November 28, 2023
5 min read
Key points:
- Most mold spores are airborne and they can affect respiratory health.
- Bleach and other irritants can make asthma worse.
- Remedial measures should focus on reducing moisture and humidity.
ANAHEIM, Calif. — Asthma patients can repair mold damage in their homes after flooding caused by natural disasters, according to a report presented at the American Academy of Allergy, Asthma & Immunology’s annual scientific meeting.
“This study was done primarily because New Orleans has a lot of hurricanes and flooding,” Amber Hardman, MD, MPH, MBA, chief resident in pediatrics at Tulane University School of Medicine told Healio. “With global warming, this is going to happen more.”
Hardman and his colleagues explained that because floods create humid indoor conditions, mold begins to grow on any surface and seep into the air.
Amber Hardman
“Most people think they can see mold. This is the only time it shows up,” Hardman said. “But most mold spores are in the air.”
Patients with respiratory illnesses, allergies, and immunosuppression are most susceptible to this exposure.
“So, their condition deteriorated significantly,” Hardman said.
Hardeman and colleagues conducted a scoping review of 20 peer-reviewed articles as well as guidance from organizations such as the CDC, Environmental Protection Agency, Occupational Safety and Health Administration, and the American Society of Allergy, Asthma, and Immunology.
“Our primary goal is to understand how mold affects the public after natural disasters, storms and floods, and what are the safest ways for patients to mitigate harmful effects after mold removal,” she said.
Effects of Mold
The review identified four proven mechanisms by which mold can have direct adverse health consequences, including allergy, toxicity, infection and irritation.
Allergies include allergic rhinitis, allergic asthma, nonallergic asthma, allergic bronchopulmonary aspergillosis and mycoses, allergic fungal sinusitis, and hypersensitivity pneumonitis.
Additionally, asthma patients are 2.16 times more likely to die when the mold count exceeds 1,000 spores/square meter3the researchers found.
In addition, volatile organic compounds (VOCs) produced by mold growth – low molecular weight carbon-containing compounds that evaporate under normal temperatures and pressures – can also irritate the respiratory tract.
In fact, one study reviewed by the researchers showed that the incidence of invasive mold infections increased from 2.5 before the hurricane to 3.69 after the hurricane, although another study found no such increase.
“Sometimes it’s hard to tell what the course of treatment will be after that,” Hardman said. “That’s something we’re looking at moving forward.”
The authors found that mold also has socioeconomic impacts.
“One of the most important things we also noticed is that there are large, disproportionately large, underserved African-American and Hispanic populations that are exposed to these molds because they tend to live in neighborhoods with higher rates of poverty,” Hardman said. Higher.” .
The authors say these communities have poor housing infrastructure and unequal access to and quality of health care.
Additionally, the authors say anxiety about mold is common and say unproven effects such as fatigue and rashes are often attributed to mold exposure.
Fix
Hardman said the review did not develop any specific remediation guidance from a physician’s perspective, but industry and government groups provided recommendations. The recommendations include four different strategies based on the size of the infected area.
Level 1 infections less than 10 square feet require the use of an N95 mask, along with water and detergent to scrub mold away from non-porous surfaces. Residents do not need to relocate.
For Level 2 infestations (areas between 10 square feet and 30 square feet), mold removal personnel should use dust-suppressing materials and dispose of damaged materials. The use of chemicals such as biocides and chlorine bleach is not recommended.
“For people to use harmful bleach and the things they’re constantly being told to use can actually do more harm than good because they are irritants themselves and can make your asthma symptoms worse,” Hardman said.
Level 3 infestations are between 30 square feet and 100 square feet and should be repaired by professionals. Buildings should be covered and/or dismantled, and ventilation ducts and vents sealed. Additionally, these areas should be unoccupied except for restoration workers who are cleaning using HEPA vacuums and damp cloths or detergent solutions.
Likewise, professionals should address Class 4 infestations, which are 100 contiguous square feet or more. These structures may need to be completely removed and the areas within the remaining structures should be dry, with humidity levels below 60%.
The authors warned that remediation work could produce particles more harmful than mold and stressed the importance of protective equipment.
Furthermore, the authors stated that over-testing and/or remediation out of fear is costly and fails to address the underlying fear.
“It’s not necessary to sample the mold because you’re going to get different values depending on where you sample it,” Hardman said.
The authors say residents should assume that flood-damaged homes may still have mold unless the moisture is removed.
“The most important thing is to dry the space or purify the air with a HEPA filter,” Hardman says.
Large pieces of damp porous material such as furniture, carpets and insulation should be removed to help the house dry. Small porous materials like blankets and toys can be washed and dried. Non-porous materials such as tables and floors can be cleaned with water or vinegar solutions instead of caustic products.
The authors also recommend that if the home’s HVAC system is operational, it should be used during the drying process, as well as using an industrial dehumidifier if available. Efforts to dry out the home should continue until the humidity drops below 60%.
The authors go on to say that patients with allergies and other chronic conditions should not participate in treatment.
public health
The authors call for public health messages to address the harm caused by fear of mold as well as the harm caused by mold itself after flooding.
Additionally, the authors call for public health initiatives to address structural housing inequalities and post-flood cleanup efforts to mitigate risks posed by long-term mold exposure to residents at high risk of worsening the condition.
Resources are also available to help people with these remediation efforts, Hardman said.
“Our main focus is education and helping them understand who can help them remediate mold in their home,” Hardman said.
Community groups can step in to help clean and dry flooded homes, especially those of older people or children with asthma, she continued.
Hardman said it’s difficult to keep people away from homes and neighborhoods that have been severely damaged.
“Even if their particular home isn’t hit as hard, they’re still exposed to all the spores in the environment as they move through the neighborhood,” she said. “Their health care situation is still deteriorating.”
However, finding alternatives for these residents is challenging, Hardman said, which often means staying with relatives or friends outside the area or in public shelters.
“But in an area like New Orleans, a lot of times that’s not possible,” she said.
Despite these challenges, Hardeman said, these efforts are important because approximately 20% of the world’s population has asthma, which is especially important for allergists and immunologists.
“And the numbers are growing,” she said.
American College of Allergy, Asthma, and Immunology Annual Scientific Meeting