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Playing Detective:

Home Evaluations Give Clues to Asthma Triggers

By Susan L. McInturff, RCP, RRT

Asthma triggers lurk around every corner, waiting to ambush your patients. But with a little detective work, respiratory care practioners can uncover their hideouts and foil such attacks.

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A thorough home evaluation is the key to identifying these tricky triggers. Evaluating a client’s physical environment is nothing new to RCPs. Home care practitioners are well-versed in detecting safety issues and impediments to care in a patient’s home. Pulmonary rehabilitation specialists assist their patients in evaluating and modifying their living space to enhance their ability to perform activities of daily living.

RCPs practicing asthma management add another perspective. They use several approaches to pinpoint potential asthma triggers, and some can be accomplished without stepping foot into the client’s abode.

For example, an RCP responsible for outpatient asthma education affiliated with a hospital or clinic can perform a “virtual” assessment without actually seeing the home by carefully interviewing the patient and/or family. Checklists or diagrams prompt responses from the patient. A diagram of the rooms in a house could be illustrated with things that are common triggers, such as a cat sleeping on a bed or a wood-burning fireplace in the living room. The patient is asked to check or circle objects that are similar to those they have in their own home. This is a useful method to evaluate the patient’s knowledge base about asthma triggers.

The RCP working with an asthma outreach program has the opportunity to visit clients’ homes to perform evaluations firsthand. It’s helpful to send the environmental assessment checklists or diagrams to be completed by the patient before the initial visit. First, it gets the patient thinking proactively about managing their triggers. Second, it gives the RCP a heads-up as to what is in the home and quantifies the client’s knowledge base about triggers.

When doing a home assessment, the RCP must possess sharp eyes, good listening skills, and a sleuth’s sense. It’s easiest to go from room to room to evaluate the patient’s physical environment, carrying a checklist to prompt you. (See page 48.)

THE LIVING ROOM

The detective work usually starts in the living or family room, which offers plenty of comfy spots for asthma triggers to hide in. Carpeting and fabric-upholstered furniture harbor dust mites and their droppings. Breeding grounds for mold include carpeting on top of concrete, old book collections, houseplants and peeling wallpaper. Animal dander, wood smoke, and poorly vent-ed gas fireplaces can trigger asth-ma as well. It’s essential to carefully question the patient to see what triggers he or she may respond to.

THE KITCHEN

The home assessment might next move to the kitchen. As seen in the living room, mold and dust are powerful enemies here. Gas fumes and fumes from cleaning agents also are known triggers to asthma. Carpets or flooring must be kept clean, food must be properly stored or discarded, and mold must be kept from growing on windows. Sponges, dishcloths and plants on the kitchen windowsill should arouse suspicion.

THE BEDROOM

A key area to evaluate is the patient’s bedroom because this is an area where he spends a majority of his time. The bedroom is a dust mite’s paradise. They feed on the skin cells that are shed by the person whose home they inhabit. It’s not the mite that the person is allergic to, but rather the droppings the mite leaves.

The person with asthma who may be susceptible to dust mites should be instructed to wash bedding in very hot water weekly. He also can purchase allergen-proof covers for his mattress and pillow, which prevent dust mites from getting through, feeding on the shed skin cells and leaving droppings. Animals should be kept out of the room, carpeting can be removed, and toys should be removed or washed weekly.

THE BATHROOM

The next stop should be the bathroom, a notorious habitat for mold. It’s also a place where noxious cleaning agents and hair products often are stored. Removing damp carpeting, rugs, clothes and towels from the bathroom is an important way to reduce mold growth. Your client can purchase mildew-resistant shower curtains and use cotton bath mats, which dry more completely. Instead of noxious cleaners, he can use a vinegar solution to clean windows, baking soda and vinegar to clean drains, and make a mixture of baking soda and liquid castile soap instead of scouring powder. Specialty catalogs offer allergen-safe products for cleaning and other uses in the home.

For some people with asthma, an evaluation of the home may not be enough. Also consider the patient’s outdoor surroundings. Basements, cellars and barns provide an optimum environment for mold growth. Identify trees and plants with pollens that are particularly irritating to the patient.

It may be necessary to assess the patient’s workplace, classroom or day care location. Be on the lookout for places that harbor dust and dust mites, places where mold can grow, storage of toxic or noxious chemicals, the presence of fumes or other inhaled irritants, and animals.

An asthma educator isn’t the only respiratory care practitioner who should do a virtual or actual home assessment for asthma and allergy triggers. The home care RCP can incorporate this perspective into his environmental assessment when a client has an allergic or asthmatic component to his health problems. The RCP in pulmonary rehabilitation can add home evaluations to his program. The RCP facilitating Better Breathers Club meetings can offer a class on identifying asthma triggers in the home. The RCP working in a doctor’s office could address this topic when interviewing pulmonary patients.

Each one of us should put on our detective hats and show our patients the clues to proactive asthma management.

Susan L. McInturff is a staff therapist at Farrell’s Home Health, Bremerton, Wash., and at Asthma Consultants Northwest, also in Washington.

Here are checklists to guide your assessment of asthma triggers at home:

Living Room/Family Room

Are there carpets or wood floors?

Is there concrete under the carpeting?

How often does the patient vacuum the living room?

Do they use a vacuum with a filtration system?

Does the room have a fireplace or woodstove that is used?

Is there any visible mold around the windows, door frames?

Is the furniture upholstered with fabric?

Is there an air conditioner in the room?

Are there any pets (dogs, cats, birds, aquarium) allowed in the room?

Kitchen

Is there carpeting, wood or linoleum flooring?

Is the stove/oven gas or electric?

Is the stove fan vented to the outdoors?

Are there any plumbing leaks?

Are any cockroaches seen?

Is food left to grow mold on counters, in refrigerators or in garbage cans?

Are there any toxic or noxious cleaning supplies kept in the cupboards?

Is there any mold around the windows or on kitchen curtains?

Bedroom

Is there carpeting or wood floor?

How often is the room vacuumed?

Is a vacuum with an exhaust filtration system used?

Are pets allowed in the room (dogs, cats, birds, aquariums)?

Does the room have any furniture that is upholstered with fabric?

Are there throw rugs in the room?

Are there any stuffed or plush toys in the room?

Is there any visible mold on the windows or curtains?

Is there any peeling wallpaper, wet garbage, old books, or other places for mold to grow?

Bathroom

Is the bathroom carpeted?

Are the bath mats and carpet allowed to dry thoroughly?

Is there mold around the tub, shower, on curtains or windows?

Are there any plumbing leaks?

Is the bathroom well-ventilated, and does it have a fan that exhausts to the outside?

Is the shower curtain or door kept clean of mold?

Are damp clothes or towels left in the bathroom?

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