May 6, 2014

Housing’s Role in Reducing the Burden of Asthma

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World Asthma Day resourcesToday is World Asthma Day, an annual event to improve asthma care and awareness around the world.  Asthma is a chronic, inflammatory disease of the lungs that has increased in prevalence in many countries, including the U.S., over the last several decades.   Asthma is the most common cause of missed school days among children, and is more common among children living in poverty and some minority groups, including African Americans.

Asthma has an important connection to the home environment.  Symptoms can be triggered by allergens from pests (e.g., cockroaches, mice), pets, mold, and dust mites, as well as irritants such as tobacco smoke and other indoor and outdoor air pollutants.  The good news is that a person with asthma can lead a normal, active life by taking steps to manage the condition, including regular healthcare visits, the proper use of medications, use of an asthma action plan, and avoiding environmental triggers.

In May, 2012, HUD and its federal partners released a Coordinated Federal Action Plan to Reduce Racial and Ethnic Asthma Disparities.  In addition, HUD is supporting several initiatives that will benefit both children and adults with asthma who live in public or other federally assisted multifamily housing.  In an effort to reduce exposure to asthma triggers, the Department launched a smoke-free housing initiative which encourages owners and managers of multifamily housing to implement policies to prohibit smoking by residents and staff.  As a result, we currently estimate that 486 public housing agencies have established smoke-free policies in some or all of the buildings they manage.

Additionally, HUD is promoting the use of integrated pest management (IPM) to control pests in federally assisted properties.  IPM takes a holistic approach to pest control that includes ongoing monitoring for pests, sealing cracks that allow pests to move between apartments, providing pest control education to residents, and, when needed, the targeted  and safe use of pesticides.

Furthermore in 2010 and 2011, HUD awarded $3.8 million in grants to conduct educational and environmental interventions for children with asthma in federally subsidized multifamily housing.  Results to date have been exciting.  For example, The Sinai Urban Health Institute used community health workers to deliver interventions to residents of Chicago public housing.  In a short time, they’ve reported a significant reduction in the need for emergency medical care among the children and improvements in the quality of life for the children’s caregivers.

We have the knowledge to create housing that provides a safe and supportive environment for children and others with asthma.  At HUD, we are promoting housing management practices and policies that we expect will reduce the burden of asthma among families that are receiving federal housing assistance.   It is important that the owners and managers of all rental housing do their share to improve the lives of those with asthma by creating and maintaining healthy indoor environments.

Peter Ashley, Dr PH, is the Director, Policy and Standards Division in the Office of Healthy Homes and Lead Hazard Control.

2 Responses to Housing’s Role in Reducing the Burden of Asthma

  1. This is a relevant article on the topic:

    Contribution of Residential Exposures to Asthma in
    US Children and Adolescents (2001) Bruce P. Lanphear, MD, MPH et. al.

  2. StopPests in Housing’s Role in Reducing the Burden of Asthma

    Research shows the Integrated Pest Management (IPM) approach to pest management works. IPM is a cost-effective means of reducing common asthma triggers associated with pest infestation. The StopPests in Housing program of the Northeastern IPM Center plays an important role in reducing the rates of asthma in public and affordable housing by working directly with housing providers who wish to reduce asthma triggers associated with pest infestations.

    Research shows that pest infestations including rodents and cockroaches can trigger asthma attacks with the allergens they leave behind in droppings, dander and body parts. We also know now that the incidences of asthma are disproportionately higher in inner cities and among low-income populations where these pests are prevalent.

    One study in North Carolina showed using IPM techniques alone to control cockroaches is the most effective method for removing common cockroach allergens. There was no statistically significant difference when combining this strategy with resident education and professional cleaning. The IPM approach alone was the factor that eliminated the allergens most effectively. Arbes et al. 2004. Another study in North Carolina schools compared allergen levels after conventional cockroach treatment versus an IPM approach employing monitoring and baits. There was a significant reduction in cockroach allergens (91-95%) when IPM techniques were employed as opposed to conventional pest management techniques, which only resulted in reducing the allergens associated with cockroaches by 53-55%. Nalyanya et al. 2009.

    Our work at StopPests in Housing is primarily to assists housing providers and pest management professionals transition to IPM by offering trainings, tools and consultation. Resources like Integrated Pest Management: A Guide for Affordable Housing, our research database, training materials and useful templates for lease language, pest management contracts, inspection forms and more are provided at to help the housing provider with all aspects of their transition to an IPM approach. Although we’d like to see IPM universally adopted in all public and affordable housing properties. Our goal is to assist 70 housing providers across the country in adopting and implementing IPM policies and practices by 2016.

    Arbes SJ, Jr., Sever M, Mehta J et al., 2004, Abatement of Cockroach Allergens (Bla g 1 and Bla g 2) in Low-income, Urban Housing: Month 12 continuation results, Journal of Allergy and Clinical Immunology in Practice, 113(1): p.109-14

    Nalyanya G, Gore JC, Linker HM et al., 2009, German cockroach allergen levels in North Carolina schools: Comparison of integrated pest management and conventional cockroach control, Journal of Medical Entomology, 46 (3): p.420-427

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