Speaker: Clinicians should be prepared to advise patients on home mold remediation
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NASHVILLE, Tenn. — As climate change increases the prevalence of damp indoor environments, which can exacerbate respiratory symptoms and diseases, clinicians should be able to advise patients on safe home mold assessment, a speaker said.
Priya Balakrishnan, MD, FCCP, assistant professor of pulmonary and critical care medicine at West Virginia University, said during the “Indoor mold manifestation: Lung health implications and mitigation” session at CHEST Annual Meeting that patients often ask her in clinic what to do with the mold they have seen in their homes.
“This talk was inspired by the recent increase in catastrophic weather events associated with climate change,” Balakrishnan told Healio. “The higher frequency of hurricanes and storms have led to increased floods thus elevating the risk of dampness in the home. Dampness causes the proliferation of mold indoors. Warmer temperatures can promote the formation of mold as well.”
Patients with allergic diseases such as rhinosinusitis or asthma can experience poor disease control or exacerbations when living in environments with indoor mold, Balakrishnan added. Such patients are also at increased risk for developing invasive fungal infections, such as aspergillosis, and allergy-induced asthma exacerbations including allergic bronchopulmonary mycosis.
“It was estimated that these symptoms/diseases increase by 30% to 50% in homes with dampness and mold,” Balakrishnan told Healio. “There is evidence that indoor dampness can lead to new respiratory symptoms and asthma in otherwise healthy individuals as well.”
Thus, it is important that pulmonologists have discussions with their patients about potential moldy home environments.
“Aside from pharmacologic treatment of worsening asthma and its complications, pulmonologist have to consider and mitigate factors leading to poor disease control,” Balakrishnan said. “This will help prevent further worsening of disease and poor outcomes (recurrent hospitalization, death, poor functionality, etc).”
To determine if a home assessment is warranted, Balakrishnan recommended using a questionnaire with patients that asks them whether in the last 12 months they have seen water problems or dampness in their homes, noticed moldy or dusty smells, observed fungal growth or condensation on their windows, or whether any of their furniture or possessions are water damaged.
“Depending on the severity of your patient’s symptoms, the presence of even one positive response may necessitate the need for home mold assessment and remediation by a professional, not just by the patient themselves,” Balakrishnan said during her presentation.
Clinicians can advise patients to do a home self-assessment to look for evidence of mold growth or dampness, making sure they check furniture and hidden areas, such as behind the fridge.
“Always advise caution by promoting the use of protective masks and/or barrier devices like gloves as the inspection process may inadvertently cause mold and dust migration,” Balakrishnan said.
Once mold is detected, environmental sampling is not usually required, Balakrishnan continued, but may be useful when the source of the mold cannot be identified. In such cases, professionally trained individuals should conduct the environmental sampling.
When patients ask how to then remove the mold they have identified, Balakrishnan said she recommends a two-pronged approach.
“Firstly, they should consider any other environmental hazards like asbestos or lead before attempting to eliminate indoor mold. Secondly, they should remove or clean all mold-damaged materials while preventing dispersion and exposure to mold,” she said, adding that the CDC recommends using 1 cup of household bleach to 1 gallon of water, or alternatively soapy water, to clean up mold.
In addition to information from the CDC, Balakrishnan recommended the resources and guides available from the U.S. Environmental Protection Agency and FEMA on how patients or professionals can clean indoor mold.
Successful remediation also requires that mold be prevented from recurring by addressing any leaks and controlling indoor moisture, Balakrishnan advised. Such practices include having home air conditioning systems inspected, using exhaust fans in the kitchen and bathroom, and maintaining indoor humidity below 65%.
“I think doctors should expect to see more allergy and infectious-related symptoms/diseases over the next few years and in the future due to effects of climate change,” Balakrishnan told Healio. “We should be prepared on how to guide patients on home remediation for mold to improve their health outcomes.”