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Asthma Friendly School Environments Jennifer Cofer, MPH, CHES, AE-C Executive Director, American Lung Association of Mississippi Our Mission Prevent lung disease and promote lung health in Mississippi through: Education Advocacy Research Lung Health Focus • Asthma • Clean Air – indoor and outdoor • Chronic Obstructive Pulmonary Disease (COPD – chronic bronchitis & emphysema) • Tobacco Control Burden of Asthma in the US • An estimated 20 million Americans suffer from asthma (1 in 15 Americans). • Asthma accounts for one-quarter of all emergency room visits in the U.S. each year. • Asthma is the #1 cause of school absenteeism among children. • The annual cost of asthma is estimated to be nearly $18 billion. Burden of Asthma in MS • 1 in every 14 adults have asthma – More women than men (8% v. 5%). • 1 in every 10 children have asthma – About 2 per classroom. – More black children than white children (13% v. 8%). – More boys than girls (12% v. 8%). Source: Behavioral Risk Factor Surveillance System, 2007 What is Asthma? Asthma: Is a life-long disease found in the airways of the lungs, causes swelling and muscle tightening. Produces frequent symptoms such as shortness of breath, tightness in the chest, wheezing and coughing. Asthma cannot be cured, but it can be controlled. What is Asthma? When asthma is triggered, airways tighten and swell, making it difficult to get air out of the airways. Early Signs of Asthma • • • • • Dry cough Feeling tired Feeling restless Trouble sleeping Stuffy nose, runny nose • Watery eyes • Congestion • Stomachache • Headache • Shortness of breath Asthma Medications • Inhaled corticosteroids (anti-inflammatories): reduce/prevent airway inflammation (swelling) • Bronchodilators: relax tight airways – Short-acting Beta Agonist: quick-relief inhaler – Long-acting Beta Agonist: daily inhaler • Combination Medications • Nebulizer/liquid forms of medicines • Other oral medications Medication Demonstration Spacers/Holding Chambers Environmental Asthma Triggers Allergens • Substances that cause you to have an allergic reaction. • Exposure in a patient who is sensitive increases airway inflammation and symptoms. Irritants • Substances that irritate the lungs and cause asthma symptoms. • Exposure causes increased symptoms or limits airflow. Allergens Examples • Require sensitization • Tree pollen (spring) • Affects only those • Grass pollen (summer) that are sensitized to • Weed pollen (fall) the allergen • House dust mite • Furry animals • Not usually dosedependent • Fungi/mold (fall to perennial) Trigger: Animal Dander Trigger: Grass, Trees Trigger: Pollen Trigger: Mold Trigger: Cockroach Triggers: Food Allergies Examples Irritants • Tobacco smoke • Dose dependent • Ozone response. • Exhaust fumes/diesel • Will affect everyone fumes at high enough • Sulfur dioxide dose. • Nitrogen dioxide • Perfumes • Cleaners • Weather Trigger: Smoke Trigger: Fumes Trigger: Pollution Other Asthma Triggers • • • • • Colds, flu, sinus problems Exercise Bursts of emotion Some medicines in sensitive individuals Anxiety Trigger: Colds/Infections Green zone - when symptoms are controlled Yellow zone – when symptoms are present Red zone – when symptoms do not go away or get worse Asthma Action Plan Peak Flow A peak flow meter is a simple device that measures the air a person can blow during the first second. A peak flow meter can help a person monitor their asthma symptoms. It is useful for persons who do not wheeze or can’t tell they’re having asthma symptoms. Symptoms of an Asthma Episode • • • • Wheezing Coughing Respiration rate >20 Retractions (sunk in neck) • Anxious • Stooped body posture • Shortness of breath • Nasal Flaring • Depressed Sternal Notch • Nausea/Vomiting • Fatigue • Decreased peak flow Childhood Asthma A child should stay home when he or she: • Has trouble breathing even after taking the quick-relief inhaler. • Gets winded after speaking or playing quietly. • Has a fever. • Has an infection or sore throat. • Peak flow is in the yellow or red zone after taking the quick-relief inhaler. What a child should do? If you feel symptoms of an asthma episode: 1. Tell an adult immediately. 2. Measure peak flow. 3. Take medication according to the Asthma Action Plan. 4. Sit up, stay calm, deep breathing/belly breathing. 5. If asthma symptoms continue or you recognize a sign of an asthma emergency, seek medical care. What to do if Asthma Episode Occurs • Review the child or adult’s asthma action plan. • Have person sit upright and check peak flow. • Administer prescribed medication: – Quick-Relief Inhaler or Nebulizer (Albuterol) • Reassure person to keep calm. Move them away from people or move the people away from them. • Controlled breathing. Indoor Air Quality (IAQ) • Each school day, some 53 million students and 5 million staff are in our nation’s schools, (20% of American population) • Half this population may be exposed to polluted indoor air, lead, asbestos, chemical fumes, pesticides, molds and other toxins, along with overcrowding and poor sanitation Health Impacts & IAQ • Asthma – 20 million people have asthma-- including 6.2 million children under the age of 18 – The cause of over 14 million missed school days each year – Costs society $18 billion/year in medical and indirect costs • Sick Building Syndrome and Building Related Illnesses • Allergies and sensitivities • Absenteeism • Reduced productivity and lower test scores Indoor Air Quality Problems: Pollutant Pathway People Source: Environmental Protection Agency (EPA) Indoor Air Quality Tools for Schools National Symposium, December 2007 Indoor Air Quality & Asthma (cont.) Elements of IAQ: 1. Contaminant Source Control 2. Humidity Management 3. Ventilation 4. Filtration Source: Environmental Protection Agency (EPA) Indoor Air Quality Tools for Schools National Symposium, December 2007 What do we add to our air? Source: Environmental Protection Agency (EPA) Indoor Air Quality Tools for Schools National Symposium, December 2007 How do we improve IAQ? Simple things first: • Stop using scented products & deodorizers • Dispose of sources • Unblock vents • Move sources away from intake vents • Learn/teach about ventilation controls • Report problems! Source: Environmental Protection Agency (EPA) Indoor Air Quality Tools for Schools National Symposium, December 2007 Why GREEN Cleaning • • • • Helps Students Stay Healthy and Learn Protects the Health of Custodial Staff Increases the Lifespan of Facilities Preserves the Environment Source: Healthy Schools Campaign, Green Cleaning in Schools What does “GREEN” mean? • • • • Products that Prevent Pollution Products that are Sustainable Multiple Attributes Has been tested by several agencies: – Green Seal - Green Buildings - US EPA – American Society for Testing & Materials Source: Healthy Schools Campaign, Green Cleaning in Schools Choose GREEN Cleaning Products • • • • • Ecolab Johnson Diversey Unisource Spartan PortionPac Source: Healthy Schools Campaign, Green Cleaning in Schools Choosing a Product • Less-toxic, effective cleaning products are readily available through most manufacturers and distributors • Independent third-party certification of institutional cleaning products is crucial • Common third-party programs are: – Green Seal™ (GS) – US – EcoLogo™ (formerly known as Environmental Choice) - Canada Source: Cleaning for Healthy Schools, www.cleaningforhealthyschools.org What chemicals not to use • What to look for on an MSDS: – Volatile Organic Compounds (VOC) content of 1% or lower – pH between 5 – 9, 7 is neutral • Avoid: – Aerosols – Products labeled as corrosive, that can cause eye or mucous membrane damage, or that can burn the skin – Ingredients that are carcinogens, mutagens, teratogens Source: Cleaning for Healthy Schools, www.cleaningforhealthyschools.org Environmentally preferable product ingredients Use these: Instead of these: • Alcohol ethoxylates and/or polyglucosides • Hydrogen peroxide • Corn-based esters • Vegetable-derived surfactants • Fruit-derived solvents and acids • Nonylphenol ethoxylates or alkylphenol ethoxylates • Harsh acids/alkali builders • Petroleum distillates • Petroleum-derived surfactants • Petroleum solvents or harsh acids Better Cleaning Equipment Use updated equipment to reduce particulates in the air • Install dirt-grabbing walk-off mats inside and outside entrances, recommended 15’ – 20’ • Use microfiber cloths and mops that pick up dirt while using a reduced amount of chemicals • Employ HEPA vacuums or microfiber mops instead of conventional dust mops • Install high-filtration vacuum attachments on other floorcare equipment Source: Cleaning for Healthy Schools, www.cleaningforhealthyschools.org Best Practices for ALL employees • • • • Keep dirt out Leave classrooms ‘ready to clean’ Clean from the top down Select durable easy to clean flooring; maintain/replace carpets • Clean up spills right away • Cleaning with all-purpose cleaners removes most germs. Disinfect only in target areas. • Reduce dust with vacuuming instead of damp mopping Source: Cleaning for Healthy Schools, www.cleaningforhealthyschools.org Cleaning for Healthy Schools Principles • Keep the dirt out • Use less-toxic, third-party certified, all purpose cleaners, paper products and hand soaps • Update and maintain equipment • Cleaning with all-purpose cleaners removes most germs. Disinfect only in target areas. • Breathe easier – clean doesn't have an odor Source: Cleaning for Healthy Schools, www.cleaningforhealthyschools.org Asthma Programs Asthma Programs Asthma Camps Tobacco Programs Jennifer Cofer, MPH, CHES, AE-C Deputy Executive Director American Lung Association of Mississippi 601.206.5810 or 800.LUNG.USA [email protected] We will breathe easier when the air in every American community is clean and healthy. We will breathe easier when people are free from the addictive grip of cigarettes and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces and workplaces is clear of secondhand smoke. We will breathe easier when children no longer battle airborne poisons or fear an asthma attack. Until then, we are fighting for air.