Richard R. MacMahon, Ph.D.
(This entire section should be xeroxed and given to students, particularly those who are asthmatic)
There are a number of simple actions that anyone may take to lessen the exposure to environmental triggers at home. Most young children spend up to 50% of their time in their bedroom. This an ideal place to start to defend oneself against the triggers of asthma.
If you are asthmatic, you need a bedroom of your own. Sharing a bedroom with a sibling or other relative is simply not acceptable. So the first job you have is to convince your parents that you need and deserve a bedroom for yourself. I realize that all families may not have sufficient income to do this. However, a small room may be rather easily and inexpensively framed and sheet-rocked by almost anyone. And in the long run, giving you a room of your own will pay for itself in time and money saved from the emergency room and doctor.
If you ask at a store such as Home Depot or Lowe's, you will find someone who can explain what needs to be done and exactly how much it will cost. They will usually have booklets available for free that will show you the exact procedure. The cost of medical visits and medicines is not cheap. You should be able to pay for the room with money saved. Finally, additions such as a room in your home may require a permit from your city or town. You must check on this before you begin your project.
You have the right to a smoke-free environment. If there is anyone in your family who smokes, you need to strongly request that the smoking takes place out of doors. Simply going to another room to smoke does not do the trick. House insulation makes our New England homes too air-tight. The tobacco smoke will permeate the house and there will be exposure. I know this is another hard thing to convince your parents of, but you need to try. Again, there should be money-saving benefits from doing this.
The key to this situation is education. You must become the teacher and teach your parents how asthma triggers affect the bronchioles and why even a small amount of tobacco smoke may induce an asthmatic response. You must then explain the absolute necessity of smoking only outdoors. There is overwhelming evidence that tobacco smoke is one of the primary triggers for asthma (Gergen
et al
, 1998; Abulhosn et al, 1997; Etzel, 1995; Kovesi, 1996a). What arguments might you use to convince your parents? First and foremost is the health argument. The fewer asthma attacks you have, the better your chances of outgrowing asthma completely by the time you are an adult. Secondly is the economic argument. Emergency room or doctor's office visits cost money. Medicines are not free. The healthier you stay, the less it will cost your parents. Finally, your house will smell better and be cleaner if it is a tobacco-free environment.
So what can you do to improve the quality of the air in your own bedroom? To begin with, remove as much from the room as you can. The simpler the room is kept, the less there will be to collect dust and encourage dust mites. This includes removing the rug from the floor, posters from the walls, excessive books and all magazines. Clothes should all be stored in the closet and dresser. Do not leave clothes lying around the room. All dirty clothes need to go in a laundry hamper or laundry bag, which should not be kept in the bedroom.
The main source of food for dust mites is you. All of us constantly shed dead skin cells. As these fall to the floor and onto our bedding, they provide food for dust mites. One of the most effective ways of limiting dust mites is to obtain mattress and pillow covers that do not allow skin cells and dust mites through. These covers may be found in any store that sells bedding, and are not expensive. If you cut off most of the food supply to the dust mites, you will reduce their population and thus their effect on you! Dust mites also need moisture. Keep your room as dry as you can. This by itself will limit the dust mite population.
In addition to dust covers for the mattress and pillows, you must be sure to change the bedding every week and wash it in hot water; and to damp mop the room as often as you can - at least twice a week. Do not dry mop! All this does is stir up the dust that is present, and along with the dust, the mites! This may sound too complicated a weekly procedure. I assure you it is not. Once you initially get the room clean, it is rather easy to keep it that way.
If your room is your refuge, what other things might you do to keep it as clean as possible? There are dust filtering machines - expensive. Here are some practical answers. Change into something like sweats when you enter the house. Keep the sweats in the bathroom, back hall, someplace that is not your room. Make sure you change your shoes. A great deal of dirt and contamination is carried on shoes. When the shoes dry out in the house, the dirt falls off.
Keep the door to your room closed. There are simple screen-door springs that cost very little. You can get one at the hardware store. Install this spring yourself with just two screw eyes and a screwdriver. Your door should always close by itself. You can also purchase foam weather stripping for your door very inexpensively at the hardware store. You can easily install this, and it will keep a certain amount of dust and dirt out of your room.
Finally, you have to face some hard facts. You know more about asthma than anyone else in your family. After all, you are the one who suffers from the condition. Your parents are not at fault for anything, but probably feel some guilt that you suffer from asthma. You must make them understand in a kind and gentle way that it is imperative that no one smokes in the house, that you have your own room, even if small and that your room must be private. If your room is invaded by your siblings all the time, or if your mother lets the cat or dog in there to take a nap, you are not going to gain the benefits that a clean, relatively dust-free room offers you.
On the next three pages are some class exercises that will demonstrate some aspects of the trigger problem.
Appendix A
Dust mites in your Bedroom
We have talked some about dust mites being the major environmental trigger in our homes. Have you ever seen a dust mite? How do you think you might be able to see one? (Would you want to see one?) This exercise is designed to show you actual dust mites, and these from your own home. This is a very simple exercise.
Procedure:
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1. Obtain two clean facial tissues and a clean envelope at home.
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2. Take one of the facial tissues and wiggle under your bed.
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3. Wipe up the dust from the floor as near under your pillow as possible
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4. Wriggle out from under the bed.
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5. Fold the tissue so that the dust is inside.
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6. Wrap the tissue in the second tissue and place in the envelope.
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7. At school, open the inner tissue
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8. Using a pair of forceps, place a small amount of the dust on a slide.
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9. Add one drop of methylene blue stain and examine under the microscope.
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10. Look for dust mites. For pictures and a detailed discussion of dust mites see Bodanis (1986)
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11. Try to draw what you see. How many pairs of legs does a dust mite have? What class of arthropods does a dust mite belong to?
Write up a laboratory report on this exercise for tomorrow. Be sure to include your drawings of what you saw. Were dust mites the only living thing present? What else did you see?
Air-borne pollutants
There are a large number of things in the air that might be triggers for asthma. If these are chemical molecules, we probably cannot show them to you. But how about particulates? These particles are mostly visible with a microscope, if you just know how to visualize them. So let us set up an experiment to trap and accumulate air-borne particles.
Equipment and supplies needed: Fan and prepared petri dishes
Procedure:
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1. Set up a small fan aimed at 8 petri dishes. Each petri dish should contain a 1% nutrient agar with 2% sucrose.
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2. Adjust the pH of the agar in four of the petri dishes to pH=5.5.
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3. Place all of the petri dishes in front of the fan. Keep one of each type covered, uncover the other six.
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4. Start the fan and let it blow continually on the petri dishes for a period of 12 hours. At the end of that time, cover all of the petri dishes.
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5. Place the control (the dish left covered) and two others of each type in an incubator at 90°F. Leave them for forty eight hours. Place the other Petri dishes in a drawer and leave them for 48 hours.
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6. Examine two of the Petri dishes immediately. Where there is discoloration of the agar, scoop up a small sample with a toothpick and make several slides. Use methylene blue stain on some of the slides. What do you see? What do you think was in the air?
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7. After 48 hours examine all of the Petri dishes. Is there a difference between the incubated and non-incubated dishes? Draw a sketch of one of each type of dish; incubated, non-incubated and control.
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8. If there is a stereo dissecting microscope available, examine the cultures under magnification. What do you see?
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9. Prepare slides from each type of culture and examine them under the microscope. What do you see? Make sketches.
Write up a laboratory report on this exercise for tomorrow. Be sure to include your drawings of what you saw. What did you see?
Chemical Pollutants in the Air
Have you ever noticed that many objects have an odor about them, especially when new? When you get into a new car there is definitely a distinct odor. If you remove the lid from a new plastic container there is certainly an odor. These odors come from the catalyst materials that were used to polymerize the plastics, or from other organic compounds added to make the product retain its flexibility, remain slippery or for some other reason.
These compounds may be biologically active, either as carcinogens or as hormone mimics or as asthma triggers. And over time, they leach out into the surrounding environment. That is why you can smell them when the product is new. But how about when the product is several years old? Are these dangerous compounds gone? Maybe we can find out. This is an extremely easy experiment.
Equipment and supplies needed: Microwave oven, old plastic containers with lids and some clean old polyester carpeting, (4" x 4").
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1. Make sure the piece of polyester carpet is clean. If not, wash it in detergent and water and be sure to rinse it thoroughly and dry it.
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2. Place a plastic container with the lid on in the microwave oven. Heat the container for thirty seconds.
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3. Gently open the container and cautiously smell the insides. Careful! Remember this is poisonous! Do not sniff if you are asthmatic!! What do you smell? Is the odor a "plastic smell"? Describe the odor. If you think this is too harmful an experiment, you do not have to sniff the container.
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4. Place the clean dry piece of carpet in the microwave. Heat it for thirty seconds. Does it have an odor? what is the odor like? Describe the odor. How much of the odor is simply dirt in the carpet? Can you detect any odor that could be from an organic catalyst?
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5. For the next class, each student should bring in something that they think will give off an odor when microwaved. Try some of the samples. If the teacher thinks the sample might in any way present a danger, do not microwave it!.
Write up a laboratory report on this exercise for tomorrow. Be sure to include a table of data - what was heated and how it smelled.
Appendix B
Teacher's Notes for Lesson Plans
Below I have included some notes that may help teachers with preparing and using the three included class exercises.
Dust Mites in your Bedroom:
1. Dust mites are very small. Your students may not be able to see much under the microscope. Check the book by Bodanis. There is a good photograph in there that you should be able to xerox for your classes to see.
2. Methylene blue stain is a stain. If students get it on clothes or shoes it may not come out easily. This stain is generally available from biological supply houses. If it spills on fingers, it will persist for a few days. Washing does help.
3. Dust mites are related to other mites, spiders, scorpions and ticks. They are in the Arachnid group of the Arthropods. Dust mites have four pairs of legs.
Air-Borne Pollutants:
4. If you have no way to prepare petri dishes, you can obtain them already prepared and ready to go from a biological supply house. Otherwise, they need to be autoclaved and sterility maintained as much as possible.
5. Your students should see a number of bacterial and fungal colonies. If the fungus is black it is probably Aspergillus. If it is greenish-blue, it is probably Pennicillium. The bacterial colonies could be any color. Although they were air-borne and are probably common, they may be more toxic in a colony. Have your students take only a small amount on a tooth-pick for examination.
Chemical Pollutants in the Air:
6. This lab seems very simple. However, it may be too risky to try, especially with a group of immature students. The fumes from the heated plastic may make some student or you sick. It is probably better if you, the teacher, try this out first. You should be able to find some carpet and plastic containers that will not asphyxiate the class when heated.
Other Exercises that might be Included:
7. Have all the asthmatics do a detailed study of their environment. Be careful! Not all asthmatics are willing to admit to asthma, and most do not wish to be identified as asthmatic.
8. Have the lab class administer this survey to the entire school and analyze the results.
9. Have the class try to find out what causes the odors? i.e. the contents of plastics that volatilize or the chemicals released from carpet? How about perfumes?
Appendix C
Asthma Survey
This survey is being conducted in order to characterize our school population with regards to asthma. All information given is voluntary and confidential. Only the total numbers will be used for statistical analysis. We will use the statistics from the survey to profile the status of asthma at HSC. The survey forms then will be destroyed and there will be no permanent record identifying any student. Would you please answer the following questions. Circle the closest value or Fill In the answer
Neighborhood (optional) _____________________________________
Grade 9 10 11 12
Gender Female Male Your Age __________
Number of Sisters ____________ Number of Brothers ______________
How old is the house you live in? 10 20 30 50 70 90 100+
How many parents do you live with? 1 2
If there is only one parent, is the parent Woman Man
Income of parents Below 20,000 21,000 - 50,000 50,000 - 95,000 +
Do your parents smoke? No Mother Father
Did parents smoke when you were born or were young? Yes No
Have you ever seen a doctor about asthma? Yes No
Have you been hospitalized or to the emergency room because of asthma?
Yes No
Do you have asthma? Yes No
(If no, you may stop here, and we thank you for your help.)
Are you currently taking medications for asthma? Yes No How Many? _______
What are your current medications?
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beta agonist (albuterol, terbutaline, pirbuterol, etc.)
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cromolyn
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Others ____________________
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inhaled steroid
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bronchodialator
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How many days did you miss from school last year because of asthma? ______
Does an asthma attack make you Anxious Angry Depressed? Other _______ ?
What kind of heat does your home have?
Oil (hot water, steam, or baseboard) Forced hot air Wood stove Kerosene
Are your floors covered with:
a. Wall to wall b.Carpet c.Area rugs d.Wood e.Vinyl f.Tile g.Other_
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Indicate which room has which type of floor covering (use a., b., etc.)
Your bedroom ___ Living room ___ Kitchen ___ Rest of house _____
How would you characterize your diet?
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Much fat and carbohydrate Mostly proteins and fiber
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"Average" food
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Vegetarian
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What is your height _________ ? weight __________ ?
How often do you eat fresh vegetables?
twice per day once per day three times a week less than 3 times/week
Do you regularly eat breakfast? Yes No
Do you regularly eat lunch? Yes No
Do you engage in any sport or form of exercise? Yes No
If Yes, what form of exercise? _____________________________
Do you have any specific allergies? Yes No
If Yes, to what are you allergic? ____________________________
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Anything else you would like to tell us or comment on? ____________
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Thank you very much for completing this survey. We will try to publish the results for all students to see when we are finished.
R. R. MacMahon
