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Environmental Triggers of Asthma
Appendix 1: Asthma Triggers Exposure History

Course: WB 1102
CE Original Date: October 17, 2007
CE Renewal Date: October 17, 2010
CE Expiration Date: October 16, 2012
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Introduction

[Adapted from The National Environmental Education and Training Foundation. Environmental Management Of Pediatric Asthma Guidelines.]

http://www.neefusa.org/health/asthma/asthmaguidelines.htm, 2005 Aug.

It is very important to ask about all environments in which a child with asthma may be spending significant amounts of time, including all residences where the child sleeps or spends time, such as the home of a relative, schools, daycare, camp, and college dorms (for 17–18 year olds). Ask the questions in the box first. Ask additional questions if indicated.

Dust Mites

Have you noticed whether dust exposure makes your child's asthma worse?

Yes [  ] /No [  ] / Not sure [  ]

Have you used any means for dust mite control? Which ones?____

Yes [  ] /No [  ] / Not sure [  ]

Does your child sleep with stuffed animals?

Yes  [  ] /No [  ] / Not sure [  ]

Is there carpet in the room where your child sleeps?

Yes [  ] /No [  ] / Not sure [  ]

Additional Questions

  • Do you know that dust exposure can trigger asthma symptoms?_____
  • Do you live in a house or an apartment? __________
  • If you live in a house, how old is it? _______
  • What type of floor coverings are in your house? ____________________
  • Is there carpet in your child's bedroom? ______
  • Do you have a HEPA vacuum cleaner? ______
  • Have you tried anything to decrease dust mite exposure?__________________________
  • Have you ever heard of putting special coverings on a pillow or mattress to decrease dust mite exposure? ______
  • Are you currently using a mattress or pillow covering on your child's bed? _____
  • How often do you wash your child's bed linens? ______
  • Do you wash them in hot, warm, or cold water? _______
  • Are there stuffed animals in your child's room/bed? _______
  • Do you use other ways to decrease dust mite exposure? _____

Animal Allergens

Do you have any furry pets? Yes [  ] /No [  ] / Not sure [  ]

Have you seen rats or mice in the home? Yes [  ] /No [  ] / Not sure [  ]

Additional Questions:

  • What type of furry pet(s) do you have? (and how many of each) ____________
  • Is it a strictly indoor pet? ______ outdoor? _____ indoor/outdoor? _____
  • How often do you wash your pet? ______
  • How long have you had your pet (s)? _________________
  • Has your child's asthma become worse since having the pet? _______
  • Has your child's asthma become better since moving the pet outside? ________
  • Have you noticed any rodents indoors or outside your home (rats, mice)?

Cockroach Allergens

Have you seen cockroaches in your home on a regular basis? (i.e., weekly or daily)

Yes [  ] /No [  ] / Not sure [  ]

Additional Questions:

  • Approximately how many cockroaches do you see in your home per day? _____
  • Do you see evidence of cockroach droppings? ____________________
  • How do you get rid of the cockroaches? ____________________

Mold/Mildew

Do you see or smell mold/mildew in your home?

Yes [  ] /No [  ] / Not sure [  ]

Is there evidence of water damage in your home?

Yes [  ] /No [  ] / Not sure [  ]

Do you use a humidifier or swamp cooler?

Yes [  ] /No [  ] / Not sure [  ]

Additional Questions:

  • Where do you see mold growth in your home? Bathroom_____ Bedroom______ Attic _____ Basement _____Garage ______ Laundry room______ Other________
  • How large an area is the mold growth? ________________________
  • Do you have problems with moisture or leaks in your home? _________
  • Do you frequently have condensation on your windows? _________
  • Do you have either of the following in your home:
    • humidifier? _______
    • evaporative-type air conditioner (“swamp cooler”)? _______
  • How often is it cleaned?_______
  • Have you tried using something to decrease the humidity in your home? _________

Environmental Tobacco Smoke

Do any family members smoke?

Yes [  ] /No [  ] / Not sure [  ]

Does this person(s) have an interest or desire to quit?

Yes [  ] /No [  ] / Not sure [  ]

Does your child/teenager smoke?

Yes [  ] /No [  ] / Not sure [  ]

Additional Questions

  • Who in the family smokes cigarettes? ___________
    • How many cigarettes per day? ______
    • Does he/she (they) smoke in the house? ______

      Outside? _____ Both inside and outside? ______ In the car? ______

  • Do you have a smoking ban in the household?_______________
  • Does anyone smoke in daycare or other childcare setting where the child stays? ______
  • Does anyone who spends time at your house smoke? (friends, neighbors, relatives?) __________
  • Describe the circumstances when your child may be exposed to smoke?_________________

Air Pollution

Have you had new carpets, paint, or other changes made to your house in the past year?

Yes [  ] /No [  ] / Not sure [  ]

Does your child or another family member have a hobby that uses toxic materials?

Yes [  ] /No [  ] / Not sure [  ]

Has outdoor air pollution ever worsened your child's asthma?

Yes [  ] /No [  ] / Not sure [  ]

Does your child play outdoors when an Air Quality Alert (i.e., ozone, particulate) is issued?

Yes [  ] /No [  ] / Not sure [  ]

Do you use a wood burning fireplace or stove?

Yes [  ] /No [  ] / Not sure [  ]

Do you use unvented appliances such as a gas stove for heating your home?

Yes [  ] /No [  ] / Not sure [  ]

Additional Questions

Indoor Air Pollution Questions

  • Does anyone in your house use strong-smelling perfumes, scented candles, hairsprays, or other aerosol substances? _________
  • Do you live in a home that was built in the past 1–2 years? ______
  • If you recently made changes to your house—installed new carpets, painted, or other changes—how long ago was that? ___________________
  • Was there a change in your child's asthma symptoms after moving to a new house or having the work mentioned above done in your home? __________________
  • Do you ever notice a chemical type smell in your home?_________________
  • If you have a wood burning fireplace or stove, how many times per month in the winter do you use it? __________
  • Do you use an unvented appliance such as a gas stove for heating your home? _____ / 

Outdoor Air Pollution Questions

  • Do you live within a ½ mile of / a major roadway or highway? ______
  • an area where trucks or other vehicles idle? _____
  • a major industry with smokestacks? ________
  • Is residential or agricultural burning a problem where you live? ______________ / 
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