Indoor air quality in your child's school.

So you've ripped out the carpeting in your child's bedroom, encased her mattress, pillow and box spring in allergy-proof covers and put her stuffed animals in a hot drier once a week.

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You even got rid of her beloved gerbil. And still you see little improvement in her asthma. Well, have you checked her classroom?

Although it's been 10 years since a government report found that more than half of the nation's 115,000 public schools had indoor air quality poor enough to cause health problems, (19) little has changed. If anything, increasing enrollment and declining funds for school maintenance have only made the problem worse, notes a 2004 Infrastructure Report Card from the American Society of Civil Engineers. (20)

"Our schools are in bad shape for many reasons," says Claire L. Barnett, executive director of the Albany, NY-based Healthy Schools Network, Inc., a nonprofit organization that works to build awareness of children's environmental health needs. "No one has paid any attention to them. Plus, the escalating cost of education and the lack of mandates on maintaining school facilities have led local decision makers to funnel money from school maintenance into mandated services."

The victims? The women and children who make up the primary residents of the nation's schools. For instance, Ms. Barnett notes, a 2004 survey by the American Federation of Teachers of its members in Chicago and Washington, DC, found about one-fourth missed three to four days of work a year because of building conditions.

"If you extrapolate that to all children nationally," says Ms. Barnett, "that means 25 percent of the nation's 54 million school children are missing school each year because of building quality." In fact, asthma alone is responsible for 12.8 million missed school days. (21,22)

So what's a parent to do?

Plenty.

Start with the Environmental Protection Agency's Indoor Air Quality (IAQ) Tools for Schools Kit. Online at www.epa.gov/iaq/schools/toolkit.html, it provides schools (and parents) with a practical, low-cost plan to improve indoor air problems.

For instance, the plan offers checklists to ensure such commonsense steps as regular dusting, checking ceilings and walls for leaks, and keeping animal cages away from supply and return vents are followed.

Simply ensuring that heating, ventilation and air conditioning systems (HVAC) are properly cleaned and maintained can make a vast difference in indoor air quality, as can using HEPA filters in vacuum cleaners.

Ms. Barnett ticks off other changes schools can make, including more classroom storage areas for papers and projects so they're not spilled out across the room; linoleum vs. carpets underfoot (easier to clean and doesn't harbor dust mites or mold); easy-to-access filters and grillwork that can be cleaned; and large mats at entry areas to trap outdoor dirt.

One other recommendation: Ask your doctor to write a note to the school asking for classroom changes, such as removing moldy carpet, says Anne-Marie A. Irani, MD, who chairs the Division of Pediatric Allergy, Immunology and Rheumatology at Virginia Commonwealth University in Richmond.

References

1 Asthma Facts. Centers for Disease Control. Updated August 16. 2005. www.cdc.gov

2 Quantum Sufficit. American Family Physician. 2002;66(10). www.aafp.org.

3 Arbes SJ Jr, Gergen PJ, Elliott L. Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol. 2005;116(2):377-83.

4 Mannino DM, Homa DM, Akinbami LJ, et al. Surveillance for asthma--United States, 1980-1999. MMWR Surveill Summ. 2002;51(1):1-13.

5 Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002;110(2 Pt 1):315-22.

6 Frieri M. Asthma and the Immune System, Asthma Magazine, Nov/Dec 2002.

7 Frieri, M. Management of Asthma in Women. Women's Health in Primary Care. 2004;7(8):408-413.

8 Tan KS. Premenstrual asthma: epidemiology, pathogenesis and treatment. Drugs 2001;61(14):2079-86.

9 Jeziorska M, Salamonsen LA, Woolley DE. Mast cell and eosinophil distribution and activation in human endometrium throughout the menstrual cycle. Biol Reprod. 1995;53(2):312-20.

10 Ozkaragoz K, Cakin F. The effect of menstruation on immediate skin reactions in patients with respiratory allergy. J Asthma Res. 1970;7(4):171-5.

11 Derimanov GS, Oppenheimer J. Exacerbation of premenstrual asthma caused by an oral contraceptive. Ann Allergy Asthma Immunol. 1998 Sep;81(3):243-6.

12 The Inside Story: A Guide to Indoor Air Quality. Environmental Protection Agency and the United States Consumer Product Safety Commission, Office of Radiation and Indoor Air (6604J) EPA Document # 402-K-93-007, April 1995. www.epa.gov.

13 Arbes SJ Jr, Cohn RD, Yin M, et al. Dog allergen (Can f 1) and cat allergen (Fel d 1) in US homes: results from the National Survey of Lead and Allergens in Housing. J Allergy Clin Immunol. 2004;114(1):111-7.

14 Arbes SJ, Sever M, Mehta J, Collette N, Thomas B, Zeldin DC. Exposure to indoor allergens in day-care facilities: results from 2 North Carolina counties. J Allergy Clin Immunol 2005; 116:133-9.

15 Damp Indoor Spaces and Health. National Institute of Medicine. May 2004. www.iom.edu

16 Molds in the Environment. Centers for Disease Control. Aug. 18, 2005. www.cdc.gov.

17 Hamilton RG. Assessment of indoor allergen exposure. Curr Allergy Asthma Rep. 2005 Sep;5(5):394-401.

18 Berger, WE and Gordon, DL. Allergy & Asthma Relief. Pleasantville, NY: Reader's Digest Books; 2004.

19 Conditions of America's Schools", U.S. General Accounting Office, Health, Education, and Human Services Division, Document #: GAO/HEHS-95-61, Report#: B-259307, February 1, 1995.

20 2004 Infrastructure Report Card from the American Society of Civil Engineers. www.asce.org

21 U.S. Centers for Disease Control. Surveillance for Asthma--U.S., 1960-1995, MMWR. 1998; 47 (55-1).

22 American Lung Association. Epidemiology & Statistics Unit, Research and Program Services. Trends in Asthma Morbidity and Mortality; May 2005.

23 Camargo CA Jr, Weiss ST, Zhang S, et al. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med. 1999;159(21):2582-8.

24 Schachter LM, Salome CM, Peat JK, Woolcock AJ. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax. 2001;56(1):4-8.

25 Hodge L, Salome CM, Peat JK, et al. Consumption of oily fish and childhood asthma risk. Med J Aust. 1996 Feb 5;164(3):137-40.

26 Schwartz J, Weiss ST. The relationship of dietary fish intake to level of pulmonary function in the first National Health and Nutrition Survey (NHANES I). Eur Respir J. 1994;7(10):1821-4.

27 Bucca C, Rolla G, Oliva A, et al. Effect of vitamin C on histamine bronchial responsiveness of patients with allergic rhinitis. Ann Allergy 1990;65:311-4.

28 Woods RK, Walters EH, Raven JM, et al. Food and nutrient intakes and asthma risk in young adults. Am J Clin Nutr. 2003;78(3):414-21.

29 Jiang SP, Huang LW. Role of gastroesophageal reflux disease in asthmatic patients.

30 Eur Rev Med Pharmacol Sci. 2005;9(3):151-60. Review. Sontag SJ, O'Connell S, Khandelwal S, et al. Asthmatics with gastroesophageal reflux: long term results of a randomized trial of medical and surgical antireflux therapies. Am J Gastroenterol. 2003;98(5):987-99.

RELATED ARTICLE: Classroom Checklist for Indoor Allergens

The Healthy Schools Network points to the following as signs that a school may have indoor environmental problems that can make your child's asthma and allergies worse:

1. The roof leaks.

2. The building is new or newly renovated and still smells like paint, varnish or glue.

3. The building is fully carpeted.

4. Your child goes to school healthy but comes home ill, cranky or exhausted.

5. Your child comes home with odd odors clinging to his/her clothing.

6. Your child has health or learning problems only in that building.

7. Building maintenance and repair costs are often cut at budget time.

8. The building smells damp or musty, or has been flooded.

For more information, visit: www.epa.gov/iaq/schools/toolkit.html or Healthy Schools Network, Inc., www.healthyschools.org.