Protecting At-Risk Youth: The Impacts of Indoor Air Quality on Asthma Peak Week (Recording)

This webinar was recorded on September 13, 2022

Asthma Peak Week recognizes the spike in asthma episodes, attacks and hospitalizations that occur each September – often for kids, aligned with a decrease in air quality and the return to school. Many common asthma triggers can be found indoors, making indoor air quality a crucial component in regulating asthma severity.

Speakers:

• Suzy Kwiecien
• Marc Gotlieb
• Dr. William Berger

Transcript:
This transcript is automatically generated. While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Sally Schoessler: Indoor air quality is a huge issue for all of us, but especially for children and youth who are at risk for respiratory issues. Today, we’re going to take a look at issues surrounding indoor air quality and interventions we can do to reduce respiratory symptoms, especially during the September asthma peak. My name is Sally Schoessler, and I’m Director of Education at Allergy & Asthma Network. Thank you so much for joining us today. Today’s webinar is sponsored by Blueair, a valued partner of Allergy & Asthma Network, and we welcome two speakers to today’s webinar.

Suzy Kwiecien is the head of brand and product marketing at Unilever Water and Air Wellness in North America. In her role, Suzy oversees all brand and product marketing initiatives for Blueair, Unilever’s indoor air purification company that boasts more than 25 years of industry experience. With a mission to provide clean air for the next generation. Suzy leads a team of 11 team members who collectively manage and execute Blueair’s various marketing functions. With more than 15 years of professional marketing experience, she has led global brands including Dyson and KitchenAid through strategic planning, product launches and business development, and more. She holds a Bachelor’s degree from the University of Birmingham in the UK and currently resides in Chicago.

William Berger, MD, is board-certified in both pediatrics and allergy and immunology. Dr. Berger founded the Allergy and Asthma Associates of Southern California Medical Group in 1981 in Mission Viejo, California, where he practiced both adult and pediatric allergy. Dr. Berger entered the field of medicine because he wanted to make a positive difference in the lives of others. His commitment to improving patient care has extended beyond his practice to clinical research, publications, leadership and professional organizations and with his work with Allergy & Asthma Network.

I’d like to thank you both for being here with us today and for sharing this valuable information on this important topic. We’re going to be looking at several items during our program today. We’re going to be looking at the basics of air quality. We’re going to look at the effects on at-risk children. Then Dr. Berger will lead us through a talk about the September Asthma Peak, and then Suzy will be back to talk about the need for clean air standards in our schools.

So at this point, I’d like to turn it over to Suzy. Thank you for being with us today.

Suzy Kwiecien: Thanks Sally. I’m really happy to be with everyone. Today I’m chatting about this really important subject. Sally mentioned my name is Suzy Kwiecien. I won’t ask you to pronounce or spell my surname again during the presentation, I promise. And yeah, I head up brand and product marketing for Blueair, which is the brand owned by Unilever and we operate out of North America in a variety of other countries as well. Ultimately our mission, as Sally also mentioned, is to produce high-performing air purifiers that can really bring relief to children and the rest of their families throughout the world. We originated 25 years ago in Sweden in Stockholm, and that’s where we’re still headquartered as a brand today. And we originated because our founder was outside in the pristine Swedish countryside and thought, ‘Gosh, I really want to be able to bring this clean air inside for my children.’ And so he’d set out to really produce a top performing air purifier that could do just that. And that’s really why our mission has been very much focused on children for the last 25 years. But again, obviously if we focus on children and we produce high performing air purifiers, that is also good for the entire rest of the family as well.

And as you can see on the slide here there are, you know, a couple of key stats which are extremely surprising. And I must admit, before I started to get into and really learn more about air purification, I didn’t know this and it really does come as a surprise. But when you think about it, it makes sense to be honest. So in the United States, the EPA has estimated that about 90% of Americans spend about 90% of their time indoors, which is a crazy amount of time. And then it makes it even more scary when you realize that the air inside your home is up to five times more polluted than the air outside. And again, this stands to reason, if you think about it, we often think about pollutants outside the home more than we do inside. We think about, you know, car exhausts and smog and smoke and, you know, everything like that outside. But obviously, that same pollution that exists outside once it comes into your home. When into your places of work. It gets magnified. It concentrates. And so this is why we see these numbers going up and the types of pollution that can exist indoors. You know, it’s anything really from viruses and bacteria, as we’ve obviously seen with the COVID-19 pandemic, to a variety of different other allergens, to chemicals, you know, gasses, huge amounts of things. Some really sort of concentrate as I said and unfortunately due to recent, you know developments in terms of different building regulations and pesticides and household cleaners etcetera, we’ve seen it rise in this in recent decades. So again even more important than it was before for us to focus on this very important issue.

So I already mentioned a couple of these indoor air pollutants, but, you know, this kind of just really shows you sort of more of a full swath of them. PM 2.5, which is sort of stated at the beginning here, that class of pollutants is 2.5 microns or less, which is about 30 times smaller than a single human hair, and common pollutants that sort of fit into that 2.5 PM bracket are things like smoke particles, pet dander. You know, bacteria and viruses you know will also fit under that. We use PM 2.5 as a little bit of a general term, but ultimately, this is a lot of particles that can cause the most damage from a health perspective because these are the size of particles that can get right down into your lungs and sort of you know impact at the more cellular level, which you know is obviously a concern for from a health perspective. As I’m sure Dr. Berger can attest, you obviously have some of the slightly larger particles that are also allergen that are also classed as allergens like dust, pollen, mold, etc. They’re a little larger, but as we all know they cause just as many issues in terms of some of the health reactions that come about.

And another leading cause of poor indoor air quality is volatile organic compounds, or VOCs, as you can see along the bottom there. And that’s again a sort of general term. A lot of things can come under that. But you know, this can be things like gasses and chemicals released from paint furniture, the use of cleaning products. There’s a huge amount of things in everyday life that produce VOCs that we just don’t really realize or think about. And then other things you know obviously that again we do classes pollutants, things like odors that can come from cooking. You know we have dust mites as well that are you know a component of dust, but in of themselves are an allergen and cause different reactions to you know the rest of the particles within dust. So there’s a lot more to a lot of these pollutants than you know anyone would first think when you understand them at a more general level.

The climate impacts indoor air quality. As I mentioned there are several things contributing to indoor air quality. Unfortunately the climate crisis that we’ve sort of seen across the globe is one area that has been contributing. So you know the increase in wildfires that has been seen in the U.S., but also across Europe and in other countries obviously in the areas that are hit and even in areas that are not hit. You know, we have wildfires on the West Coast but that impacts air quality all the way over on the East Coast. People just don’t think about wildfire smoke traveling that far, but it really does. You get these increased sorts of weather events and increased humidity. We’re seeing rises in temperature or longer periods of higher temperatures, and you know, that can obviously increase the risk of mold growth, etc.

And then the other thing that again we’re sort of doing, in a lot of ways, is combat these issues with climate impact, in terms of weatherizing our public buildings and really trying to protect ourselves in a lot of ways against this. Unfortunately, when it comes to indoor air quality, that can actually have the opposite effect because ultimately we’re sealing ourselves into a box which, while it protects us from the outside, from the sort of elements that we can touch and feel, it doesn’t protect us from those pollutants that we can’t touch and feel that do seep in regardless. And with no reduced kind of ventilation, in a lot of ways they’re unable to go anywhere. And so that’s why we continue to get, as I mentioned a few slides earlier, this concentration of pollutants in our indoor environments.

So growing and protecting our children, as I mentioned earlier on, you know, this was really what certainly drove the company that I work for, Blueair, to sort of be developed and founded and grow. One of the main concerns we have at Blueair is how polluted indoor air negatively impacts children. And I was saying, as I’m sure Dr. Berger can attest, healthy environments are absolutely critical for children because they’re growing. Their bodies are still developing and so any kind of negative impact, any pollution that they’re absorbing, is impacting that growth and development. And so we have to be especially careful about the pollution levels that they are exposed to while they’re still growing at the rate they are.

Indoor air and children, so again to kind of highlight this issue even more and really dig in here. Children breathe more air as well. So it’s not just that their bodies are developing relative to their size. They’re taking in 50% more air than adults. Not only are they more susceptible to these pollutants because they’re growing, they’re also experiencing greater concentrations of these pollutants because they’re breathing in far more of them. So it’s kind of a double whammy, if you will, unfortunately for our children. So this highlights the need for us to really concentrate on how we’re protecting them from many of these common household pollutants like dust, smoke, chemicals, etc. And you know we talk about the kind of the health impacts of these pollutants.

So I know everyone’s here today. You know we’re here with the Asthma & Allergy Network. The asthma and allergy issues and the way that pollutants can impact and progress that condition is obviously one factor. But you know the other thing is even if you have a child that doesn’t suffer from asthma and allergy symptoms or issues, even just every child can be impacted by polluted air because if you don’t have clean air, it is going to impact their ability to concentrate, their ability to process information, and think logically because again a lot of their neural pathways in their brains are still developing. There’s a lot that goes on and a lot of these pollutants do get in the way of some of that development and some of these areas of their brains working properly and transmitting signals.

So the effects of better indoor air quality impact allergies and asthma. It’s sort of, as everyone knows, if you’re exposed to anything that you know is a trigger for an allergy or for an asthma event, then that’s obviously going to exacerbate your condition. It can even cause, if you’re exposed to these pollutants, even without having previously developed allergy and asthma issues, it can, actually, cause early-onset asthma in children and in adults. So it worsens existing symptoms and can cause these conditions to actually start in the first place. One study that was done, we saw students who were in classrooms with higher air ventilation rates, therefore cleaner air – they scored 14 to 15% higher on some of their test scores than children in classrooms with lower ventilation rates. So again, it really just goes to prove how that polluted air can impact in areas that, again, we wouldn’t necessarily immediately think about better sleep.

So again everyone’s searching, parents and children alike, are searching for a better night’s sleep. But it’s especially important again in children who you know again they’re growing, they’re developing. They need that sort of quality sleep in order to help them perform to their best the next day and obviously continue to grow and develop at the speed and rate that they should. So again even and a lot of studies have shown that common levels of air pollution can affect sleep quality, unfortunately, and then you know, a healthy environment. So we have issues when we need to pay attention to the buildings that were existing in, regardless of whether they’re old, and to be honest, whether they’re new as well. Older buildings, oftentimes you do run the risk of having higher dust concentrations with potentially older materials that are still emitting certain chemicals found in paints, furniture and flooring. But even when we sort of replace them with newer materials and newer builds, we have to be very careful because certain new paints, certain new furniture, can also cause off-gassing and things like that. Just generally being far more aware of the materials and of the pollutants that can come from those materials that you spend so much time around and that the children spend so much time around, can then really help direct how to then go about combating that or making better choices that can really prevent the pollution from happening in the first place ultimately.

So keeping indoor air clean and healthy, and as I mentioned on my last slide, you know, identifying and eliminating pollutant sources is crucial. So again, just really being more educated and really finding out where are the common pollutant sources that whether it’s in your home, whether it’s in school, whether it’s in the office building, just really being aware of where these things can be coming from so you know excess moisture, obviously if people are smoking, cleaning supplies, if you’re near to a busy highway, if you have a lot of cars that park outside and leave the engines running, all of these types of things, you can sort of go down a list and tick off and then really try to reduce that at the source. Having a space around a school or wherever for where no cars are allowed, for example. Or, you know, really paying attention to the specific cleaning supplies that you bring in and making sure they’re of a certain chemical makeup. Improving ventilation is so important and for most people, even with all of this attention, you’re never going to be able to remove all of these pollutants at the source. So then the next thing really is improving ventilation. So that’s really looking at, again, as mentioned, maybe having windows open and cracked open, having fans going to keep air moving and using air purifiers as well to help both circulate and clean the air.

And today luckily there are … Oh, sorry, we can go back to the prior slide. Still got a couple of points. Today luckily we do have a variety of ways to help keep track of our indoor air quality and address it. So you know, in the first place you can purchase things like air quality indicators that can sort of immediately say, you know what the air quality in a certain environment is like. And then you can understand how urgently it needs to be addressed and how much it needs to be addressed, and investing in higher quality air purifiers – like really having an air purifier that can clean the air in a given room as quickly as it needs to in order to be able to keep up with more pollutants coming in. Because that’s the other thing we have to be aware of is that you’re forever getting outside pollutants coming in, so cleaning your air once in a day is not going to mean it stays clean. It’s a constant kind of ongoing attention that is needed to keep on top of pollutant levels within a certain area.

So having an air purifier or having a device or having whatever method it is you’re using, windows cracked, whatever, to keep continuously the air flowing and removing particles that are continuously coming in is important. And if you’re going to use an air purifier, having one that performs at the level that it needs to keep up with those pollutants is especially important. Air purifiers offer a compact and really effective way to improve indoor air quality, and they work by simply removing pollutants from the air they use. Most of them will use some kind of a filter. There are various different technologies out there that can work to, you know, use filters plus maybe a different type of tech. In order to remove a certain percentage of airborne pollutants that come through the air purifier and out the other side. They do like and just purely from the fact that they are removing a good level of pollutants, like most air purifiers will remove around 99.97% of particles down to about 3 to 1 microns. So most of them are fairly good at that and just by way of removing these pollutants, these allergens, obviously that is going to be one tool in anyone’s fight against reducing allergy and asthma symptoms. Because if you remove the allergen itself then that should go a long way to helping you to keep some kind of control over that health issue. In the same way if you’re inside and, as we’ve recently all experienced potentially higher levels of bacteria and viruses being spread around, if you can remove those virus and bacteria particles from the air, where they exist in an airborne state, you’re reducing your chances of getting sick. So we all know having a well-ventilated room both for you know, for the variety of different pollutants is just going to help to reduce chances of symptoms and sickness.

One thing to remember with any air purifier, how it works, most will use a filter. You have to clean them or replace both those filters regularly for the device to remain effective. If you think about it, the filter is like the air purifiers lungs. They’re almost working as a second set of lungs for whoever is in the room and it’s taking on all the pollution versus you and your lungs, which is obviously preferable. But because of that they get, you know, the filters obviously do build up you know pollution and their over time so they have to be regularly replaced. So that the product can continue to work as it needs to clean air delivery rates.

So this sounds a little bit technical, so I’m not gonna spend too much time here, but this points to the fact that I was stating a few slides ago where it really is important if you are going to use an air purifier as part of your toolkit that you get one that is of a certain performance level. Clean air delivery rate really looks at – it doesn’t just look at the absolute percentage of part of pollution that’s being removed. So I mentioned that 99.97% it looks at ultimately how much clean air is being produced by the product. So you could remove a high percentage of pollutants, but if you’re only removing a high percentage of pollutants from a really small amount of air, that’s not doing you much good. You’re only producing a small amount of clean air, which isn’t going to, you know, impact the overall air quality in your room to a high level. So what you really need to look at is air purifiers that have a high clean air delivery rate, because that takes into consideration the size of the particles, removes the percentage, but then also importantly the volume of air passing through the unit. So it really measures the amount of really clean air that you’re getting out of the product, and then the other element is understanding the size of room that you’re putting the product in. So again, if you have a small product that’s producing a smaller amount of clean air, so a lower CDR, you could use that in a really small room and it would be fine because it will probably still replace all the air in that room, maybe every you know about every 12 to 15 minutes, which is a pretty good level. But if it has a much lower CDR, you’re putting it in a much larger room. You’re not going to have that same air exchange, you know, the same kind of replacement rate of all the air in the room. And so that’s, again, why we sort of say you need to not only look at the clean air delivery rate, but also look at the size of room. If you’re putting it in a massive room, you’re going to need a much higher clean air delivery rate to be able to replace all the air in the room and clean all the air in the room up to about four to five times an hour, which is ultimately the recommended replacement rate of the industry. And again, the reason for that replacement rate is because if you’re only replacing the air in your room, say, once an hour, you’re not actually keeping up with all of the newer pollutants that are coming in from outside. And so you know you’re still going to have higher levels of pollution.

So just a few things just to think about if an air purifier is going to be part of your solution, part of your toolkit in the future. Air quality impacts on children with asthma. So again as I mentioned earlier on like this is as I think we all understand a massive issue and you know numerous studies have really shown that polluted air can cause reduced lung function, increased rates of rescue, medication use, emergency department visits, hospitalizations. It’s not good. And so again you know, we just, we really need to focus on our children and how we protect them from these negative effects.

One of the reasons I’m really proud to work for Blueair is our founding mission was to produce high performing air purifiers that can, you know, ultimately protect children in the best possible way. But you know we’re not just about producing products. We also have a clean air for children initiative where we advocate in much the same way that the Asthma & Allergy Network do and that’s why they’re such a great partner for us. You know we advocate for awareness, for education to really kind of drive understanding of this issue. We also don’t need loads of products all around the world. There are different needs institutions for whether that be schools or local governments, but we really just make sure that those in need really do have access to air purifiers where they need them. And it’s hugely important. And unfortunately, in some cases what we see is those affected by these issues and those in certain areas where you know the environment is such that they’re going to have far higher levels of pollution. And there are those that are, perhaps, in dire economic straits and therefore can’t afford some of these solutions. So again, it’s just incredibly important that we all kind of come together to protect children, you know, really across the spectrum and across the world for these types of issues.

And now we’ll turn to Dr. Berger for some words on the September Asthma Peak.
William Berger, MD: Thank you and thank you for sharing this morning a little bit about how we can protect our children. As many of you know, September is a very challenging month. For kids with asthma, there’s been many clinical studies that have shown that asthma flares and unfortunately some of them require hospital or emergency room visits. We tend to see them mainly early to mid-September and then a slow decline in mid-October. An interesting statistic, about a quarter of all asthma hospitalizations and children are in the month of September. As a matter of fact, they’ve been able to actually pin down the third week of September as the peak week for hospitalizations and emergency room visits. As you can see, that week is coming up next week. So certainly we want to be aware of the fact that September is a peak month for asthma and our young kids.

Now the question of course then comes up, Why is September the asthma peak? Why does that happen during the month of September? Well, there are a lot of different factors that contribute to this finding. First, as we all know, those who have school aged children that when the kids get back to school they get exposed to all of the things that during the summer may not have been a problem, such as indoor mold, animal danders, and irritants that can affect the respiratory tract such as air pollution even from idling school buses.
In terms of pollen, weeds tend to be during the late summer and early fall months. Usually we can actually set our clock to August fifteenth as to the start of the ragweed season. That goes all the way through October through the first frost, first snow. And so we see high levels of ragweed and also mold allergens play an important role again during the late summer and early fall months.

We also then see children when they return to school, much greater exposure to other kinds of cold germs and viruses including flu and COVID-19. I’m located in Southern California and the big news story yesterday and will probably be for the next couple of weeks is that the influenza virus has taken hold so very early. Normally we don’t see it until later in the fall, early winter, so we are seeing it now. Influenza being a significant problem with children missing school and unfortunately some of them actually being hospitalized. As you know for asthma patients viral infection is a major trigger for asthma symptoms. Now, in terms of medication use, we know that when kids are out of school and they’re out playing and going to summer camps that there’s not a regular schedule of medication. With some obviously at greater risk. For asthma flares because they’re not taking their medications and this can be a problem when they return to school in September. And then you throw in more triggers such as germs and allergens, and you’ve got a real serious situation.

And for many young children when they’re starting school, there’s a lot of anxiety and stress. We’ve all had children. Remember that first year of school? When they’re there, there’s a lot of fear and concern about what the future holds for them. So and again, this is usually associated with a new school year, especially if there’s a change in schools. Children going from one school to another, or they’ve graduated and are now attending another. Again, this is another factor in terms of this September asthma.

Now let’s talk about some of the solutions. What are some of the ways that we can keep kids healthy during September? Absolutely. Well, the allergist will tell you that we get all of the requests for visits and for school forms so that patients can have rescue medications or if they have significant allergies to keep epinephrine injectable epinephrine in school. So the key is to schedule an asthma checkup with the child’s doctor before the school year begins. So August is usually a very busy time.

We’re helping patients to be up to date with their needs, medications for prescriptions for check up, or and evaluations in terms of medications. Make sure that all these medications are refilled but really don’t want to let them run out and then the child could go for a period of time without being treated. So make that a part of the start of the school year. And of course many of the medications are long acting as medications that are prescribed by the doctor needs to be taken on a regular basis to prevent asthma symptoms from occurring. And of course certain medications need to be kept at school. Most importantly, a quick release inhaler. The peak flow meter, as many of you know, is a device that allows you to measure lung function and when there is an Asthma Action Plan, using this device can help you signal there’s a lung problem on the horizon.

Now what else can you do? During the pandemic people have gotten a lot more used to washing their hands. Frequent hand washing hopefully will help to reduce the risk of catching a cold or virus and spreading it from one child to another. As many patients will tell you if they can identify and avoid their environmental triggers and certainly could decrease their exacerbation rate, their rate of having severe asthma symptoms. And pollen is out there regularly. Obviously, already in the country there is a lot of pollen and talking with the patient’s teacher, there might be a plan to stay inside on high pollen days so that there’s not the exposure that you would get from outdoor activities.
Get the flu vaccine this year. Looks like the flu vaccine is going to need to be given earlier. Waiting until November, December may not be the right plan. I would recommend getting the flu vaccine early this year as soon as possible. And obviously you want to stay up to date on COVID-19 vaccines. And if there are any boosters needed have those scheduled in addition and of course you know the regular immunization schedule for children should be followed.

Have your doctor or nurse practitioner or physician assistant work with you to develop an Asthma Action Plan so that when you monitor your child’s asthma and there’s a problem, you have a very good idea of what you should do. And it’s a really good idea to provide this as an action plan to the school nurse so they know what medications to administer, if any symptoms. The key is to maintain good asthma control throughout the entire year. Even though symptoms are better during the summer when you, as I mentioned, hit the fall months since they start to be a real problem again. So prevention is always the best way to deal with chronic medical problems such as now.

One of the things that we feel is very important is that children should be able to be involved in their care. We refer to that very often as Shared Decision-Making. So how can you approach it? What are some of the ways that you can include your child with asthma in managing their symptoms and to avoid flares? Well, first it’s very important to help them understand what they have. There are resources available to the Allergy & Asthma Network that help you work with your child, understand what the problem is, when to take medications, and how to take the medication. There have been studies that have shown that the majority of patients, including children, do not use their inhalers properly, so it’s important that delivery of medication.

I often would say to the people that you know, it’s great to have a great medication, but it’s not delivered appropriately. It’s not going to work. Respiratory medicine is unique in that the delivery of the medication is just the medication itself. I’ve got to tell the kids that if you order pizza and it goes to the wrong address, you’re not going to be able to enjoy it. So it’s the same thing with your medication. It isn’t delivered appropriately to the lung and you’re not going to get the benefit.

Also, help them to know what it feels like to have their asthma under control. Many people think that it’s normal for their child to cough or wheeze with exercise and would have problems. And in fact, the vast majority of children should be able to participate in a full and active life and obviously know what to do. That means what they should not be doing also. And as I mentioned before, it’s very important to renew, review with them how they use their inhaler. Showing them once is like showing an adult once how to program their DVD CR player. That’s what they’re still using. Usually within 10 minutes they forget. So I think you can make a deal. If you show them how to use an inhaler, they’ll show you how to use your iPhone. So ask something. But also make sure that your provider, whether it be a doctor or your PA, prescribes the valved holding chamber. Not only does it make it easier to use an inhaler, but also enhances its delivery into the airways of the lung. So as it says on the bottom, involve your children in the conversation. And the lifestyle that we have, and here you see a very happy family, obviously enjoying an excellent lifestyle.

Make sure that everybody in the family gets an annual flu shot. Now a lot of people will say, well, I haven’t had the flu. I really haven’t had any problems. Well, it’s unpredictable that there is no effective prediction this season. It’s going to be a very bad flu season. And of course, you know, if only one person gets the flu vaccine, the other people in the family still are exposed. And if no one gets the flu vaccine, then for example, mom or dad getting the flu, then transmitted to the child with asthma, so it’s important that everybody in the household gets the annual flu shot.

Reducing daily stress. Easier said than done, but obviously stress can sometimes aggravate asthma, so anything they can do to reduce that stress, certainly. Beneficial exercise. All children with asthma should exercise, and with proper treatment they should be able to have a full and active life. Getting enough sleep certainly factors in. Benefits to help asthma – healthy diet and good personal and social hygiene, especially as we talked about frequent hand washing especially. The COVID virus is still around. Everything that we just talked about is available in an infographic, which I think is excellent. This is available in the Allergy & Asthma Network. If you’re interested in getting this infographic on how to avoid the September Asthma Peak, you go on the internet to the Allergy & Asthma Network site, click on school on the navigation bar, and then school health. So that’s a little summary of some of the considerations you should have about this asthma peak that we see in September and things that you can do to keep your child.

Sally Schoessler: Well, thank you so much, Dr. Berger. Now we’ll move back to Suzy.

Suzy Kwiecien: Thank you, Dr. Berger. And I’d like to now spend some time talking about why it’s important for schools to have clean air standards and ultimately how we can all take action today to make this possible. So again, some more sort of surprising stats for everyone, but in the United States, the typical elementary age child spends 943 hours in school each year and the majority of that time is spent within a classroom and obviously as I mentioned earlier on in my presentation. We know the challenges with concentrations of pollution in an indoor environment. Unfortunately, many schools in the U.S. have high levels of PM 2.5 and PM tens. Those are some of those pollutants that I was talking about earlier. And unfortunately 50% of schools in the U.S. report poor air quality and so again, that’s a hugely high number I would never have thought it would be that high. The causes of this can vary, but include a lack of ventilation, reliance on old buildings, and consistent use of dangerous cleaning supplies in classrooms, all of which I’ve chatted with you about before.

Oftentimes, schools might be surrounded by structures that contribute to increased pollution, such as highways or construction zones. Again, as I sort of mentioned earlier, recent data shows that nearly 8,000 U.S. public schools lie within 500 feet of highways, truck routes, and other roads with significant traffic. So that’s about one in every 11 public schools and there’s only a handful of those states that actually require schools not placed next to environmental hazards and or busy roads. And furthermore, again as I sort of mentioned, earlier it is known that unfortunately, students attending public schools that are classified as high risk for equality are significantly more likely to be Hispanic, Black or Asian/Pacific Islander, or ultimately in other kinds of lower income. poorer areas. And when it comes to our pollution in schools, we’ve seen that, you know, students themselves are actually taking notice.

So over the last year or so, Blueair has been working with various different organizations in the U.S. and around the world to kind of talk to students in schools and poll them about their thoughts about indoor air quality and their concerns. And ultimately, we found that within the U.S., three in five children are worried about the impact of air pollution on their health. Ultimately, what we’re trying to do with this is take this, these facts and this petition to the United Nations and get the right to clean air added to the Children’s Bill of Rights. And ultimately that can then hopefully help to drive more policy and more ultimately action in this space. But I think the point still stands that you know, we as adults and protectors are aware of this issue, but the children themselves are also becoming keenly aware of it.

So yeah, so again as I already mentioned, the impact of poor air pollution on our children and on students manifests itself in both physical ailments like worsened allergies and asthma, as well as that cognitive impairment that can ultimately affect their ability to learn and concentrate within school. And, you know, studies have shown that children with asthma struggle more in class when they’re symptoms are well controlled and we’ve seen nearly 14 million school days missed each year in the U.S. due to asthma. So it makes it the number one reason that students ultimately miss school.

So how can we take action? And I think this is you know this is the big thing and obviously Dr. Berger sort of spoke about the medical and health areas that we can obviously pay attention to and take action with which to protect you know our children. But there are other things that we can do outside of this to sort of really halt the issue at its source ultimately. So, you know, during the COVID-19 pandemic, the federal government did allocate funds to help with infrastructure updates in schools, which allowed many schools and districts to replace their HVAC systems and purchase portable air purifiers. We ultimately believe that the federal government should take this a step further by creating a permanent federal standard for indoor air quality in schools. So, you know, really creating some minimums that everyone has to abide by. As part of those standards, as I mentioned earlier on, in order to combat air pollution you need to make sure you’re getting and utilizing the right devices to do that and have those devices working at a certain level in terms of performance. So again, kind of having some clear standards established and minimums that have to be met. If you are going to utilize air purifiers and other similar devices, we believe it is incredibly important as part of that. And in addition, you know, federal and state governments can consider providing resources and budget for public schools to upgrade HVAC systems, and ultimately continue to allow you know the schools to purchase additional air purifiers, air purifying technologies as well.

We can also take the opportunity to reduce pollutants in school zones by putting in place stricter rules around where schools can be built and implementing car free areas. I mentioned that earlier as well, one example that we shouldn’t go by is I think my mother tends to when she’s near a school. If she sees people parked outside with their engine running, she knocks on the window and tells them to stop, which I don’t think I would advise. I think we would be much better if we have some actual official standards in place to help manage that. So whether other actions that can be taken again include things like, you know, discontinuing the use of harmful, cleaning supplies, and ventilating classrooms as much as possible. You know, again, there’s sort of this laundry list of and checklist of things that we can do on the more basic level as well. Just, you know, simple things that can actually really help a lot.

So then on the more local level, I think there are several things that the EPA recommends school administrators, facility managers, teachers and even parents should do to improve indoor air quality and environments for students. From a management perspective, districts and schools can create those indoor air quality or IAQ management programs to establish processes for tackling air quality issues. So, for example, facilities. Managers should avoid deferring maintenance on each track system you know they should really keep. On top of that, you know they should be implementing portable air purifiers if possible, and potentially for those areas of schools that are, you know, more frequented, more highly trafficked. It’s also critical for schools to plan for emergencies such as extreme weather events, mold issues and other potential pollutants. So obviously we also have like two prominent allergy seasons every year. So what potentially could be done to sort of prepare for a known increase in pollen, which as we know is a known trigger? And teachers play a role here as well. So teachers can help to keep dust and dust mites minimal in their classrooms by sort of eliminating any kind of cloth or textile items wherever possible so things like curtains and rugs and other furniture, you know, this is the same at home, all of these things harbor dust and other allergens. And so ultimately, either if you’ve got to have them, keeping them well cleaned or ideally just getting rid of them altogether is the preferred approach.

Additionally, teachers should report maintenance issues immediately and if you do have an HVAC or air purifier, you really need to keep the area around them free of clutter and so that they can do their job properly. And again, in terms of any cleaning products, just really kind of using those with care or just making sure that they’re, you know, they’re specified in the right way so they are not harmful. And then for parents, you know communication is ultimately key, so keeping. Lines of communication open, especially if your child has, you know, allergies or asthma, and you can consider joining or creating an IAQ indoor air quality committee through your local parent teacher organization and really kind of advocating. Within the school you know to really kind of have a program and pay attention and have an agreed-upon checklist that everyone adheres to. So I think overall, as I’ve gone over the last few slides, there are a number of things that we can be doing to improve indoor air in our schools. I think it’s about, you know, being armed with the right information and then that as I said there are some things that are perhaps a little harder to get to, but as I have gone over there are a lot of things that are fairly low-hanging fruit that I think, again, if paid attention to you can create hugely beneficial impact on indoor air quality and in protecting our children.
So with that, I will hand this back to Sally now for our Q and A session.
Sally Schoessler: Well, thank you so much. So I’ve got to shift over here to the questions and thank you so much for all this great information. Someone’s asking the question – this one would probably be for Dr. Berger. I’m noticing many of the primary care physicians are not utilizing peak flow meters. If we have no base range on these students, how are we to use peak flow meters in our offices? In school?

Dr. Berger: Well, one of the resources that can provide you with information is the Allergy & Asthma Network and they have Asthma Action Plans that are accessible. But I would definitely ask the primary care doctor to provide you or direct you to get a flow meter and to develop. As natural and based on that, if they don’t have that capability, then what I would do is I would ask for a referral to a board-certified allergist that can provide you with that. That’s part of the literally the basic approach to children with asthma and adults. It’s set up an Asthma Action Plan based on flow. But yeah, if your doctor is not your primary care, the doctor is not able to do that. They have the responsibility to get you to someone who can’t do that.
Sally Schoessler: Ok, this next question is probably best directed to Suzy. What is your thought on classroom pets and how that affects indoor air quality?

Suzy Kwiecien: That’s an interesting question. I love it. Classroom pets. So I mean obviously pet dander is a pollutant. It can cause more issues in some people obviously who do suffer from asthma and allergies than others. So, you know, I think all of these things need to be taken in moderation so I think there are obviously benefits for children to kind of have a classroom pet. But equally if you’re going to do that then it’s making sure that you go through and have these steps in place that we talked about in terms of making sure you have good ventilation in the room, you know making sure there’s an air purifier there, etc., to sort of ultimately mitigate that. You know it’s having an indoor pet, something that’s going to come in, it’s going to introduce an allergen and it’s going to leave. So it is just important at the moment to make sure that you know you have things in place to deal with those additional pollutants that are going to be brought in. That said, if there is obviously anyone in the classroom who has, you know, severe asthma and allergy issues, I would say that’s probably a no at that point and really trying to avoid that because obviously that can then be a triggering event. So to be honest, use a checklist to mitigate it. Using common sense when it comes to the specific children and their elements that are in the classroom and tailoring having a classroom pet present accordingly.
Sally Schoessler: Ok, Dr. Berger, this one’s for you. I’ve noticed many doctors are not doing Asthma Action Plans. Most of my asthma clients do not have one. How do we educate a physician on the importance without offending them?

Dr. Berger: That’s a tough question. It is. That’s a tough question. My personal feeling is that as a physician, your first responsibility is to do what’s best for your patient. I think that primary care doctors have a very difficult situation. They have to take all comers. They are being asked to have a huge workload and certainly don’t have the time or experience to sometimes delve deeper into a particular medical problem again. There is nothing wrong with going to your primary care doctor and saying, look, this is what I believe needs to be done. I would be very happy to work with you if you cannot do this. And I’d like you to refer me to a board-certified allergist. You can do this because you know asthma is a very complex disease and there’s not sometimes an appreciation for it really. Depth of knowledge, you really have to have an experience to take care of it appropriately. So I don’t think it’s something that would be if a patient came to me and was having some joint problems. I’m certainly no expert in arthritis, but I would refer to rheumatologists, for example, because I want to do what’s best for my patient, not what’s best for me.

Sally Schoessler: Ok, thank you. Now, Dr. Berger, I’m aware that it’s the top of the hour and you need to leave.

Dr. Berger: Thank you. It’s no problem.

Sally Schoessler: Oh, OK. I just wanted to check. Our last question that we’re going to be able to take today is from a patient who says I have a 4-year old son. My bedroom apartment is facing the highway. I open the window twenty four seven because the air conditioner makes us sick sometimes. What’s your advice? This one could be for either one of you.

Dr. Berger: I’ll let Suzy take it first.
Suzy Kwiecien: Ok, yeah, so that’s a tricky one because I completely agree having the window open is going to help you with ultimately your AC issues and help ventilate. But then you are bringing in air pollutants at the same time. I mean, I would advocate for having an air purifier running 24/7 in the room, potentially having the door closed, but the window because you want to ideally what ideally in an ideal situation, you would create a closed environment. So you would just close your windows for the bedroom at night, you would close your door and you would have your air purifier running because then that would keep ultimately the outside pollutants out as much as possible given you have a direct source, right? Outside your window, obviously you have this AC issue.
My advice would be to, even with that, try keeping the window closed and have an air purifier running maybe on high 24/7 in the room in the bedroom, especially if you have had it turned off. Especially turn it on a little while prior to going to bed so that it clears the room and see how that does for you. If it should clear any of the issues that the unit is producing, but if not then you can potentially crack the window a little bit and the air purifier should do the job of cleaning anything that comes into the room from outside and inside. It’ll be a little bit of a trial and error for you given the AC impacts on you, but I would say try it. Try a full room closed first, and then see how you get along.
Dr. Berger: I agree with everything that Suzy said, this is the classic case of being caught between a rock and a hard spot. But in addition, from a medical point of view it is because of the fact that there are various different types of irritants and pollutants that it’s even more critical that you approach the asthma in terms of prevention, to make sure that the doctor prescribed the medications of the impact once or twice a day. Make sure you take it every day and get immunized with the flu vaccine. Do everything you can to stabilize asthma so that they’re less susceptible. Kind of like if you put alcohol on somebody’s hand, it’s not going to hurt too much, but if you have an open wound with alcohol in it, you’re going to jump. It burns. The same thing here if you can prevent the inflammatory process from getting out of control, which can happen in asthma. But if you keep the inflammation under control, then there’ll be less sensitivity to environmental irritants.

Sally Schoessler: Well, thank you so much and thank you to both of our speakers for all the information today. And we really enjoyed having a really good look at improving indoor air quality. And we’d like to extend a special thank you to our partners blue air for sponsoring today’s webinar. Blueair was founded on the firm belief that the freedom to breathe is a basic right. So please join us for our next webinar on September 15 when we look at ‘COVID Isn’t Over: Rebound Infections, New Guidance and More,’ please join us at 4:00 PM eastern time. Please stay on the line for 2-3 minutes to complete an evaluation survey. We review your comments and incorporate them into future webinar planning. Thank you again for joining us. This is Sally Schessler for the staff at Allergy & Asthma Network. Join us as we work to improve indoor air so we can all Breathe Better Together.