Environmental Testing & Monitoring CAC Paul Detjen M.D. - PowerPoint PPT Presentation

Environmental Testing & Monitoring CAC Paul Detjen M.D. November 2016

Con3lict of Interest

Importance of The Environment We Know the Symptoms Skin Test Environment We know the Skin Tests The Problem Today: limited insight into our paDents’ Symptoms indoor environments

Allergic vs Nonallergic Asthma • Symptoms: Is it Asthma? • Treatments: Are they effecDve? • ComorbidiDes: Chronic SinusiDs GERD • Environment: Pets Dust Mold Pollen • Triggers: Irritants high? Irritants normal? • Avoidance: Does it work?

How do we get information today? • PaDent History - AssumpDons - Educated Guesses • Pollen and Mold Counts - Surrogates, Not Local • Industrial Hygiene - Mold • Research Dust Sampling - Not Air

Assumptions: “Mold” questions from CME article • Do your symptoms get worse when you are in an environment with visible mold? • Do your symptoms get worse when you visit an old house or building? • Do your symptoms get worse when you enter a basement or other damp environment? • Do your symptoms get worse aRer rain storms? • Do your symptoms get worse aRer you mow the lawn, rake leaves, or work with compost or hay? • Do your symptoms get worse when you are in buildings with a moldy or musty smell? • Do your symptoms get worse during the late summer and fall? - JACI-IP 4(3):405-414, 2016

OR We could just measure the allergen

We need to know both the irritants & the allergens in patient’s indoor air. The information should be accurate, meaningful, and local for more personalized patient management.

The Landscape is Changing Irritants Allergens

Measure Irritants that Exacerbate Asthma Name Type Sensors Price In Market Birdi Real Time Smoke, CO, PM 2.5, $120 Nov 2016 Humidity, Temperature, Ambient Light Humidity, Air Quality, $100 Available Netatmo Real Time Noise, Temperature Home Air Lab TesDng Formaldehyde, VOC, $100- Available Tobacco 200 Check Alersense Real Time ParDcles, Humidity, VOCs, $250 Unknown Temperature Uhoo Real Time Temperature, Humidity, $300 April CO2, VOC, PM 2.5, Air 2017 Pressure, CO, Ozone Foobot Real Time VOC, Humidity, PM 2.5, $200 Available Temperature

EPA: VOCs • VolaDle organic compounds (VOCs) are emided as gases from certain solids or liquids. • VOCs include a variety of chemicals, some of which may have short- and long-term adverse health effects. • ConcentraDons of many VOCs are consistently higher indoors (up to ten Dmes higher) than outdoors. • Organic chemicals are widely used as ingredients in household products. All of these products can release organic compounds while you are using them, and, to some degree, when they are stored.

Sources of VOCs • wood preservaDves • paints, paint strippers and other solvents • aerosol sprays • cleansers and disinfectants • moth repellents and air fresheners • stored fuels and automoDve products • hobby supplies • dry-cleaned clothing • PesDcide • building materials and furnishings • office equipment such as copiers and printers, correcDon fluids

VOCs - Health Effects • eye, nose and throat irritaDon • headaches, loss of coordinaDon and nausea • damage to liver, kidney and central nervous system • some organics can cause cancer in animals, some are suspected or known to cause cancer in humans. • allergic skin reacDon • dyspnea • declines in serum cholinesterase levels • nausea, emesis • epistaxis • faDgue • dizziness

Standards or Guidelines “No federally enforceable standards have been set for VOCs in non-industrial sejngs.” Measured in part per billion, WHO advises a maximum VOC level of 300ppb.

CO – Carbon Monoxide • CO is found in fumes produced any Dme you burn fuel in cars or trucks, small engines, stoves, lanterns, grills, fireplaces, gas ranges, or furnaces. CO can build up indoors and poison people and animals who breathe it. • The most common symptoms of CO poisoning are headache, dizziness, weakness, upset stomach, vomiDng, chest pain, confusion and death. • Each year, more than 400 Americans die from unintenDonal CO poisoning not linked to fires, more than 20,000 visit the emergency room, and more than 4,000 are hospitalized.

Measure Irritants that Exacerbate Asthma Name Type Sensors Price In Market Birdi Real Time Smoke, CO, PM 2.5, $120 Nov 2016 Humidity, Temperature, Ambient Light Humidity, Air Quality, $100 Available Netatmo Real Time Noise, Temperature Home Air Lab TesDng Formaldehyde, VOC, $100- Available Tobacco 200 Check Alersense Real Time ParDcles, Humidity, VOCs, $250 Unknown Temperature Uhoo Real Time Temperature, Humidity, $300 April CO2, VOC, PM 2.5, Air 2017 Pressure, CO, Ozone Foobot Real Time VOC, Humidity, PM 2.5, $200 Available Temperature

First of Its Kind – Measure Actual Exposure to Airborne Allergens

My Experience with Exhale