DOLORES DaSilva of Stamford, Connecticut, thought she was doing a pretty good job controlling her son Jonathan’s asthma with medication and trips to the doctor.
She had no idea that keeping her five-year-old’s lungs clear would be a home-improvement project as well as a medical one.
DaSilva found that out one recent Saturday when a housing inspector and a public health nurse performed a voluntary inspection of her tired, second-floor walk-up apartment and pointed out numerous factors that could trigger or exacerbate Jonathan’s asthma.
The inspection represented a relatively new approach to confronting the asthma epidemic: targeting individual homes to search out and eliminate asthma triggers.
The Stamford Department of Health and Social Services started visiting homes last spring, funded by a grant from the US Department of Housing and Urban Development.
The US grant programme, called the Healthy Homes Initiative, distributes about US$10mil (RM38mil) a year for projects aimed at preventing illness by identifying and cleaning up household pollutants such as allergens, carbon monoxide and toxic mold in homes and apartments.
The programme is modelled after much older initiatives to prevent childhood lead poisoning by cleaning up homes contaminated with peeling or chipping lead paint.
Stamford became the only city in Connecticut to win a Healthy Homes grant for asthma remediation after the city’s health director, Dr Anthony Iton, found that more than 1,500 – 8.6% – of Stamford schoolchildren have physician-diagnosed asthma. Many of those children, he found, live in the city’s poorest neighbourhoods.
Under the programme, school nurses contact the health department to suggest families who might benefit from home inspections. Inspections are voluntary, and some people, especially undocumented immigrants, have been wary, said Marge Kappas, a public health nurse trained to perform the inspections.
Kappas and housing inspector Ronald Miller arrived at the DaSilva home on a Saturday morning when bright sunshine was powerless against the icy air.
Inside, the kitchen was warm from the heat of a gas stove. Condensation beaded on the windows. Both the stove fumes and mold growing on the damp window sills could irritate Jonathan’s lungs. But Kappas and Miller would save that information for later.
The visit started at the kitchen table, where Kappas asked scores of questions. Did Jonathan have a special attachment to make his inhaler work better? No, that would cost US$50 (RM190), his mother said. “I will get one for you,” Kappas said.
Is there a nebuliser in the house? A neb uliser is a machine that turns liquid asthma medication into steam so it can be inhaled. “No,” said DaSilva, “but I have a vaporiser.”
“I’m going to tell you to get rid of that,” Kappas said, a little apologetically. Some experts say vaporisers or humidifiers are only a little below cigarette smoke on their top-10 lists of asthma no-nos. Humidifiers can promote the growth of mold and dust mites, believed to be two major asthma triggers.
“Do you have dogs or cats?” Kappas continued. The answer was no. But two parakeets made their presence obvious in their cage beneath the kitchen table. Feathers, as well as pet fur and dander, can make asthma worse, she said.
“Do you have a hypoallergenic mattress cover?” Kappas asked. Such covers can cost US$50 (RM190) each, way outside the budget for DaSilva, a native of Brazil who cleans houses two days a week. Her husband is a house painter.
“We’ll provide it,” Kappas said.
After the initial inspection, which included a walk-through of the home to look for dusty stuffed animals in bedrooms and mold in the shower, Kappas and Miller will return every three months for a year to see if the family is making progress in removing asthma triggers.
On each visit, they will bring a gift, possibly hypoallergenic mattress and pillow covers or in some cases a vacuum with a special filter that throws out less dust when it cleans. Miller, who has authority to enforce the city housing code, contacts landlords and orders that health and safety violations be taken care of.
At the DaSilva home, Miller discovered that the gas stove in the kitchen was the only source of heat for the five-room apartment. One room was sealed off by a door and pillows, and the others were heated to about 58 degrees by portable electric heaters.
During each visit, Kappas will ask about the number of attacks the child has had and how much medicine has been needed to control asthma in the previous months. Iton said he hopes to come up with evidence showing that cleaning up houses can prevent or reduce asthma attacks.
At the same time, Dr Hossein Sadeghi, a paediatric pulmonologist who treats the most serious cases of asthma in Fairfield County children, will track emergency room visits and hospital admissions among children enrolled in the healthy home programme.
He said he expects to see a reduction in those numbers.
Dr Michelle Cloutier, a pulmonologist and director of the asthma centre at Connecticut Children’s Medical Centre in Hartford, said home visits are a good place for asthma prevention to begin because indoor air quality is probably one of the most important factors in asthma control.
“If I could choose one place to begin, I would look for a healthy home,” Cloutier said. But she cautioned that it should not be the last place to look.
Cloutier and her colleagues are now taking air samples at 20 Hartford-area child-care centres to try to identify allergens. They want to see if simple interventions such as installing dehumidifiers and using air filters can reduce asthma rates in children who use those centres.
She said if a child gets better after the home is cleaned up, then the problem may be solved. But in some cases it might be necessary to measure allergens in various locations and at different times of year to pinpoint a specific asthma trigger.
Glodimene Louis said she has already seen a huge change in her son, Ezra, 6, since Kappas and Miller first visited her family at the Vidal Court housing project in June.
On that visit, the inspectors found black and white mold covering the kitchen, living room, bedrooms and hall closets of the apartment where Louis and her husband lived with three young children.
“The closet was literally pitch black,” Kappas said of the mold. Paint was flaking from the walls and ceilings, roaches scurried around with impunity, and the pilot light on the stove was out, causing a constant gas odour.
The condition of the city-owned apartment was so bad that Kappas and Miller had the family moved to another unit around the block with fresh paint and linoleum floors, instead of carpeting, which can also harbour dust and exacerbate asthma.
“My son had bad asthma. He used to miss school,” Louis said. “Now he’s breathing a lot better.” – LAT-WP
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