Indoor Biological Contaminants and Development of Asthma in Children in the UK - Case Study Example

Risk Perception: The Relation between Indoor Biological Contaminants and Development of Asthma in Children in The UK Background In the UK context, deaths from asthma are uncommon, but asthma is a leading reason for visits to the General Practitioner (GP) and hospitalisation admissions. Off late asthma in children is on the decline, possibly because of better medical care but during 1955 and 2004, it multiplied (Anderson et al, 2007). Data provides critical insights on children in the age groups 1-4 and 5-14 taking asthma consultations, the number of which was 275 per 10,000 in England in 2005 and 462 in Wales respectively. Incidentally, in 2006, 45 and 23 per 10,000 aged between 0–4 and 5–14 years old were admitted to hospitals for asthma, respectively, in the UK, as reported by the Lung and Asthma Information Agency (2008). One in five children in the UK keeps an inhaler to get instant relief from asthma attack and one in four kindergarten children are afflicted with wheezing that is not asthma (POSTNOTE, 2010). Introduction Asthma symptoms can appear in children from allergens developed from house dust mites and in the dander of furred pets. These are the most leading causes of children’s skin diseases. To prove the point, a UK research by Price et al. (1990)) is referred that reveals, nearly 80% of asthmatic children caught allergy from house dust mite. Fur of animal was also found to be the leading reason of allergy in children, as revealed from a Swedish research that 57% of asthmatic children were allergic to at the minimum one kind of fur of the domestic animals. It was found that the possibility of house dust mites was relatively higher in damp houses. Therefore, the happening of mite-induced asthma is possibility higher in damp houses. The leading mammalian sources of allergens are the dander (skin scales) of cats and dogs, as well as dried urine and saliva of pet animals are also possible sources of allergens. Chances of allergy to atopic children seem to be higher from cats than from dogs. Mice, rats and various other rodents kept as pets may also add-on to the problems of allergy (European Collaborative Action, 1993). On a relative scale, it is noticed that mould is the least possible reactant to create respiration issues than house dust mite and animal dander but in children with atopic allergy, mould is the catalyst of causing severe health issues (European Collaborative Action, 1993). Air quality – the present situation The present situation is grim in the sense that various stakeholders are not working in sync to face the risk of asthma due to indoor biological contaminants to the UK children. A balanced policy approach, action plan and better provision of public information on indoor air quality would help in managing the associated risks. Responsibility needs to be fixed for keeping the indoor air quality hazard-free. Formulating an action plan can be of great help in improving the indoor air quality (Krieger & Higgins, 2002). European Collaborative Action (ECA) (1993) identifies from different reports to connect the four types of biological particle, carrying the possibility of a number of allergic manifestations. One of these includes showing of asthma symptoms, such as wheeze, contraction in the chest and short breath through indoor biological contamination. Krieger & Higgins (2002) report a research done in Britain on the impact of childhood living conditions from health perspective, which indicates a modest linkage between insufficient ventilation and mortality among other health issues. Another cohort research indicated linkage between recurrent periods of housing deprivation and severe ill health. According to the Health Protection Agency, UK (2009), children are particularly prone to the ill effects of poor air quality indoors. It is because their lungs are still in the process of development and they breathe in relatively more air than adults (WHO, 2005b)). Dampness and Mould As per off late epidemiological research, a robust linkage is seen between reported dampness and mould in houses and respiratory symptoms in children living in the houses. Possibility of a non-allergic framework remains for the increased respiratory symptoms among children in damp houses (European Collaborative Action, 1993). When it comes to the analysis of fungi for causing allergic diseases, it normally resides as saprotrophs, leading an independent life under damp conditions by using for growth and multiplication the organic matter in wall coverings, soil, like plant pots, dust, humidifiers, air ducts and soft furnishings, like upholstered furniture and carpets (European Collaborative Action, 1993). Mite Mite allergen is quite common in atopic children, as their finding ranges between 45-85% among asthmatics. Asthmatic children need to remain sensitive, as it is an acute risk factor for causing the problem of asthma in children. For children with manifest allergy to house dust mite, exposure to 500 mites/g dust matching to 10 µg Der p I/g dust, is a risk level that could cause severe asthma attacks (European Collaborative Action, 1993). Possibility of finding mites in houses is generally in mattresses, bedding, pillows, childrens stuffed toys, upholstered furniture, and carpeting. In totality, the number of mites may differ from 10 to more than 1000 mites/g house dust (European Collaborative Action, 1993). Pet Animals Pet animals like cats and dogs produce allergens that can be inhaled. Indoor environment can get allergens even from rats, mice and insect vermin. Analysis reveals that pet-derived allergenic content is definitely free from environmental elements like humidity, temperature, height or the standard of the building. The hazard from allergenic content can be reduced by thorough cleaning of the house (European Collaborative Action, 1993). Fungi Whether fungi plays a critical role in enhancing asthmatic conditions is doubtful but reaction is reported to single or clustered spores of fungi in air, which includes asthma as well. Allergic reactions to fungi may be either instant, or developing within minutes of exposure (Type I), or delayed, happening 4 - 8 h later (Type 111) (European Collaborative Action, 1993). Causes, effects and solutions Department for Communities and Local Government (2006) has set physiological needs for Hygro-thermal conditions, such as damp and mould growth. Hazards from damp and mould growth are both physical and mental, from: • House dust mites • Mould or fungal growth Both are triggered by dampness and/or high humidity. Probable effects on health include: • Breathing problems caused by house dust mite and mould; • Depression and nervousness because of the conditions; • Asthma and • Fungal infection causing hurdle in the treatment for cancer. Causes of dust mite, mould and fungal growth They are common, as both are connected straight to dampness, which happens due to: • Insufficient ventilation levels; • Higher humidity levels, when crossing 70%; and • Hotter indoor temperatures in winter because of housing design in renovated houses. Precautionary steps that could have a huge effect on possible loss outcomes linking to moisture production and ventilation include: • Damp proof grades, membranes and working around doors and window gaps; • Outside paint to be kept in good condition to stop rain penetration; • Frost guard for pipes and tanks; • Suitably fixed baths, sinks etc., with • Suitably fixed drainage; • Suitably fixed and kept rainwater goods; • Suitably ventilated roof and in-between floor areas to see to it that timber remains water-proof; • Sufficient extraction of moisture rich air during peak hours, such as cooking, bathing and laundry; • Incessant low-level background ventilation if needed; • Enough outlets of ventilation to control moisture from routine house activities without opening windows that could cause loss of heat, and • Suitable ventilation for houses of high residential density. Indoor temperatures If most of the criteria above are fulfilled then raising indoor temperatures, taking into consideration energy efficiency and price of heating, can hugely minimise dust mite problems. So a performing heating system suitable for the fabric (thermal properties) of the building is significant (Department for Communities and Local Government, 2006). As per WHO guidelines for indoor air quality: dampness and mould 2009, indoor dampness is relatively common among low-income communities in the UK. Those living in rent houses and council houses had high levels of dampness and mould in the past than owner houses and mortgaged accommodations. Various other causes of dampness include harshness of climate affecting weather and the resultant rise in sea level besides flood-prone regions face additional damp issues (POSTNOTE, 2010). Measurement of microorganisms and microbial agents -- Problems of quantification When it comes to appraising the indoor concentrations of microorganisms, it is unique in challenges. Risk level differs for various types of Pathogenic microorganisms, as some could be risky at totally low levels, while other organisms may become critical health risks only at concentrations of higher density. Some organisms and spores are highly resilient, while others are deactivated during sampling. Certain fungal spores are easily located and numbered. Highly acute methods can help in quantifying only some microbial particles. Many of the off-late developed methods have not been well responded but even some validated methods reveal noticeable differences in concentrations. Additionally, not all the biological agents related with damp indoor environments and their health effects have been identified (WHO, 2009). Garrett et al. (1998) measure indoor air quality to check the presence of mould, dampness, and fungi. Methods are of two types: culture-based methods and non-culture based methods. Culture based methods Airborne concentrations of microorganisms can be quantified by counting culturable propagules in air samples or spread dust samples. Their sampling is based on impaction, liquid impaction or air filtration. After gathering sample, colonies of fungi are developed on culture media at a fixed temperature for the defined time for colony development (generally 3–7 days). Colonies are numbered manually or by image analysis techniques. So far, no unique methods are available for searching and counting fungi in indoor surroundings, which greatly reduces the possibility for relating data from various researches (Garrett et al., 1998). Major drawback of this method from the perspective of the International Organisation for Standardization (ISO) technical committee 147/SC is that so far no global parameters relating to indoor air for sampling by filtration and impaction and for the cultivation of fungi have been fixed. Non-culture-based methods In non-culture-based methods, non-culturable microorganisms are normally sampled by air filtration or liquid impingement methods. Microorganisms can be tinted with fluoro- chrome like acridine orange and numbered under an epifluorescence micro- scope (Thorne et al., 1994). Slit impaction on glass slides and tinting with lactophenol blue is a routine for microscopic finalisation of the complete concentration of fungal spores. The likeability of typifying microorganisms taxonomically is reduced as no structure is visible. Electron microscopy or scanning electron microscopy permits better results (Eduard et al., 1988). The major benefit of microscopy is that both culturable and non-culturable microorganisms can be measured, choice effects are controlled, personal air sampling can be taken, the sampling time can, for a number micro- organisms, be different across a vast range and outcomes are fast. The disadvantages include the techniques are not authenticated, possibility of non-tracing of related toxic or allergenic parts or cell debris, reduced chances for proving microorganisms, arduous and complex processes and increasing cost for each sample of the relatively sophisticated methods. The benefits of these methods for indoor risk assessment are not sure (WHO, 2009). Jaakkola et. Al., (2002) analyses the environmental burden of disease related to lack of sufficient housing, causing indoor dampness and mould issues in homes and asthma attack in children, while Nicholas & Guay (2011) find evidence of exposure-risk connection in the UK case control research where they notice an important relation between formaldehyde concentration in bedroom and the random visibility of symptoms (WHO, 2009). Ormandy & Braubach (2011) study policy implications of poor housing and health conditions. The new housing design and construction guidelines needs to include: sufficient damp-proofing enough provision of ventilation energy saving tools usage for heating and draught- proofing bordering of pools and ponds security latches and restrictors to windows safe design and mapping of kitchens There is need to apply legislative measures for strict enforcement and take maximum measures of adherence to standards. For old houses, search should be conducted to decide the requirement of mould control measures. Rented accommodations’ burden for preserving all elements remains with the landlords (WHO, 2011). Synthesis of a briefing note for various stakeholders The discussion above on the risk perception on a linkage between indoor biological contaminants and development of asthma in the UK children includes examination of the risk issues by various stakeholder government agencies and WHO reports. These include ECA, DCLG, WHO and various reports of authors in their individual capacity whose role can help in controlling the indoor environment from the hazards of biological contaminants, stated above. The Department for Communities and Local Government, 2006 The Department for Communities and Local Government is a leading stakeholder, representing the government level initiatives in creating awareness among the masses on the need of taking control measures on certain indoor biological contaminants, affecting children’s health in relation to asthma health issue. Approach is highly thematic, suggesting through easy comprehending bulleted guidelines. (DCLG) (2006) assesses the causes and effects of hygro-thermal conditions such as dampness and mould growth in Appendix III, categorising hazards into four kinds. Different hazard are profiled to help in their risk assessment. First, hygro-thermal conditions for damp and mould growth are bulleted with possible health hazards. Causes of dust mite, fungal and mould growth follow, ensuing with various preventive steps that could have a huge impact on possibility and risk perceptions connected to moisture development and ventilation. While assessing hazards, various variables like design, condition, renovation of the housing unit, location and current climate besides size of the room play a critical part in making the appraisal complex. Therefore, precautions need to be made as per the dwelling type and all variables. Flats and HMOs are more prone to indoor health hazards, as dampness due to the possibility of living in a limited area. The document provides necessary information on the hazard rating system practiced by the DCLG. It tells about the scoring system prescribed by the HHSRS (England) Regulations 2005 (SI 2005 No 3208), as stated in the statutory HHSRS Operating Guidance for local authorities. It tells about the availability of the Regulations from the Stationery Office and the Operating Guidance from the publications sales centre in Wetherby. A reading of the relevant sections of indoor biological hazards provides appreciably good information on the causes, effects and precautions to be taken by various housing types. European Collaborative Action: Indoor Air Quality & its impact on Man, Report no. 12 Biological Particles in Indoor Environments, 1993 The purpose of this report was to discuss the strategy and methodology on four leading kinds of biological particle indoor. The report widely discusses the effect of fungi, mould, dampness and pets on respiratory problems faced by UK citizens among a host of other health related problems. It provides critical data on UK children suffering from these indoor allergens, using past literature research by various authors. The report is quite exhaustive and data provides relative analysis of the causes of getting allergy infection from various pets. When it comes to choosing the higher risk factor from house dust mite and dampness, both are closely related for presenting higher risks when houses are damp as well as mite-ridden. It discusses health effects, occurrences, sampling methods, methods of analysis and evaluations from the outcomes of various indoor allergens, such as house dust mites, dander from pets and fungi. The report derives critical conclusions on various aspects of certain allergens relatively critical in indoor non-industrial environment such as fungi. It cites the importance of sampling methods for analysing biological particles in the air to show their relative presence and importance for identification. It stresses on the need of providing exhaustive data over the condition of environmental factors during sampling process. Lack of standards in sampling and analysis methods is underscored, reporting failure in making statistical analysis of the risk factors. Finally, it stresses on the need of conducting global level research on sampling and analysis methods for future standardisation. WHO guidelines for indoor air quality: dampness and mould, 2009 This document serves the purpose of offering comprehensive guidelines from the health hazards from dampness and other indoor allergens, as based on the review and approximation of evidence from the experts. Importance of indoor air quality is underscored to control allergens like fungi and moisture causing asthmatic reactions to the inmates. This case study primarily discusses various methods of measuring microbial agents and the problems faced in their quantification. Discussing the nature of various indoor allergens, it describes two measurement methods, namely culture-based methods and non-culture methods. Numbering of culturable microorganisms has some serious drawbacks. These include poor reproducibility; choice of certain species for sampling method, culture media or temperature selected; and failure to detect non-culturable and dead microorganisms, cell debris and microbial parts for containing toxic or allergenic properties. Besides, there are no worthy methods for sampling individual air for culturable micro- organisms and air sampling beyond 15 minutes, whereas air concentrations generally differ greatly across time. However, numbering culturable microorganisms is possibly a very sensitive technique, permitting the identification of various species. Quoting from various authors, it describes various non-culture based methods. Further, it discusses the various benefits and disadvantages of microscopy. Overall, houses are relatively more at risk from mould and dampness like allergens, causing respiratory health issues and asthma in particular. Overall risk to asthma has increased but dampness control measures are enough and in place to control negative health results. One cannot ignore the fact that asthma and related allergies are affecting increasing populations for housing mould and dampness. Environmental Burden of Disease associated with Inadequate Housing -- A Method Guide to the Quantification of Health Effects of Selected Housing Risks in the WHO European Region, 2011 Ormandy and Braubach study policy implications, stressing on following the design and construction guidelines, stipulated in the World Health Organisation’s document (2011). Particularly in the case of indoor biological allergens, the authors stress on damp proofing, ventilation, energy saving tools, fencing of pools and safe designing. It is acknowledged that past reports have covered all indoor biological contaminants that help in the prevalence of asthma in children. This report stresses on the adherence to legislative codes and resultant penalties for not-adherence. It stresses on taking strict action on defaulters. It also talks about effective planning management for securing housing from different outside hazards entering housing. The report talks about affordable housing to fulfil the local and national housing requirements so that related risks from overcrowding could be minimised. It discusses the impracticality of improving the standards of old construction. Although retrofitting and reducing steps can be taken for controlling contamination yet controlling measures need to be taken for mould growth. The report guides that landlords need to share their burden of responsibility in ensuring that their buildings are free from biological hazards. It highlights the need of framing policies and programmes for selected focused areas where conditions are not worth healthy living standards. Funding for renovating existing houses emerges as an issue, which needs to be resolved to the wider societal benefit. The report suggests many ways of helping out the borrower, either to get loan from the state at subsidised rate or offering the option to release equity by buying a part of the property. As maintaining temperature is a critical factor, it requires buildings to be energy-efficient. As a solution to this problem, it suggests providing of financial subsidies, striving to arrange funds to meet sufficient temperature needs. It suggests following a national policy to safeguard the health of residents, both ways, the short-run as well as long-term strategy for making buildings energy-efficient. So far as housing design is concerned, the report discusses how builders, designers and managers can take measures that ensure innovative solutions that reduce the risk to the dwellers. At government level, awareness campaigns can help in creating an awakening among the stakeholders that renovation and refurbishing of houses can help the property from further deterioration. Such awareness steps need to be backed by law for landlords, housing companies and managers to take sufficient maintenance measures on their own. The report suggests formulation of a list of duties for implementation by all stakeholders along with penalties backed by systems and inspection for adherence. References Anderson, R.H., Gupta, R., Strachan, D.P., & Limb, E.S., 2007. 50 years of asthma: UK trends from 1955 to 2004. Thorax, 62, pp. 85–90. Department for Communities and Local Government, 2006. Housing health and safety rating system guidance for landlords and property related professionals. Eduard W et al., 1988. Identification and quantification of mould spores by scanning electron microscopy (SEM): analysis of filter samples collected in Norwegian saw mills. Annals of Occupational Hygiene, 31, pp. 447–455. European Collaborative Action (ECA), 1993. Indoor air quality & its impact on man. Report No. 12 Biological particles in indoor environments. Garrett, M.H., Rayment, P.R., & Hooper, M.J., 1998. Indoor fungal spores, house dampness and associations with environmental factors and respiratory health in children. Clinical and Experimental Allergy, 28, pp.459–467. Health Protection Agency, March 2009. A children’s environment and health strategy for the UK. Jaakkola, M.S. et al., 2002. Indoor dampness and moulds and development of adult-onset asthma: a population-based incident case-control study. Environmental Health Perspectives, 110, pp. 543–547. Krieger, J., & Higgins, D.L., 2002. Housing and health: Time again for public health action Public Health Matters. Lung and Asthma Information Agency, 2008. Asthma. Accessed 16 Feb. 2014 from: http://www.laia.ac.uk/ Nicolas L. Gilbert, Guay, M., 2011. Formaldehyde and respiratory symptoms in children. In Environmental burden of disease associated with inadequate housing, (ed) Brauback et al. Ormandy, D., & Braubach, M., 2011. Policy implications. Environmental burden of disease associated with inadequate housing, (ed) Brauback et al. POST Note, November 2010. UK indoor air quality. Post note number 366. Thorne, P.S. et al., 1994. Bioaerosol sampling in field studies: Can samples be express mailed? American Industrial Hygiene Association Journal, 55, pp. 1072–1079. Read More