive ($10-$50) instrument available at many
hardware stores.
AANMA Indoor AIRepair at Home • 11
Clues that there may be
an indoor air problem:
Temperature and humidity
differences from the rest of
the house
Musty smell; rodent or pet
urine smell
Silverfish, crickets, spiders or
other insects
Black or brown rodent droppings,
particularly in corners or along
the perimeter
Mold spots or dust on coils of
Look for the cause of dampness.
Use a flashlight to look for cracks
in the foundation or warped
wallboard or paneling. Lift
carpeting along the edges to
check for mold growth. If
interior walls are exposed,
look for cracks in the
foundation. If found, you
may need to contact your
landlord or an expert to
repair the foundation
of your home.
Common allergens
and irritants:
Mold, cockroaches,
pet dander, rodent
Common allergens and
irritants: Mold, insulation
fibers, dust, bird and/or
rodent droppings
12 • AANMA Indoor AIRepair at Home
If you plan to remodel an
unfinished basement, contact your
heating and air-conditioning
contractor to ensure your existing
system can handle the increased
demand of heating and cooling
finished spaces.
Do not block air vents or restrict
air flow around air handling
equipment (furnace, swamp cooler, air conditioner, etc.). Keep area
clean and dry.
Use a dehumidifier when humidity
climbs over 50 percent.
Clues that there
may be an indoor
air problem:
Sounds of birds or animals in the
Birds flying into eaves
Bird or other animal droppings,
Wet or warped interior walls, studs,
Daylight visible in areas that should
not be exposed
Moldy, damp or rotten smell
Matted or moldy-looking insulation
Clean dehumidifier
drip pan according
to manufacturer’s
Leave the lights
on (mold prefers
dark spaces) in
basements with
limited windows.
Avoid using carpet on concrete
basement floors.
Ideally, apply a water sealant to
outside walls before finishing
basement interior.
Replace cardboard storage boxes
with plastic containers with lids.
Wash mold off hard surfaces and
dry completely. Moldy ceiling tiles,
carpets, wood, furniture, etc.,
should be removed (wear a dust
mask and goggles) and replaced.
Be certain to fix the cause of
the mold!
Use childproof, nontoxic
cockroach, insect or rodent
bait or traps.
Do not use the basement for
sleeping purposes. Family
members with asthma or
allergies should minimize time
spent in the basement.
Bird and animal proof your attic.
Seal any gaps leading to living
spaces, such as around light fixtures
or heating and air-conditioning
vents. You may want to contact a
heating and air-conditioning
contractor to do this for you.
Determine cause of wet or warped
walls, studs or flooring.
Repair cause (construction faults or
storm damage) of problem and
replace damaged insulation and
structures. Check your homeowner’s
insurance policy. Damages may be
covered. If you do not own your
home, notify the landlord as soon as
you discover the problem.
Know Your Allergens
board-certified allergist can provide allergy testing and consultation to help you find out which things in your home may be
causing your symptoms or making them worse.
Focus your indoor air repair actions and budget on those areas
most likely to cause symptoms. For example, if your biggest
problem is dust mites, concentrate on reducing humidity and
allergy proofing the bedroom first.
our laundry area may be down the hall
of your apartment building, in your kitchen,
outside your bedroom door, in the basement or in the garage. However, always
keep your laundry area clean and dry to
eliminate mold, a sign of high air moisture
content and possible hidden water damage.
Common allergens
and irritants: Mold, dust
Clues that there may be
an indoor air problem:
High humidity or moisture levels
Wet clothes left in the washing machine
Wet clothing piles
Clothing lint and dust on floor and walls
near washer and dryer
Cleaning agents such as bleach or heavily
scented fabric cleaners and softeners
Pull the washing machine away from the
wall. Use the flashlight to look for plumbing leaks. Tighten pipes and hoses if
needed. Clean the floor before replacing
the washing machine.
Pull the dryer away from the wall. Use
the flashlight to check the exhaust hose.
It should be vented to the outside of the
house. Turn the dryer on while the
exhaust hose is still attached to the wall.
Then go outside your home and find the
exterior vent. Do you feel warm air coming out? If so, that’s good news. If it is
weak or you don’t feel any air at all, you
have a problem that needs to be fixed.
Either your exhaust hose is clogged with
lint or it is not properly vented to the
outside of your home. Clean the floor
and walls before replacing the dryer.
Ask your landlord to keep your laundry
facility neat and dry with plenty of fresh
air ventilated into the area.
Bleach is an airway irritant known to
produce symptoms in some adults and
children with asthma. Avoid using bleach.
Use unscented laundry products.
Home builders increasingly attach the car garage directly to the
home – sometimes off the kitchen, underneath a bedroom or next to
the family room.
When used to store old paint cans, gasoline, lawn mowers, pesticides,
wood stains, woodworking projects and/or household cleaners, the
garage becomes the most toxic room in the house. Chemicals seep into
your breathing space through tiny cracks and gaps between the
home’s foundation and walls.
Families also often put recycling bins and trash cans inside the garage;
however, failure to keep this area clean will attract rodents, cockroaches
and other unwelcome allergens and irritants.
Common allergens and irritants:
Chemicals, cockroaches, rodent droppings
Clues that there may be
an indoor air problem:
Attached garage
Car(s) inside garage
Gasoline-powered tools and
Cleaners, pesticides and other
strong-smelling chemicals
Trash cans, recycle bins
Switch to electric or humanpowered lawn mowers, hedge
cutters and other tools.
Paint should never be stored
in the garage; temperature
extremes cause it to go bad
rapidly. When finished painting a
room, pour a small amount of
paint into a clean glass jar with a
tight-fitting lid. Label with date,
color, manufacturer and room it
was used in before storing in a
part of your home where it will
not be exposed to temperature
Dispose of unused lawn and
garden powders, sprays and pellets.
If using the garage for hobbies
or fix-it projects, make sure it is
well ventilated.
Do not leave car running in
AANMA Indoor AIRepair at Home • 13
Why is it so important to
have a Smoke-free home?
Secondhand smoke is a mixture of
the smoke given off by the burning
end of a cigarette, pipe, or cigar,
and the smoke exhaled by smokers.
It contains more than 4,000 substances, several of which are known
to cause cancer in humans or animals.
EPA has concluded that exposure to
secondhand smoke can cause lung
cancer in adults who do not smoke.
It has also been shown in a number
of studies to increase the risk of
heart disease.
Children are particularly vulnerable
to the effects of secondhand smoke
because they are still developing
physically, have higher breathing
rates than adults, and have little
control over their indoor environments. Children exposed to high
doses of secondhand smoke, such as
those whose mothers smoke, run
the greatest relative risk of experiencing damaging health effects.
If you smoke at home, consider how
it affects your child’s health:
More frequent and severe
asthma attacks
airways and triggers asthma symptoms. According to the Centers for
Disease Control and Prevention, children with asthma who breathe secondhand smoke have more severe
asthma episodes and lower lung
function than children with asthma
who are not exposed to smoke.
Inhaling secondhand smoke may
actually cause asthma in some children. A study in the American
Journal of Respiratory and Critical
Care Medicine found that the
number of children diagnosed with
asthma at age 6 or younger was
twice as high in families who
smoked as in nonsmoking families.
Greater risk of lower respiratory
tract infections (bronchitis and
According to the Environmental
Protection Agency, secondhand
smoke exposure causes 150,000 to
300,000 lower respiratory tract
infections every year in children
18 months or younger, resulting in
as many as 15,000 hospitalizations
per year. Secondhand smoke can
also aggravate sinusitis, bronchitis,
cystic fibrosis and chronic respiratory
problems like cough and postnasal
More frequent ear infections
Inhaled secondhand smoke irritates
the Eustachian tube (the tube
connecting the back of the nose
with the middle ear) and causes a
build-up of fluid in the middle ear.
Greater risk of Sudden Infant Death
Syndrome (SIDS)
Mothers who smoke while pregnant
are more likely to have their babies
die of SIDS. Babies who are around
secondhand smoke—from their
mother, their father, or anyone
else—after they are born, are also
more likely to die of SIDS than children who are not around secondhand smoke.
Secondhand smoke irritates the
What do most children with asthma who are treated in hospital emergency
departments have in common?
They live with family members who smoke at home.
What is the best way to eliminate tobacco smoke from the home?
Do not allow any person to smoke in your home or near windows and
doors leading to your home.
14 • AANMA Indoor AIRepair at Home
U.S. Asthma Statistics
Asthma prevalence increased from
7.3% in 2001 to 8.6% in 2011, when
25.9 million persons had asthma.1
18.9 million adults aged 18 and over 2
7.1 million children aged 0–17 years 3
Females have higher asthma
prevalence than males
(9.9% compared with 6.2%) 2
Adults of multiple races have the
highest asthma prevalence (14.5%) 2
14.2 million physician office visits4;
1.3 million outpatient visits5; and
1.8 million emergency department
visits for asthma 6
Number of deaths per year: 3,404 7
l 34% higher among females than males
l 75% higher for black persons than white persons
l 6.3 times higher for adults (over 18) than children
at a Glance
Number of hospital discharges with asthma as first-listed diagnosis:
439,000 9
Average length of hospital stay: 3.6 days 9
10.5 million school days and 14.2 million work days missed by people
who experienced at least one asthma attack during the year 8
Medical expenses associated with asthma increased from
$48.6 billion in 2002 to $50.1 billion in 2007 10
3 in 5 people with asthma limit their physical activity 11
1 in 5 children with asthma went to an emergency department
for asthma-related care in 2009 11
1 Summary Health Statistics for the U.S. Population: National Health Interview Survey, 2011; National Center for Health Statistics data brief
Series 10, Number 255; Centers for Disease Control and Prevention;
2 Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2011; National Center for Health Statistics data brief Series 10,
Number 256; Centers for Disease Control and Prevention;
3 Summary Health Statistics for U.S. Children: National Health Interview Survey, 2011; National Center for Health Statistics data brief Series
10, Number 254; Centers for Disease Control and Prevention
Exposure to allergens, irritants, respiratory infections,
dry or cold weather or exercise
can cause asthma symptoms to
become more noticeable.
When asthma happens,
swollen airways fill with fluid
and mucus, restricting breathing
space. The muscles surrounding
the airways tighten (bronchospasm).
Asthma medications treat and
prevent inflammation,
swelling and bronchospasm,
but the first step to controlling
asthma is avoiding exposure to
allergens and irritants in your
environment that set off
Children exposed to secondhand smoke have more severe
asthma episodes and lower
lung function than those not
exposed to smoke.1
4 National Ambulatory Medical Care Survey (NAMCS): 2010 Summary Tables, table 13; Centers for Disease Control and Prevention
5 National Hospital Ambulatory Medical Care Survey (NHAMCS): 2010 Outpatient Department Summary Tables, table 11; Centers for Disease
Control and Prevention
6 National Hospital Ambulatory Medical Care Survey (NHAMCS): 2010 Emergency Department Summary Tables, table 12; Centers for Disease
Control and Prevention
7 Deaths: Final Data for 2010, tables 10, 11; National Vital Statistics Reports, Vol. 61, No. 4; May 8, 2013; Centers for Disease Control and
1 “Involuntary Smoking and Asthma
Severity in Children,” Chest, 2002,
8 National Surveillance of Asthma: United States, 2001-2010, Vital and Health Statistics, Series 3, Number 35, November 2012, Centers for
Disease Control and Prevention
9 National Hospital Discharge Survey: 2010 table, Average length of stay and days of care; Centers for Disease Control and Prevention
10 Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education – United States, 2001-2009; Morbidity and
Mortality Weekly, May 6, 2011; Centers for Disease Control and Prevention
11 Asthma’s Impact on the Nation, 9/23/2013; National Asthma Control Program, National Center for Environmental Health, Centers for
Disease Control and Prevention
AANMA Indoor AIRepair at Home • 15
AIRepair Friends and Neighbors
Most of AANMA’s AIRepair tips are
easy to make part of your cleaning
routine. Some suggestions take
more time than others. You may discover serious problems that require
expert help. Then again, you may
have friends who will swap their
plumbing or carpentry skills for your
babysitting and cooking talents.
Once you’ve completed your inspection, create a plan for tackling the
to-do list using AANMA’s AIRepair
Checklist. Don’t try to accomplish
everything in one day. For those
items that cost more money than
you’ve currently budgeted, look for
creative ways to save money to make
the repairs as soon as you are able.
American Industrial Hygiene
American Society of Home Inspectors
Spanish resources available
American Lung Association® Health
House® Program
[email protected]
Helpful Resources
Allergy & Asthma Network
Mothers of Asthmatics
Spanish resources available
U.S. Environmental Protection Agency
Indoor Air Quality Information
Spanish resources available
Centers for Disease Control
and Prevention
Spanish resources available
16 • AANMA Indoor AIRepair at Home - Restoration Industry
301.231.6505 – North
Dakota State University Extension
Service – The HVAC
Inspection, Maintenance and
Restoration Association – National Council of
La Raza (Spanish resources)
You are not alone! One-third to
one-half of all buildings have damp
conditions that may encourage
mold and bacteria. Every home has
dust mites. And no area of the U.S.
is immune to rodent or cockroach
There is a wealth of fascinating and
helpful information, photographs,
links and services that can be found
FREE on the Internet. If you don’t
have Internet access at home, visit
your local library and ask someone
to teach you how to go online. - National Association
of the Remodeling Industry provides
consumer information on remodeling, including help finding a professional remodeling contractor
847.298.9200 – National
Alliance for Hispanic Health
Other useful
Web sites: –
Building for Health Materials Center
800.292.4838 – search
engine/directory for environmentally
friendly products
Room Air Filters
Room air cleaners are found on
department, variety and hardware
store shelves throughout the country.
Do they really reduce symptoms? If
you buy one, will it clean your indoor
air well enough that can you sleep
with your cat and dog and smoke in
your home?
Air cleaners do not replace the need to
eliminate or reduce indoor air allergens and irritants known to produce
symptoms. Be wary of any manufacturer
making health claims. Ion generators
and electronic air cleaners may produce ozone, a lung irritant. For more
information on room air filters, visit
Financial aid
Medical insurance company – call your
benefits office; ask if your insurance
covers physician-recommended devices
like air cleaners or dust-mite-proof
mattress covers to improve your health.
Local utility company – ask if they offer
financial help for renovations to
improve air quality.
State, county or city health departments – call your Public Health
Department; ask what division can help you with indoor air quality
renovations. Check online or look in the government pages of your
local telephone book for offices that deal with family health; environmental health; preventive health; community and family health services; primary care and family health.
For a state-by-state list of public health officials and telephone numbers,
visit, or call the Association of State &
Territorial Health Officials (ASTHO), 202.371.9090.
Places of worship – local churches, synagogues, mosques and other
religious groups often have compassionate aid for people in need; you
do not always need to be a member of the congregation.
National service organizations offer personal and financial help to
people in need. Look in your telephone book for local chapters of the
American Red Cross, Kiwanis International, the Lions Club, Rotary
International, or the Salvation Army.
Help dealing with insurance
companies, builders or landlords
Find out about neighborhood
associations, tenants’ rights groups
and community groups dealing with
asthma. Local asthma coalitions may
be able to provide resources.
Check online or in the telephone book for
Consumer Affairs organizations; try your
local government, newspapers or television
The nonprofit Patient Advocate Foundation
can provide help with insurance claims and
other financial problems: 800.532.5274;
Spanish resources available.
Home improvement
To locate contractors: check the Internet
or telephone book for organizations
that can provide professional services
or recommendations:
l Local Home Builders Association
l Local Board of Realtors
l Local remodelers’ or contractors’
l Local Better Business Bureau
Construction or drainage matters:
Contact your city or county planning
office, building inspector’s office, or
library for information on applicable
building codes and inspection/permit
requirements; local stormwater ordinances; local subdivision and zoning
ordinances; and local flood damage
protection ordinances and maps required
by the National Flood Insurance
Administration (NFIA). Other sources:
l Local/county Soil Conservation Service
l City/county hydrologist or engineer
l Agricultural Extension Service
l Professional engineer or hydrologist
l University Civil Engineering or
Agricultural Engineering departments;
ask about experts in drainage,
foundation and structures
l Professional/commercial house inspectors
For information on federal and state regulations, contact U.S.
Department of Housing and Urban Development (HUD), 800.669.9777; Spanish resources available.
States and counties have their own tenant laws. Contact your local
government Housing department to find out about your laws; ask
about Housing Rights Committees.
AANMA Indoor AIRepair at Home • 17
Indoor AIRepair Checklist
Use this chart to note allergens and irritants found in your home and create a to-do list of clean-up actions.
Joey’s Room
Moisture and mold on
window frame
18 • AANMA Indoor AIRepair at Home
Removed mold, caulked windows,
cleaned rain gutter outside window
Date Fixed
Helping Parents, Students and
Teachers Breathe Easier
When children with asthma go off
Five tips:
to school each day, they carry more
than just their backpack and lunch –
they also tote a load of worries: Will I
cough during gym today? Will I need
my inhaler during the math test? Will
I get that tight feeling in my chest
again while I ride the bus?
1. Recognize asthma is a serious,
potentially life-threatening condition. Establish a plan to prevent and respond to emergencies.
It’s no wonder they have trouble concentrating. What can you do?
Working together, parents, teachers
and other school staff can create a
healthy learning environment.
2. Follow the written asthma management plan provided by the
child’s healthcare provider.
Identify and avoid activities and
irritants that set off breathing
problems. Treat symptoms when
first noticed.
3. Teach the child to listen to his
body’s early warning signals and
use medications responsibly.
4. Identify and eliminate allergens
and irritants in the classroom.
5. Maintain clean indoor air
throughout the school building.
AANMA Indoor AIRepair at School • 19
Indoor Air Pollutants
Finding the Source
Allergens, irritants and indoor air pollutants are everywhere. It is impossible to rid a school of every germ, pollen grain,
dust mite, mold spore or pest. However, there are common-sense precautions to take. Some can be taken by parents and
teachers in the classroom; others require school maintenance.
Asthma affects each person in a
different way. Some people react
when they inhale or touch things to
which they are allergic, such as
animal dander, dust mites or mold.
Others cough when the air is full of
irritants such as smoke or strong
odors. Still others find it hard to
breathe during exercise.
Asthma symptoms can develop
rapidly within minutes, or gradually,
over hours or even days. Don’t
assume that because the child didn’t
begin coughing when the puppy
came to visit it was not a problem.
The irritation from the animal dander
could grow slowly, turning into
breathing problems that keep the
child up half the night.
Some common factors that
set off asthma symptoms:
Allergens in the air: animal dander,
mold, pollen, dust mites, cockroach
and rodent allergens
Irritants in the air: smoke, household
chemicals, strong odors, air pollution,
including fumes from idling school
buses and cars
Activities: exercise
Weather-related factors: changes in
air temperature and humidity levels
Food allergens
Other illnesses: rhinitis, sinusitis,
gastroesophageal reflux, viral infections
Emotions: stress, crying, laughing
Common Allergens
and Irritants
Found in the
Even the most perfectly maintained
system cannot protect students and
staff from allergens, irritants and
other airborne pollutants that start
in the classroom.
chalk dust
dry erase markers
paints and glues
strong odors, such as perfumes
or room deodorizers
chemicals from science or
art projects
upholstered furniture
rug mats or nap pads
classroom pets or visiting
furry animals
20 • AANMA Indoor AIRepair at School
The EPA has identified five steps to reduce
asthma triggers in schools:
Clean up mold and control moisture
Remove animal
Eliminate secondhand
smoke exposure
Reduce exposure to
dust mites
Control cockroach and
other pest allergens
Clean Up
Mold and Control Moisture
Molds are a natural part of our
world. Outdoors, they break down
organic matter such as fallen leaves
and dead trees. Indoors, they stain
and damage walls and furnishings.
Mold growth can also attract cockroaches, dust mites and other pests
and cause health problems.
Molds reproduce by sending billions
of tiny spores into the air, traveling
on breezes until they land on a
damp surface where they can
multiply. Invisible to the naked
eye, as many as 250,000 spores
could fit on the head of a pin.
Moisture control is the key to mold control.
Inhaling or touching mold spores
may cause sneezing, runny nose,
red eyes, coughing, wheezing or
skin rash (dermatitis), even among
people not allergic to it. Symptoms
can be immediate or delayed.
Schools Breathe, Too
Many factors affect indoor air
quality in schools:
Clues that indoor mold might be present:
Black spots in dark, warm, humid areas such as
– Bathrooms
– Locker and shower rooms
– Basements
– Under sinks
– Utility areas and mechanical rooms
l Musty smell among stored papers or books
l Black or brown spots in closed-in areas:
– Underneath and behind furniture
– Behind cabinets
– In coat closets
l Discolored or damp carpeting and/or padding, especially underneath
windows, against outside walls and under water fountains
Fix the water or moisture problem. The mold will return if you don't.
It could be as simple as moving a cabinet away from the wall, storing
papers in plastic bins, or cleaning the area around the water fountain
daily. Other times, it may require caulking around leaky windows,
removing mold-infested carpets, or fixing a plumbing problem behind
a wall.
Dry water-damaged areas and items within 48 hours to prevent mold
Clean up the mold. If the moldy area is on a washable surface, clean it
using equal parts of white vinegar and water. Avoid using bleach as
this can irritate breathing passages. Use a dust mask and goggles to
shield nose, mouth and eyes from airborne spores while cleaning.
Larger areas of mold (greater than 10 square feet) should be cleaned
by a professional following guidelines established by the
Environmental Protection Agency.
Building design and building
materials used
Number of students and staff in
each classroom and building
Types of activities performed
Size, type, location and age of
air handling equipment
Maintenance and cleaning
Maintained properly, the school’s air
handling system traps and filters
many particles but does not purify
dirty, polluted air. So, for example, if
school buses or cars pick up and drop
off students in the back of the school
near air handling equipment,
exhaust fume particles will travel
throughout the school’s supply lines.
And that’s not healthy for anyone.
Clues that your
school’s air handling
system needs servicing:
Black or gray powdery dust
on ceiling tiles, walls and
vent covers
Standing water underneath
or near the air handling unit
Dead animals, insects, bird
or rodent nests in or near
outdoor units
AANMA Indoor AIRepair at School • 21
Cockroach and Other Pest Allergens
Found in just about any school in
America, cockroaches, mice and rats
are often-overlooked causes of allergy and asthma symptoms among
schoolchildren and school staff.
Microscopic proteins from pest waste
(urine and fecal pellets) and saliva
can travel through the air and cause
allergy and asthma symptoms when
inhaled. Symptoms may be immediate or delayed.
Because these lightweight particles
remain in the air hours after being
stirred up, the best pest management
programs begin by removing the
problem at its source, repairing
damage, and making the school
environment less attractive to pests.
To fight pests, remove their food and
water source; fix plumbing leaks,
moisture or mold problems; and
enforce safe food handling and
storage policies.
Pesticide tips:
Use Integrated Pest
Management (IPM) practices
instead of pesticides whenever
possible. Visit
Notify parents and school staff
before applying pesticides.
Schedule pesticide applications
when areas will be unoccupied
and can be well ventilated
before occupants return.
Use pest control chemicals in
strict accordance with regulations and follow instructions on
the container.
Clues that pests are in the classroom:
Pest treatment in the schools is best left to professionals, but teachers can
do their part to keep pests away from their classrooms.
22 • AANMA Indoor AIRepair at School
black or brown pellets about the size of rice or slightly larger (mouse
dead cockroaches
urine stains or smell
dust clumps that have insect droppings and decaying insect parts
in them
greasy smears on walls (which could indicate possible rat runs)
Store food and water in tightly closed containers in the classroom
overnight; this includes items for class or science projects.
Fix plumbing leaks.
Remove clutter where cockroaches and other pests can hide.
Seal cracks in walls and under sink areas.
Use poison baits, boric acid or traps before using pesticide sprays.
Store dumpsters away from the school building.
Animal Allergens
Whether they live in the classroom
or visit for show-and-tell, warmblooded animals such as hamsters,
birds, rabbits, cats and dogs can
cause allergy and asthma symptoms
in sensitive students and teachers.
Allergy symptoms (immediate or
delayed) range from itchy eyes or
skin to red welts (hives) on the skin,
sneezing, nasal congestion, shortness
of breath, wheezing or coughing.
Even so-called “safe” pets such as
lizards, chameleons and snakes can
cause problems, particularly if they
eat live foods such as grasshoppers,
mealworms, mice and rats. The pets
and their food sources produce waste
products that decay and provoke
allergy or asthma symptoms.
The tiny protein particles from the
animal’s urine, saliva and dander fly
into the air when the pet or its cage
is handled or cleaned. If they get
into the school’s air handling
systems, the allergens move from
one part of the school to another.
Take a good look around your child’s school and
classroom. Note the problems you see and share this
information with teachers and school administrators.
Eliminate Secondhand Smoke
Secondhand smoke – whether from the burning end of a cigarette or
Prohibit smoking on school
grounds (indoor and outdoor),
on school buses and at
school-sponsored events.
Clearly communicate the
school's smoking policy to
students, staff and visitors,
including punishments for
Develop smoking prevention
programs and education on
how to stop smoking for students and school personnel.
exhaled by a smoker – is an irritant that can set off asthma symptoms.
A 2011 Center for Disease Control and Prevention (CDC) report found that
18.1 percent of high school students and 4.31 percent of middle school students polled said they smoked. Despite federal and state laws prohibiting
smoking on school grounds, secondhand smoke continues to be a problem.
The Pro-Children
Act of 1994
prohibits smoking
in kindergarten,
elementary and
secondary schools
that receive
federal funding.
AANMA Indoor AIRepair at School • 23
to Dust Mites
any children with asthma also
have allergies to dust mites.
Too small to be seen with the naked
eye, dust mites set up housekeeping
wherever they find humidity and a
steady food source. They particularly
like to dine on shed flakes of human
skin (dander), decaying food crumbs
and mold. In schools, they’re likely to
be found in carpets, naptime floor
mats, pillows, stuffed toys and
upholstered furniture.
Tools for Schools
The Environmental Protection
Agency (EPA) Indoor Air Quality
Tools for Schools program has
helped hundreds of schools
throughout the country
maintain healthy air in their
facilities and create a safe
learning environment. Find out
how this innovative program
can help your school. Visit or
call 800-490-9198 to order.
Use only washable stuffed animals in the classroom and wash them
weekly in hot water.
If your child uses a nap pad or pillow at school, take your own and
cover it with a dust-mite-proof zipped cover. Keep a washable cotton
cover to use over the nap pad. Take covers home and wash in hot
water at least twice a month.
Replace upholstered furniture. A wooden rocking chair with
washable cushions and a collection of vinyl bean-bag chairs
make good alternatives.
Encourage your school to consider replacing carpeting with solid
surface flooring. Carpets hold onto fine dust particles, animal dander,
mold, dust mites, food crumbs, dirt and bacteria. Even with daily
vacuuming, these particles are impossible to remove. (Just lift a
carpet’s edge and look underneath.) People walking across the
carpet send powdery allergens swirling into the air where they
can be inhaled.
24 • AANMA Indoor AIRepair at School
Managing Medications
at School
parents can
take to manage asthma
at school:
Get a written asthma management plan from your child’s
doctor before each school
year begins. The plan will list:
– allergens, irritants and
activities that cause asthma
or allergy symptoms in your
– your child’s early warning
signs that an asthma
episode is progressing and
needs medical attention
– names and dosages of
medications to be used at
home and at school
l Ask your healthcare provider
to check your child’s inhaler
technique to be sure he is
using it correctly.
l Complete and return all
emergency care forms before
the first day of school.
l Give a copy of the management plan to your child’s
teachers, coaches and school
nurse and discuss any questions.
any asthma medications can be
given daily at home to control
symptoms at school. However,
since breathing problems can
appear unexpectedly, children with
asthma need immediate access to
prescribed quick-acting inhaled
Oral medications should be stored
in the school clinic.
Some asthma medications cause
children to feel sleepy, irritable,
shaky or unable to sit still in the
classroom. Teachers should tell
parents if these are a problem in
the classroom, so they can talk
with the child’s healthcare team
about adjusting medications.
While asthma medications are
important, they do not eliminate
the need to maintain healthy
indoor air quality.
Some children with asthma also
have anaphylaxis, a life-threatening
allergic reaction. The throat, tongue
and lips swell and block breathing
passages. Usually caused by a bee
sting or food allergy, the reaction
must be treated immediately. The
key to preventing serious problems
from anaphylaxis – including
death – is using epinephrine as
soon as possible.
Auto-injectable epinephrine can be
self-administered or be given by an
adult. Afterward, the child should be
taken immediately to the hospital.
The medication wears off after 20
minutes. A second injection may
need to be given on the way to the
hospital, so two auto-injectors should
be with the child at all times.
All states have laws that protect students’ rights to carry
and use their prescribed lifesaving asthma medications at
school and 49 have similar laws regarding anaphylaxis.
Check the laws in your state and find more resources to
help students breathe easier at
When is a child old enough to
handle his own medications?
There is no magic age when a child automatically becomes ready to carry his
medications at school and take them on his own or with adult supervision.
It is a gradual learning process. Teach your child to take responsibility for his
own medications at home, where you can watch and help, before taking them
to school. To get your child ready, teach him to do the following:
Know the names of each medication and when to use each
Know how to avoid allergens and activities that cause his symptoms
Know what to do when symptoms first appear and when to ask for help
Show his healthcare provider that he can use the inhaled medication
AANMA Indoor AIRepair at School • 25
Medication Myths
Myth #1:
Inhaled asthma medications
make students high.
Inhaled bronchodilators are the inhaled medication used most
often by students at school. Common names include, ProAir™,
Ventolin®, Proventil® and Xopenex®. Bronchodilators relax
twitchy airways and make it easier for the student to breathe;
they are not intoxicating and do not make students high.
Myth #2:
Inhaled bronchodilators
can be dangerous if used
by classmates who do not
have asthma.
Inhaled bronchodilators will not improve the breathing or
harm the airways of students who do not have asthma. Users
may feel jittery, as if they just drank a cup of strong coffee,
but only for a short time. Most will not like the taste of the
Myth #3:
Students with asthma often
say they need to use inhaled
medications as an excuse to
get out of the classroom,
doing school work or
participating in physical
education classes.
Students with asthma are no different from their classmates
when it comes to avoiding things they don’t like. However,
restricting a student’s access to lifesaving medications is
dangerous, so teachers should assume the student needs it
when asking for it. Students who’ve developed the skills
and maturity to carry and use inhaled bronchodilators by
themselves do not need to leave the classroom to get them.
Myth #4:
Inhaled medications should
be locked in a cabinet in
the school clinic.
Most children with asthma will experience symptoms at school
from time to time, but they’re not likely to begin while the student is standing in front of the clinic with a trained healthcare
worker standing nearby. More often, symptoms will begin in
the classroom, playground, gym, or even on the bus, or while
walking to and from school.
Sending a coughing or wheezing student on a trek to the clinic
or making him wait as a classmate retrieves the prescribed
inhaler from a locked cabinet wastes precious time and may
place the student at risk of death. Keep the bronchodilator
inhaler with the child at all times and store back-up medication
labeled with the child’s name and prescribing instructions in
the locked cabinet with the asthma management plan.
26 • AANMA Indoor AIRepair at School
Advice for
Take information around the
school to all personnel who
will come in contact with
your child. Don’t forget
the school librarian! Don't
assume that the office or the
nurse will reach everybody
who needs to know.
Cathy Boutin
AANMA’s volunteer Outreach
Service Coordinators work with
schools and communities across
the country. We asked them
what parents, teachers and
school administrators need to
remember to keep students
healthy at school.
It is the nature of asthma
symptoms to change periodically. When this causes a
change in your child’s medications or the overall treatment
plan, contact the school
nurse and your child’s teachers
right away. Let them know
when your child is heading
into an episode but is healthy
enough to attend school.
And tell them when your
child has been to the emergency department or hospitalized for symptoms.
Sue Cook
If you want the right message to be given about the
care of your child at school,
deliver it yourself. Don’t
leave this job to your child
or scribble a note onto a
piece of paper.
Christy Olson, RN
From the time they are little,
teach your children to know
early warning signs and how
to take care of their own
asthma symptoms.
Christy Olson, RN
Teach your child to keep
track of the number of doses
used in inhalers, and not to
exceed the number of doses
listed on the canister even if
it seems medication remains.
Always keep a back-up
inhaler in the clinic at school.
Check the expiration date on
each inhaler.
Dianne Danzig
Notify the school if you have
changes to the Emergency
Contact Information Card.
Provide telephone numbers,
names, at least two back-up
contacts, and the name and
phone number of your child’s
Connie Carcel
Teach your child to know and
stay away from asthma triggers
and when to ask for help.
Lisa Blemmer
AANMA Indoor AIRepair at School • 27
Advice for
Remember that what you
do in the classroom makes a
huge impact on the air
quality in the classroom and
on your students’ health.
Furry classroom pets, stuffed
animals, floor pillows,
carpeted rest mats, large
area rugs, stuffed animals,
pet visitation days, smelly
science experiments and
perfumes can cause
breathing problems for
some students.
Cathy Boutin
Talk with the parents; let
them voice their concerns
and work with them to meet
their children's needs.
Pat Smith
Tell the parents if their child
is experiencing cough, shortness of breath, wheezing or
chest tightness or using their
bronchodilator inhaler more
often than their management
plan suggests.
Darcy Ellefson
Please don’t think I am overprotective or obsessed with
my child's allergies and asthma.
I am not trying to isolate my
child from others, but when a
classmate gets a cold, he has a
runny nose for five days.
When my child gets a cold,
he has to be on oral corticosteroids, take nebulizer treatments four times a day, and
stay home from school.
Cassie Kelly
Children must have fast,
easy access to their
bronchodilator inhaler.
Dianne Danzig
Advice from a
Make sure you know which
children in your class have
allergies and asthma (and
other chronic health conditions). Have the information
readily available for
substitute teachers and
for specialists that may visit
or work with your class.
Theresa Grill
28 • AANMA Indoor AIRepair at School
It’s important for parents of children with asthma to communicate
with the school. If I know what sets off a student’s asthma I can plan
ahead to prevent problems. Most teachers are willing to do anything
they can to help students stay healthy and safe so they can come to
school and learn. I know that students with asthma have an
increased struggle when they catch a common cold. Parents should
remind their children to wash their hands regularly and to dress in
layers because the temperature fluctuates in buildings and outside
and students should be prepared to go out.
Christine Whitley, special education teacher
Indoor AIRepair Notes
AANMA Indoor AIRepair at School • 29
Breathe Better Together
with AANMA!
Allergy & Asthma Network Mothers of Asthmatics (AANMA) engages,
educates and empowers families to win over allergies and asthma.
Since 1985, it’s been our mission to end needless death and suffering
due to asthma, allergies and related conditions.
Join at no cost to you by visiting
8229 Boone Boulevard, Suite 260, Vienna VA 22182
800.878.4403 •
Follow us
The Business
of Being a
Who doesn’t like to play? No
matter what your age, playing is
great fun!
Play gives children a chance to learn
about themselves and other people –
how to share and take turns, how to
be patient and fair, how to be a
good sport. It also builds creativity,
imagination and physical skills.
However, a playmate’s runny nose
can lead to your child’s asthma
attack. A simple birthday party
invitation can set your mind racing
about allergens, irritants and other
pollutants that can make your child
sick. And holidays leave family
members thinking you’re simply
How do you keep asthma symptoms
from interfering with fun? How do
you safely let children explore the
world through their own eyes,
outside your protective reach?
When children with asthma can’t
escape the allergens, irritants and
pollutants that set off breathing
problems, play loses its fun. When
was the last time you felt like playing
when you couldn’t breathe?
Children with asthma don’t want to
live in a bubble. They want to run
and play with their friends; go to
parties and sleepovers, take dance
classes and drum lessons, and simply
The good news is – they can, with
planning and communication.
The key is to minimize risk and
maximize fun.
AANMA Indoor AIRepair at Play • 31
Sensible Crafts
and Allergy
Fun Busters
Nothing can ruin a play day at
the community center or a sleepover
at a friend’s home faster than
overwhelming exposures to these
No scents
Many children’s products are
scented – art markers, paints,
crayons, disposable wipes,
bubble baths, shampoos and
more. However, even the
unscented products may have
masking fragrances that cover
unpleasant odors. Masking
scents added at low concentrations are not always listed on
the label.
Healthy hobbies
Woodworking, sanding, using
spray paints, sculpting and
other creative hobbies send
tiny pieces of dust into the air.
The ones that fall to the
ground quickly are actually less
of a problem than those that
stay in air for longer periods.
Whenever possible, keep indoor
work or hobby spaces well
ventilated and wear dust or
vapor masks to protect the
airways. Seal off rooms under
renovation from the rest of the
house: Cover air vents and seal
off windows and doors with
Dust mites
in carpets, upholstered furniture, bedding, pillows and stuffed animals
Cockroaches, mice and other pests
in family rooms and bedrooms as well as kitchens – anywhere traces of
food, water and dirty dishes are allowed to linger
wherever humidity levels are high; if you smell something musty, it’s moldy
not just dogs and cats – all furry animals produce dander, including mice,
guinea pigs, gerbils, hamsters, rabbits and ferrets
birds and reptiles – as well as their food and cages – also release allergens
and irritants
Secondhand smoke
a powerful irritant that can quickly set off coughing and wheezing
Other irritants
strong scents, including art supplies and candles
dust from construction and remodeling projects
offgassing (chemical smells) from new carpets, flooring and cabinets
latex balloons
pesticide sprays and toxic chemicals, often as irritating as the pests they kill
cosmetics, such as perfumes, nail polish and nail polish remover
Take stinky or dusty projects
32 • AANMA Indoor AIRepair at Play
AIRepair Tips from AANMA Members
Play Dates
and Birthday
When we go to someone’s house in
the winter, I always ask them not to
have a fire going in the fireplace. So
far nobody has seemed offended.
The request usually opens a dialogue about asthma. I have found
that most people don’t realize the
seriousness of asthma.
It is important to know about
cultural practices that may exist at
a friend’s house, such as use of
incense or candles. You can nicely
tell the parent: “Jeremy’s asthma
acts up when I use strong perfumes
or soap....he’d really love to come
over and play at your house, but
I just wanted to know if you
sometimes burn candles or use
any special scents at your house to
make sure he can stay away from
them and enjoy the playdate!”
Lois Wessel, RN, CFNP, Tysons Corner, VA
Beth Allen, Palatine, IL
If our son is invited to play at
someone's house or go to a party,
we ask about smoking; if it's not
nonsmoking, he doesn't go.
Gigi Gerben, Venetia, PA
Slumber Parties and Overnights
Away from Home
Before we make a play visit, we
invite the mother and child to our
home. That way we have a pretty
good idea of the other family's
feelings about helping with
exposure to things that might
cause a reaction. If we don't feel
good about the other family's
attitude, we just politely invite
the child to come to our house.
For parties, we send her own
blankets and pillow with an allergy
pillow cover on it, request she does
not sleep on carpeted floor, make
sure she takes all her meds with
her, and wash all her bedding and
clothing when she comes home.
For family vacations, we make sure
there are no feather pillows in motel
rooms and do not use the big
comforter on tops of beds.
Gayle Schroader, Taylor, SC
It is really difficult if the inviting
friend has a parent who smokes.
We taught our children to assert
themselves to ask the smoker to
smoke outside because of their
asthma. If that wasn't possible, our
child would go to another level of
the house to wait out the smoke.
While that wasn't ideal, it did help.
We have asked parents not to
smoke while driving our children in
their vehicle; they don't get
offended when they understand
what could happen.
Laura Smith, Dallastown, PA
Cindi Shea, RN, BA, AE-C, Beckley, WV
Parties and sleepovers can be
stressful. To make sure our daughter
enjoys the event without worry we
make sure the host of the event
thoroughly understands the
significance of her allergies and
understands what measures to
take if an outbreak begins. If we
are still not comfortable, we go
to the event with her or do an
alternative "special outing" of
her choice.
Michael Cason, Centreville, VA
When he goes to a friend’s home
overnight or just to birthday parties
he always carries his inhaler. We
let the adults in charge know
about his asthma and they always
know how to reach us if he has a
problem. Our son has never been
embarrassed or had problems with
anyone; in fact, he will tell you
anything you need to know about
asthma and why he has to do what
he does every day to stay healthy.
DaLynn Walker, Windsor, CO
AANMA Indoor AIRepair at Play • 33
Community Center Classes
and Events
When we visit relatives we bring
along our son's dust-mite-proofing
gear – including mattress cover,
pillows and blankets. Often our
family and friends understand
how sensitive he is to dust and
take the extra initiative to specially
dust-proof the bedroom or even
the entire house for him. When
renting a vacation home, we
always request accommodations
that have no animals or smoking
allowed, with a minimum amount
of carpet.
Jennifer Frey, Millbrae, CA
I have my daughter enrolled in ballet,
swimming and basketball classes.
Since she needs a change of clothing
for each of these activities, I separate
them into sealed plastic bags inside
of her individual carrying bags. I
do this to prevent any allergens
from accumulating inside gym
lockers, since you don't know what
gets thrown inside those lockers.
Ivette Davila-Richards, Brooklyn, NY
When my son was invited to a laser
tag party, I had no idea what it
really was. When I went with him to
check it out, the first sign I read was
a warning to patients with asthma
that there is a fog that the players
run around in that could be hazardous. We sat down and did a
treatment prior to the game, just in
case, and I talked to several of his
buddies who agreed to keep an eye
on him. I was very nervous, but his
friends were wonderful and very
proud to have been given such an
important task which they took
very seriously. I generally hang
around quite a few parties and
Our sons wanted to join a children's
bowling league after school on
Mondays. To our dismay the parents’
smoking became a huge problem
for them. They approached the
manager and told her that the
smoke left them sick and had even
led to an ER visit. They talked her
into requiring the parents to keep
the general bowling area smokefree during the children's league
time. Others could go outside or to
the enclosed bar area to smoke.
“No smoking” signs were posted
each Monday and parents caught
lighting up were asked to leave.
Maureen Damitz, Chicago, IL
Our daughter takes karate and
gymnastics, both held indoors. To
prevent problems, we tote our
'medicine bags' everywhere. These
are insulated (particularly important
on an extreme weather day)
lunchbags that easily hold all the
necessary medicines. The pocket on
the outside holds an emergency
letter listing her medications, doses
and times to be given.
We contact hotel managers and
museums before a trip to find out
if there is any painting going on.
If so, we don't go. Once, a museum
manager told us there was a small
amount of trim being painted. We
explained our situation and she
sent the painters out of the building to return on a day when the
museum would be closed. Because
of the excellent ventilation system,
we were able to enjoy the museum
with the boys and no one could
tell that there had been any
painting done earlier that day.
Gayle Schroader, Taylor, SC
Donna Biroczky, Fontana, CA
Andrea Holka, Malcolm, NE
34 • AANMA Indoor AIRepair at Play
Word Jumble
Unscramble the words,
then unscramble the
circled letters to answer
the clue.
What clean air helps you do...
Check out these additional “kids” resources
on environmental controls:
Games, Quizes and Projects
National Institute of
Environmental Health Sciences
Answers to Word Jumble:
Answer to the Clue:
Habit, Exit, Inhale, Exhale, Airway, Smart, Asthma
AANMA Indoor AIRepair at Play • 35
8229 Boone Blvd., Suite 260
Vienna, VA 22182
Phone: 800.878.4403
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