Indoor air quality and health in schools

Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD)

BACKGROUND

This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation.

METHODS

We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months.

RESULTS

97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project.

CONCLUSIONS

There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation.

Investigating seasonal air quality variations consequent to the urban vegetation in the metropolis of Faisalabad, Pakistan

Urban atmospheric pollution is global problem and and have become increasingly critical in big cities around the world. Issue of toxic emissions has gained significant attention in the scientific community as the release of pollutants into the atmosphere rising continuously. Although, the Pakistani government has started the Pakistan Clean Air Program to control ambient air quality however, the desired air quality levels are yet to be reached. Since the process of mapping the dispersion of atmospheric pollutants in urban areas is intricate due to its dependence on multiple factors, such as urban vegetation and weather conditions. Therefore, present research focuses on two essential items: (1) the relationship between urban vegetation and atmospheric variables (temperature, relative humidity (RH), sound intensity (SI), CO, CO2, and particulate matter (PM0.5, PM1.0, and PM2.5) and (2) the effect of seasonal change on concentration and magnitude of atmospheric variables. A geographic Information System (GIS) was utilized to map urban atmospheric variables dispersion in the residential areas of Faisalabad, Pakistan. Pearson correlation and principal component analyses were performed to establish the relationship between urban atmospheric pollutants, urban vegetation, and seasonal variation. The results showed a positive correlation between urban vegetation, metrological factors, and most of the atmospheric pollutants. Furthermore, PM concentration showed a significant correlation with temperature and urban vegetation cover. GIS distribution maps for PM0.5, PM1.0, PM2.5, and CO2 pollutants showed the highest concentration of pollutants in poorly to the moderated vegetated areas. Therefore, it can be concluded that urban vegetation requires a rigorous design, planning, and cost-benefit analysis to maximize its positive environmental effects.

Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD)

Background

This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation.

Methods

We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months.

Results

97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project.

Conclusions

There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation.

Issue 2 - "Update on adverse respiratory effects of indoor air pollution" Part 1): Indoor air pollution and respiratory diseases: A general update and a Portuguese perspective

OBJECTIVE

To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population.

RESULTS

Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances.

CONCLUSIONS

Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.

A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies?

PURPOSE

We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy).

METHOD

A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f0, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]).

RESULTS

No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P = 0.011) and spontaneous speech f0 increased (P = 0.024) after the therapy and [a:] SPL increased (P = 0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P = 0.012) and spontaneous speech f0 decreased (P = 0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P = 0.003; Trad P = 0.01) but only in Carryover at follow-up (P = 0.000). Voice symptoms decreased in the Carryover group post-therapy (P = 0.001) and at follow-up (P = 0.000) and after Controls' eight-week non-therapy period (P = 0.003).

CONCLUSION

The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group's voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.

Carbon dioxide effects on daytime sleepiness and EEG signal: A combinational approach using classical frequentist and Bayesian analyses

Environmental carbon dioxide (CO₂ ) could affect various mental and physiological activities in humans, but its effect on daytime sleepiness is still controversial. In a randomized and counterbalanced crossover study with twelve healthy volunteers, we applied a combinational approach using classical frequentist and Bayesian statistics to analyze the CO₂ exposure effect on daytime sleepiness and electroencephalogram (EEG) signals. Subjective sleepiness was measured by the Japanese Karolinska Sleepiness Scale (KSS-J) by recording EEG during CO₂ exposure at different concentrations: Normal (C), 4000 ppm (Moderately High: MH), and 40 000 ppm (high: H). The daytime sleepiness was significantly affected by the exposure time but not the CO₂ condition in the classical statistics. On the other hand, the Bayesian paired t-test revealed that the CO₂ exposure at the MH condition might induce daytime sleepiness at the 40-min point compared with the C condition. By contrast, EEG was significantly affected by a short exposure to the H condition but not exposure time. The Bayesian analysis of EEG was primarily consistent with results by the classical statistics but showed different credible levels in the Bayes' factor. Our result suggested that the EEG may not be suitable to detect objective sleepiness induced by CO₂ exposure because the EEG signal was highly sensitive to environmental CO₂ concentration. Our study would be helpful for researchers to revisit whether EEG is applicable as a judgment indicator of objective sleepiness.

Low Level Carbon Dioxide Indoors—A Pollution Indicator or a Pollutant? A Health-Based Perspective

With modern populations in developed countries spending approximately 90% of their time indoors, and with carbon dioxide (CO2) concentrations inside being able to accumulate to much greater concentrations than outdoors, it is important to identify the health effects associated with the exposure to low-level CO2 concentrations (<5000 ppm) typically seen in indoor environments in buildings (non-industrial environments). Although other reviews have summarised the effects of CO2 exposure on health, none have considered the individual study designs of investigations and factored that into the level of confidence with which CO2 and health effects can be associated, nor commented on how the reported health effects of exposure correspond to existing guideline concentrations. This investigation aimed to (a) evaluate the reported health effects and physiological responses associated with exposure to less than 5000 parts per million (ppm) of CO2 and (b) to assess the CO2 guideline and limit concentrations in the context of (a). Of the 51 human investigations assessed, many did not account for confounding factors, the prior health of participants or cross-over effects. Although there is some evidence linking CO2 exposures with health outcomes, such as reductions in cognitive performance or sick building syndrome (SBS) symptoms, much of the evidence is conflicting. Therefore, given the shortcomings in study designs and conflicting results, it is difficult to say with confidence whether low-level CO2 exposures indoors can be linked to health outcomes. To improve the epidemiological value of future investigations linking CO2 with health, studies should aim to control or measure confounding variables, collect comprehensive accounts of participants’ prior health and avoid cross-over effects. Although it is difficult to link CO2 itself with health effects at exposures less than 5000 ppm, the existing guideline concentrations (usually reported for 8 h, for schools and offices), which suggest that CO2 levels <1000 ppm represent good indoor air quality and <1500 ppm are acceptable for the general population, appear consistent with the current research.

Addressing COVID-19 contagion through the HVAC systems by reviewing indoor airborne nature of infectious microbes: Will an innovative air recirculation concept provide a practical solution?

As the world continues to grapple with the reality of coronavirus disease, global research communities are racing to develop practical solutions to adjust to the new challenges. One such challenge is the control of indoor air quality in the COVID-19 era and beyond. Since COVID-19 became a global pandemic, the "super spread" of the virus has continued to amaze policymakers despite measures put in place by public health officials to sensitize the general public on the need for social distancing, personal hygiene, etc. In this work, we have reviewed the literature to demonstrate, by investigating the historical and present circumstances, that indoor spread of infectious diseases may be assisted by the conditions of the HVAC systems. While little consideration has been given to the possibility of indoor airborne transmission of the virus, the available reports have demonstrated that the virus, with average aerodynamic diameter up to 80-120 nm, is viable as aerosol in indoor atmosphere for more than 3 h, and its spread may be assisted by the HVAC systems. Having reviewed the vulnerability of the conventional ventilation systems, we recommend innovative air circulation concept supported by the use of UVGI in combination with nanoporous air filter to combat the spread of SARS-CoV-2 and other harmful microbes in enclosed spaces.

Air pollution and indoor settings

Indoor environments contribute significantly to total human exposure to air pollutants, as people spend most of their time indoors. Household air pollution (HAP) resulting from cooking with polluting ("dirty") fuels, which include coal, kerosene, and biomass (wood, charcoal, crop residues, and animal manure) is a global environmental health problem. Indoor pollutants are gases, particulates, toxins, and microorganisms among others, that can have an impact especially on the health of children and adults through a combination of different mechanisms on oxidative stress and gene activation, epigenetic, cellular, and immunological systems. Air pollution is a major risk factor and contributor to morbidity and mortality from major chronic diseases. Children are significantly affected by the impact of the environment due to biological immaturity, prenatal and postnatal lung development. Poor air quality has been related to an increased prevalence of clinical manifestations of allergic asthma and rhinitis. Health professionals should increase their role in managing the exposure of children and adults to air pollution with better methods of care, prevention, and collective action. Interventions to reduce household pollutants may promote health and can be achieved with education, community, and health professional involvement.

Indoor air quality at school and students' performance: Recommendations of the UNESCO Chair on Health Education and Sustainable Development & the Italian Society of Environmental Medicine (SIMA)

The issue of indoor air quality (IAQ) concerns 64 million students across Europe, but it is still a neglected topic, although it impacts both their health and learning outcomes. Classroommicroclimate is the first key factor determining a healthy or unhealthy school environment, and it is influenced by ventilation, temperature and humidity rate. Classrooms are usually crowded, overheated and poorly ventilated, thus resulting in possible increases of carbon dioxide (CO₂), that can cause several problems when its concentrations exceed the value of 0.15 percentage volume of CO₂ (1500 ppm) or even at lower levels (1000 ppm). CO₂ can also arise from outside the school, being widely produced by the combustion of fossils or road traffic. Anthropogenic activities are responsible for the emission of nitrogen dioxide (NO₂) and polycyclic aromatic hydrocarbons(PAH) too, which represent other possible external contaminants potentially impairing IAQ. Furtherdangerous exposures for students' health are those related to natural emission of gas Radon, which typically accumulates in poorly ventilated classrooms, and volatile organic compounds (VOCs, released by building materials, paints, furnishings, detergents), while chemicals substances (i.e.cyanoacrylate, lead, cadmium, nickel) might be contained in school materials. Finally, particulate matter (PM2.5 and PM10) originating from road traffic, domestic heating or industrial activities represent additional possible contaminants impacting schools' air quality. Poor IAQ might result in mild adverse events (i.e. headaches, nausea etc.) or cause respiratory problems. More frequently, IAQ affects students' attention and their school performances, as widely documented by many studies. Standardized tests administered to pupils exposed to poor IAQ (to assess reading and mathematical abilities) systematically result in worse outcomes compared to students staying in healthy classroom environments. In this paper, we present recommendations of UNESCO Chair on Health Education and Sustainable Development and Italian Society of Environmental Medicine(SIMA) to ensure an optimal IAQ at school, including some post-COVID-19 issues.

IEQ Field Investigation in High-Performance, Urban Elementary Schools

School buildings are one of the most commonly occupied building types for children, second only to their homes. Indoor environmental quality (IEQ) is an ongoing issue in schools, especially in urban environments where students are exposed to higher levels of outdoor pollutants. To examine this issue, five elementary school buildings located in a major city on the East Coast of the United States were selected for one-week of quantitative IEQ measurements, with a satisfaction survey collected from teachers at the selected schools. The schools included three high-performance schools, one recently renovated school, and one conventional school. Despite building designers and operators following the recommendations of current high-performance design standards, the three high-performance school buildings did not have measurably better IEQ than the renovated and conventional school buildings, nor were they perceived as better based on the satisfaction survey. This indicates that current high-performance design standards may not place enough emphasis on reducing health-related pollutants in urban schools.

Building and indoor environmental quality assessment of Nigerian primary schools: A pilot study

A total of 15 classrooms went through on-site assessments/inspections, including measurements of temperature (T), and concentrations of carbon monoxide (CO) and carbon dioxide (CO₂ ). In addition, the level of surface biocontamination/cleaning effectiveness was assessed by measuring adenosine triphosphate (ATP) levels on students' desks. Based on the data, the quality of facilities in the buildings was low. Classroom occupancy exceeded ASHRAE 50 person/100 m² standard in all cases indicating overcrowding. However, concentrations of CO₂ remained below 1000 ppm in most classrooms. On the other hand, indoor T was above the recommended levels for thermal comfort in all classrooms. Maximum indoor CO was 6 ppm. Median ATP concentrations on the desk tops were moderately high in all schools. The use of open incinerators and power generator sets near classrooms, which was suspected to be the main source of CO, should be discouraged. Improved hygiene could be achieved by providing the students access to functioning bathroom facilities and cafeteria, and by effective cleaning of high contact surfaces such as desks. Although ventilation seems adequate based on CO₂ concentrations, thermal comfort was not attained especially in the afternoon during extreme sunlight. Therefore, installing passive and/or mechanical cooling systems should be considered in this regard.

Children environmental exposure to particulate matter and polycyclic aromatic hydrocarbons and biomonitoring in school environments: A review on indoor and outdoor exposure levels, major sources and health impacts

Children, an important vulnerable group, spend most of their time at schools (up to 10 h per day, mostly indoors) and the respective air quality may significantly impact on children health. Thus, this work reviews the published studies on children biomonitoring and environmental exposure to particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) at school microenvironments (indoors and outdoors), major sources and potential health risks. A total of 28, 35, and 31% of the studies reported levels that exceeded the international outdoor ambient air guidelines for PM₁₀, PM_2.5, and benzo(a)pyrene, respectively. Indoor and outdoor concentrations of PM₁₀ at European schools, the most characterized continent, ranged between 7.5 and 229 μg/m³ and 21-166 μg/m³, respectively; levels of PM_2.5 varied between 4 and 100 μg/m³ indoors and 6.1-115 μg/m³ outdoors. Despite scarce information in some geographical regions (America, Oceania and Africa), the collected data clearly show that Asian children are exposed to the highest concentrations of PM and PAHs at school environments, which were associated with increased carcinogenic risks and with the highest values of urinary total monohydroxyl PAH metabolites (PAH biomarkers of exposure). Additionally, children attending schools in polluted urban and industrial areas are exposed to higher levels of PM and PAHs with increased concentrations of urinary PAH metabolites in comparison with children from rural areas. Strong evidences demonstrated associations between environmental exposure to PM and PAHs with several health outcomes, including increased risk of asthma, pulmonary infections, skin diseases, and allergies. Nevertheless, there is a scientific gap on studies that include the characterization of PM fine fraction and the levels of PAHs in the total air (particulate and gas phases) of indoor and outdoor air of school environments and the associated risks for the health of children. There is a clear need to improve indoor air quality in schools and to establish international guidelines for exposure limits in these environments.

Online Questionnaire as a Tool to Assess Symptoms and Perceived Indoor Air Quality in a School Environment

School environments are a complex entirety where various different exposure factors are related that contribute to the indoor air quality (IAQ) and may affect occupants’ health and well-being. Indoor air questionnaires are useful for collecting information about the occupants’ experiences and perceptions of the indoor air and for evaluating the results of the measures taken. A common way to implement health questionnaires is to ask the respondents to describe symptoms at certain time points, such as weeks or months. The aim of our study was to develop a short and easy online questionnaire to assess symptoms and perceived IAQ. We also aimed to test the usability of the questionnaire in school buildings and assess the differences between the online measurement data (CO2, T, and RH) and the IAQ complaints and symptoms reported by the pupils. A total of 105 teachers and 1268 pupils in 36 classrooms at six schools answered the questionnaires over a two-week period. The participants completed the questionnaire always after the lesson in the studied classroom. We received 719 answers from the teachers and 6322 answers from the pupils. The results demonstrated that the teachers reported more IAQ problems and symptoms than the pupils did. Differences between classrooms were observed in both the IAQ problem and reference schools. The most common significant differences (p-value > 0.05) between the classrooms were among humidity, too cold air, and stuffy air, and among symptoms, dry/sore throat, tiredness, headache, and skin symptoms. Maximum values of CO2 measurements and the highest prevalence of stuffy air were relatively consistent. The testing process demonstrated that such a questionnaire was suitable for adults and children aged at least 12 years. The results of our study suggest that a quick and easy online questionnaire that is completed within a short period may be useful for gathering valuable knowledge about perceived IAQ. It could be used in combination with other indoor environment investigations to produce detailed results and restorative measures.

The ventilation problem in schools: literature review

Based on a review of literature published in refereed archival journals, ventilation rates in classrooms often fall far short of the minimum ventilation rates specified in standards. There is compelling evidence, from both cross-sectional and intervention studies, of an association of increased student performance with increased ventilation rates. There is evidence that reduced respiratory health effects and reduced student absence are associated with increased ventilation rates. Increasing ventilation rates in schools imposes energy costs and can increase heating, ventilating, and air-conditioning system capital costs. The net annual costs, ranging from a few dollars to about 10 dollars per person, are less than 0.1% of typical public spending on elementary and secondary education in the United States. Such expenditures seem like a small price to pay given the evidence of health and performance benefits.

Indoor air quality in preschools (3- to 5-year-old children) in the Northeast of Portugal during spring-summer season: pollutants and comfort parameters

Indoor air quality at schools (elementary, primary) has been the subject of many studies; however, there are still relative few data regarding preschool (3- to 5-year-old children) environments. This investigation determined the concentrations of particulate matter (PM)_2.5, total volatile organic compounds (TVOC), formaldehyde, carbon monoxide (CO), and ozone (O₃) as well as the levels of carbon dioxide (CO₂), temperature, and relative humidity (RH) in the indoor and outdoor air of two preschools situated in different geographical regions of Portugal. The indoor concentrations of TVOC, CO, O₃, and CO₂ were predominantly higher at the end of school day compared to early morning periods. The TVOC and CO₂ concentrations were higher indoors than outdoors suggesting predominantly an indoor origin. Outdoor air infiltrations were the major contributing source of CO and O₃ to indoor air in both preschools. The concentrations of all pollutants were within the limits defined by national regulations and international organizations, except for TVOC that exceeded 8-12-fold higher than the recommendation of 0.2 mg/m³ proposed by European Commission. The levels of CO₂ were below the protective guideline of 2250 mg/m³ (Portuguese legislation); however, the observed ranges exceeded the Portuguese margin of tolerance (2925 mg/m³) at the end of school days, indicating the impact of occupancy rates particularly at one of the preschools. Regarding comfort parameters, temperature exerted a significant influence on O₃ concentrations, while RH values were significantly correlated with TVOC levels in indoor air of preschools, particularly during the late afternoon periods.

Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools

Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO₂, CO, NO₂, O₃, CH₂O, total volatile organic compounds (VOC), PM₁, PM_2.5, PM₁₀, Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM_2.5, PM₁₀, CO₂ and CH₂O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO₂. However, mitigation measures were not always sufficient to decrease the pollutants’ concentrations till values considered safe to protect human health.

Recent advances in environmental controls outside the home setting

PURPOSE OF REVIEW

It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood.

RECENT FINDINGS

In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity.

SUMMARY

Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.