Triggers: Hiding in plain sight

A trigger.

The Breathe Easy at Home program, a partnership between the City of Boston Inspectional Services Department and the Boston Public Health Commission, helps those with asthma discover and eradicate the triggers of asthma attacks in the home. More than 90 percent of one’s time is spent indoors, according to the Environmental Protection Agency. That means that a person with asthma is confronted with triggers basically all of the time.

A trigger is a substance or condition that causes flare-ups in people with asthma. They differ from person to person and in intensity. According to Indira Alvarez, the chief of staff of the BIS, the department looks for four triggers in particular: mold, signs of moisture, roaches and mice. This choice is understandable. Researchers determined that cockroaches caused flare-ups in up to 60 percent of people with allergic asthma. In another study, scientists from the National Institute of Environmental Health Science found that 82 percent of homes in the United States — whether urban, suburban and rural — had mouse allergens.

Mold and moisture

Massachusetts law mandates that in new construction and updates, bathrooms be equipped with mechanical exhaust fans that prevent the buildup of steam, a precursor to mold. The exhaust fans should vent outdoors. “If there is no proper ventilation, open the window,” advised Alvarez.

Inspectors check under sinks, all ceilings, walls and areas where moisture can accumulate, including bathrooms and bedrooms adjacent to bathrooms. Kitchens are another source of moisture if the hood of the stove is not ventilated. Humidity, especially when higher than 50 percent, is the perfect environment for mold to accumulate. Mold is a fungus that can grow rapidly. Its spores travel through the air and are small enough to penetrate the airways.

Roaches

Cockroaches are hardy insects. They preceded the dinosaurs, so they’re not going away anytime soon. Unfortunately, their saliva, shell and droppings can trigger an asthma attack. They can get into a home through vents or crevices, warned Alvarez, and have a penchant for stoves and under the sink. More often, however, you unwittingly invite them in through shopping bags and boxes.

Rodents

As winter approaches, mice and rats head inside. “They’re trying to find a warm place,” said Alvarez. They’re also very determined. “They can bite through concrete,” she explained. They look for any tiny entrance through which to squeeze. The droppings and dander of rodents can trigger asthma and allergies, and are stronger predictors of asthma symptoms in young children than exposure to roaches, according to a recent study.

Integrated Pest Management

To eradicate mold, roaches and mice Alvarez advises Integrated Pest Management, which, according to the Environmental Protection Agency, is an effective and environmentally sensitive approach to pest management. IPM programs develop ways to manage pest control with the least possible hazard to people, property and the environment. For instance, traps are used instead of sprays and poisons.

After the inspection tenants and landlords are provided a list of the findings and recommended solutions. A follow-up visit is scheduled. The overall purpose of the program is not only to keep people healthy but also to keep them healthy in their homes.

COMMON TRIGGERS AND SOLUTIONS

Triggers in the home

MOLD AND MILDEW

Source: Bathrooms, kitchens, laundry rooms, basements

Solutions:

• Run exhaust fan or open window when showering, cooking or using dishwasher.
• Clean sinks, tubs and showers with green products, then dry.
• Use a dehumidifier or air conditioner.
• Keep humidity below 50 percent.

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DUST MITES

Source: In anything made of cloth or fiber: curtains, carpets, upholstered furniture, pillows, stuffed toys, mattresses

Solutions:

• Use allergy-proof mattress and pillow covers.
• Wash sheets and pillow cases in hot water (130°) every week, and dry in clothes dryer.
• Remove carpets.
• Eliminate clutter.
• Dust regularly with a damp cloth

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COCKROACH AND RODENTS

Source: Preference for dark, damp places, clutter and behind walls

Solutions:

• Store food in closed containers
• Fix leaks; don’t leave water in sinks or pots and pans.
• Clean up crumbs and wipe up spills.
• Plug cracks around windows and doors.
• Block holes in walls, cabinets and foundation.
• Use baits and traps instead of sprays.

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FURRY OR FEATHERED PETS

Source: Animals like dogs, cats, hamsters and birds

Solutions:

• Keep animals out of the bedroom.
• Vacuum weekly with a HEPA vacuum cleaner.
• Wash hands after touching animals.

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STRONG ODORS

Source: Cleaners and bleach, pesticides, air fresheners, potpourri, paints, glue, perfume

Solutions:

• Use “green” products instead of caustic cleaners.
• Use an exhaust fan or open window.

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SMOKE

Source: Cigarettes, pipes, cigars, fireplaces, wood-burning stoves

Solutions:

• Avoid smoke from all sources.
• Don’t smoke.
• Call 1-800-QUIT-NOW for help to stop smoking.

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POLLEN AND AIR POLLUTION

Source: Spring: trees, grasses and weeds; Fall: ragweed and weeds; smog, haze, smoke, dust

Solutions:

• Use air conditioner or keep windows closed.
• Check pollen count at www.pollen.com.
• Check the air quality at www.airnow.gov.

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EXERCISE

Source: Sports or gym class or when running or playing hard

Solutions:

• Start slowly and cool down.
• Breathe through your nose.
• Use rescue inhaler if prescribed by your doctor.

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WEATHER

Source: Cold or dry weather

Solutions:

• Wear a mask or scarf to warm the air you breathe.

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MEDICAL ILLNESSES

Source: Colds and viruses, GERD or heartburn

Solutions:

• Wash hands often.
• Avoid people with the flu.
• Get a yearly flu shot.
• Avoid foods that cause GERD, such as fatty or fried foods.

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Other possible triggers are some medicines, strong emotions, such as anger or stress and foods containing sulfites.

Source: Asthma and Allergy Foundation of America, Boston Public Health Commission