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

Environment Symptoms Skin Test

We Know the Symptoms We know the Skin Tests The Problem Today: limited insight into our paDents’ 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
• ther 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, Humidity, Temperature, Ambient Light $120 Nov 2016

Netatmo Real Time

Humidity, Air Quality, Noise, Temperature $100 Available

Home Air Check Lab TesDng

Formaldehyde, VOC, Tobacco $100- 200 Available

Alersense Real Time

ParDcles, Humidity, VOCs, Temperature $250 Unknown

Uhoo Real Time

Temperature, Humidity, CO2, VOC, PM 2.5, Air Pressure, CO, Ozone $300 April 2017

Foobot Real Time

VOC, Humidity, PM 2.5, Temperature $200 Available

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

• utdoors.
• 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, Humidity, Temperature, Ambient Light $120 Nov 2016

Netatmo Real Time

Humidity, Air Quality, Noise, Temperature $100 Available

Home Air Check Lab TesDng

Formaldehyde, VOC, Tobacco $100- 200 Available

Alersense Real Time

ParDcles, Humidity, VOCs, Temperature $250 Unknown

Uhoo Real Time

Temperature, Humidity, CO2, VOC, PM 2.5, Air Pressure, CO, Ozone $300 April 2017

Foobot Real Time

VOC, Humidity, PM 2.5, Temperature $200 Available

First of Its Kind – Measure Actual Exposure to Airborne Allergens

My Experience with Exhale