Breathe Easy - Airway Disease from the Home and Home Environment Lawrence Martin, M.D., FACP, FCCP The watchword for the 1990s and beyond is "environment." Everyone knows about air and water pollution, dumping in our rivers and streams, the dangers of global warming, depletion of ozone, etc. But where do we spend most of our time? In the home, of course. Pictures of Los Angeles smog or New Jersey chemical pollution always focus on the outdoors, as if the bad air somehow stops at your front door. In truth, the house environment can account for many illnesses, from minor irritations to asthma, to severe, debilitating disease. Asthma and other airway diseases can occur from the home. This situation is not confined to old, musty houses, by any means. Some of the worst problems occur with new houses. As already discussed, the basic cause of asthma is not known, but we know many triggers of an asthma attack. Surprisingly, many of these triggers are in the home, including:
- house mites
- cockroach and other insect parts
- cleaning chemicals
- carpets
- air conditioners
- humidifiers
- ordinary house dust
- formaldehyde (new construction)
- paint
- pets
- passive cigarette smoke
Again, it is important to distinguish between the root cause of asthma and the trigger of an attack. People who have asthma can develop an attack from many triggers. Thus you may have asthma and your doctor says you react, or have an allergy to your cat. So you get rid of the cat but you still wheeze on occasion, and mainly at home. Well, your asthma didn't go away; you just got rid of one of the triggers, your cat. Now, you may be reacting to the carpet, or cockroach parts, or even house dust. Sometimes you can't find out what the culprit is. You can remove a cat and take up the carpeting, but you can't get rid of house dust. So if you've cleaned up the house as much as possible, your only recourse may be to take medication for symptoms. The problem is, many people don't clean up the house. The houses of asthmatics are often filled with "triggers." A few are listed above. I recommend a professional cleaning service. Don't underestimate the role of passive smoke. If a man or woman with asthma is to be in a clean environment, that means the spouse or other people in the house must quit smoking completely. Smoking confined in the garage or in the basement may help, but smoke will still find its way into the house, especially on the clothes of the smoker. Woman have contracted fatal asbestos disease from cleaning the asbestos-laden clothes brought home by their husbands. This is a silent killer if ever there was one. He brings the clothes home, she washes them, and two or three decades later they're both dead from asbestos. This problem is rare today, but don't discount something your spouse may be bringing home. Many people are sensitive to allergens given off by cockroaches. This is a particular problem in the south, where cockroaches are more prevalent. One allergy clinic in New Orleans found 50% of asthmatics reacted to skin tests made from cockroach parts. In other parts of the country, people may react to parts of butterflies and moths (in Japan they react to silkworms). You can't get rid of house dust but you can protect against cockroaches. But choose your exterminator carefully. Many asthmatics also react to insecticide. If you have asthma and are concerned that something in the house may be triggering attacks, consult an allergist. But a word of caution. Some doctors practice allergy without special training in the field. It is difficult to sometimes interpret the skin tests many allergists use, and specialized knowledge can be helpful. If you consult an allergist I recommend you choose one who is board certified in the field.
WHAT ABOUT AIRWAY IRRITANTS IN THE HOUSE? THE CASE OF BETTY S. Betty S. is a 50-year-old artist with a studio in her home. She specializes in abstract oil painting and has built up a nice collection of art over the years. She came to see me one day complaining of peculiar chest symptoms. However her family history was negative, and she did not smoke. "Tell me again what your symptoms are." "In my studio at home I develop this raw feeling in my lung area." She pointed to her breast bone. "It's like an irritation." "Do you cough?" "No, that's not a problem." "Do you smoke?" "No." "Any family history of asthma?" "No."
Her symptoms sounded like asthma. To rule out this possibility we did all the usual tests: breathing tests, chest x-ray, some blood tests - all were normal. When I explained the results Betty looked worried. "Is it in my head?" she asked. "Not at all. Your story was too consistent to be made up or psychosomatic. Let's try an experiment." Betty spent a week at her mother's and the symptoms went away. Then she went back home, but not to her studio, which was a large room in the back of her house. Within 24 hours of returning home her symptoms came back. Chest irritation and burning. I saw her a few days later. "Why do I feel so bad? Should I see a psychiatrist? I know I feel something but I haven't been in the studio in almost two weeks?" "Do friends feel the same things when they come over?" "No, she said, but they can smell turpentine in the house. It just doesn't bother them, I guess." We talked some more. It seems that she had kept some sort of studio in her house for over 20 years. For the first few years it was actually in the front of the house, then it was moved to the back. Betty admitted that "the walls are impregnated with all my chemicals." So the problem was apparent. Having ruled out any specific disease, I came to the conclusion Betty had "chemical irritation." Moving to a different room of the house would not work. The problem was throughout the house. It would probably not bother most other people but after all these years it was finally getting to Betty. I laid it out to her. "Look, I said, this is pretty drastic. But if you want to get better you have to move out of your house and give up painting." I expected a rebuttal but there was none. "I know, she said. I have come to that same conclusion."
Betty sold her house - a lovely bungalow in the country. She did give up oil painting but went into watercolors - and has not been bothered since.
WHAT ABOUT THE ENVIRONMENT NEAR THE HOME? Dioxin in Missouri. Love Canal in Niagara, New York. Arthur Kill in New Jersey. These names in yesterday's headlines all have two things in common. They were the site of major chemical dumps in the last half century. And homes were built on top of landfill over these dumps. You could spend a lifetime researching the history of chemical dumps, the illnesses that have resulted from them, and the lawsuits they have engendered. For each family uprooted from their home, for each child or adult who came down with leukemia, or chronic respiratory illness as a result of cancer, these dumps have spelled personal tragedy. Are we smarter in the 1990s than in the 1960s, 70s, and 80s? Hardly. Consider: From the Wall Street Journal, February 25, 1992, in a story headlined: "U.S., Mexico Take On Border Pollution":
The bustling industrial corridor just inside Mexico's border with the U.S. has attracted explosive development - and environmental devastation. Factories in Ciudad Juarez, Mexico, across the Rio Grande from El Paso, Texas, burn tire for fuel. Residents howl about the strain on the border region's spotty infrastructure of sewage plants, water systems, roads and bridges. The American Medical Association describes the region as a "virtual cesspool." ...In the rainy season, effluent from Nogales, Mexico - whose population has jumped tenfold to 300,000 in two decades - runs down the hillsides into Nogales, Ariz., which now has rate of hepatitis 20 times the national average...In testing sewage, the county found live polio viruses and other viruses and parasites in high numbers...Another concern was contamination of some 100 private wells, including those used by produce packing houses to make ice that accompanies much of Mexico's vegetables and fruits.
We tend to think of community pollution as "out there" when, in fact, it often hits home. Sure, you can air condition your house, buy humidifies and air purifiers, but at some point it can begin to affect your castle, your home. Contaminated well water - from Mexico? Mexican and American alike should be alarmed at the possibility of hepatitis developing from contaminated well water. | 
