The Lead+Asthma Project piggy-backed asthma trigger control interventions onto an existing lead poisoning prevention program. The Lead+Asthma Project developed and piloted parent education, hazard assessment and environmental interventions.

The small-scale feasibilty project was carried-out in cooperation with the Cleveland Department of Public Health Lead-Safe Housing Program. The Program conducted lead abatement and parent education in partnership with the Cleveland Housing Network.

Lead and Asthma

Both are major environmental health concerns for poor and minority children, based on:

Lead and Asthma Similarities

Why Add Asthma to Lead?

• Childhood asthma is a major and growing public health problem.
• Lead poisoning infrastructure of screening, case management, inspection, environmental intervention, parent education and funding in place.
• Can be cost effective to address housing-related health hazards together.

Why Add Asthma to Lead?

Broader inspection and intervention focus can impact other housing-related health hazards:

• pesticide exposure
• combustion gases
• toxic molds

Asthma Triggers

• Can cause the development of asthma in people with a genetic predisposition.
• Can cause increased frequency and severity of asthma symptoms.

Variety of Asthma Triggers

• Psychosocial stress, exercise, cold weather, infection, etc.
• Outdoor air pollution -- ozone, particulates, pollen
• Indoor allergens and irritants

Indoor vs Outdoor Triggers

• Opponent of strict air pollution regulation point to role of indoor triggers to get outdoor pollution off the hook.
• Both indoor and outdoor pollution trigger breathing problems for asthma sufferers.

Residential Triggers

• Cockroach dust -- parts, feces
• House dust mites
• Molds
• Combustion gases
• Animal dander and saliva
• ETS -- environmental tobacco smoke
• Consumer products with irritants

Housing Conditions

• Excessive moisture
• Roach infestation
• Contaminated dust on surfaces and reservoirs
• Faulty combustion appliances

Program Description

• Lead + Asthma piggybacked on Cleveland's Lead-Safe Housing Program.
• Families with an EBL child and a self-reported asthmatic child recruited.
  • 102 Families with EBL Child (>15µg/l)
  • 26 families (24%) reported a child in the residence with doctor-diagnosed asthma
• Health Department lead inspectors trained in visual assessment for moisture problems, mold, roaches, faulty combustion appliances, etc.
• Visual assessment:
  • Guide and record observations by inspectors to identify health hazards.
  • Focus on triggers and underlying housing conditions; other hazards.
  • Provide input to the remediation strategy and spec writing.
• Specs written for integration of lead hazard control, asthma triggers reduction and weatherization.
• Some work required of building owner and occupants.
• Building owners and occupants required to attend two two-hour sessions on lead and asthma hazard remediation.

Standard Lead Interventions

1. Correct moisture problems (to reduce paint failure).
2. Cleanup lead-contaminated dust.
3. Remove dust reservoirs (e.g., carpeting).
4. Make horizontal surfaces cleanable.
5. Eliminate pest infestation (so lead abatement crews can work).
6. Educate parents and caregivers.

1. Correct moisture problems to make the environment less hospitable for dust mites, molds and roaches.
2. Use cleanup techniques effective for reduction of roach antigen, mold and dust mites, as well as for lead-contaminated dust.
3. Remove carpet in kitchen and bath; consider removing carpet in other rooms to eliminate accumulation of dust contaminated with lead, roaches, mites, mold and animal dander.
4. Make effective ongoing cleanup of recontaminated dust easier: 1) create smooth floor surfaces 2) provide low-emissions vacuum cleaner with "dirt finder."
5. Use integrated pest management (IPM):
   1. Environmental controls - deny food, water, harborage, entry
   2. No broadcast application of pesticides - no sprays, foggers or bombs
   3. Small amounts of low-toxicity low-volatility pesticides in bait stations and gel baits
   4. Monitor with sticky traps for bait placement
   5. Capture with HEPA vacuum
6. Expand parent education to include control of asthma triggers (and other housing-related health hazards).
   Provide cleaning kits, IPM kits and low-emissions vacuum with embedded dirt finder.

Moisture Control Strategy

• Divert rain water
• Seal building envelope
• Increase ventilation
• Repair plumbing leaks
• Repair faulty combustion systems
• Cover soil in crawl spaces

Sample Specs:
Moisture Control

• Vent clothes dryer to exterior.
• Insulate crawl space and cover dirt floor with plastic.
• Fix plumbing leaks.
• Open floor drains and fill traps.
• Install and properly vent kitchen and bathroom exhaust fans.
• Repair gutters and downspouts.
• Disconnect downspout if storm drain leaks into basement.
• Grade soil around house so water drains away from foundation.
• Fix roof and sidewall leaks.
• Undercut bedroom and bath doors for improved air circulation.

Sample Specs:
HVAC Appliances

• Check furnace chimney clean-out opening and remove debris.
• Check furnace and hot water flues.
• Create closed cold air return system.
• Install pleated furnace filter.
• Discourage humidifier use.
• Install window air conditioner.

Sample Specs:
Mold Control

• Remove wet and moldy material.
• Clean mold contamination.
• Remove mold host material from basement (e.g., rugs, cardboard boxes).
• Provide ventilated shelving in basement.
• Remove bath and kitchen carpet.

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