EPA Region 6 Deputy Administrator Jerry Clifford kicked off the Healthy Indoor Environments 2000 Conference & Exhibition with a show of hands: Who in the audience currently has or has had asthma or allergies? Most of the 400-plus attendees raised their hands and then set out on a three-day journey to discover the link between IAQ and asthma and allergies, and what products, methods and cleaning approaches are best for prevention.

"We can't do enough to address this issue," Clifford told attendees.

The premiere of the Healthy Indoor Environments show brought together medical and IAQ professionals to improve the communication between the two sides for the study of asthma and allergies in the indoor environment. The show was sponsored by The University of Tulsa Indoor Air Program, EPA Region 6, Indoor Environment Communications and IE Connections, U.S. Public Health Service Region 6, The University of Texas Health Science Center at San Antonio School of Medicine and Nursing, Glaxo-Wellcome, National Air Duct Cleaners Association, Mycotech Biological Inc., and Aerobiology Laboratory Associates Inc.

"When I had my first asthma attack, the doctors gave me something to inhale and that solved the problem," Clifford said. "I know now that there are many things we can do in our daily lives from an indoor air perspective to reduce the likelihood or severity of those asthma attacks. Oftentimes, we don't seem to get the indoor air people who are experts in that area connected with the clinicians and practitioners who are in the process of treating and diagnosing people with asthma.

"I think this conference is something that can be modeled throughout the country to provide dialogue and share information," he added. "To the extent that we can marry the indoor air folks with that information, that technology and those practices and methodologies with the clinicians who are diagnosing the problems, I think our ability to arrest this problem and get a handle on it, increases exponentially. I'm very happy to see the wide participation and the enthusiastic support of the conference."

Something Different

Richard Shaughnessy, director of The University of Tulsa's Indoor Air Program, served as the conference moderator. During his introduction, Shaughnessy stressed the challenge of bringing medical and IAQ professionals together in the same room.

"We're trying something a little different here," he told attendees. "We're trying to bring professionals in the field together with medical professionals. As many of you know, on both sides, this is a difficult marriage. It's one in which we both have a lot of learning to do from each other."

The conference was developed before the release of the report, Clearing the Air: An Assessment of Asthma and Indoor Allergens, a compilation of recommendations by the Committee on the Assessment of Asthma and Indoor Air, Institute of Medicine of the National Academy of Science. Commissioned by EPA's Indoor Environments Division, the report specifically encourages events- such as Healthy Indoor Environments- to increase interdisciplinary involvement to solve asthma and allergen problems.

"This [report] solidified our feelings that this is a conference that is needed," Shaughnessy added.

Integrating Children's Health

Robert Axelrod, former director of EPA's Indoor Air Division, is now part of the agency's new Office of Children's Health Protection. The office is basically charged with getting children's health protection integrated into everything the agency does: from risk assessments to rulemaking to information activities. Axelrod also serves as the EPA co-chair of the Asthma Workgroup of the President's Taskforce on Environmental Health and Safety Risks for Children.

"You're going to hear a lot of statistics about the worsening problem of asthma," Axelrod told attendees. "What I want to focus on is how the federal government has been working together to try to establish policies, to try to bring resources to bear, and how environmental controls fit into the larger issue."

"Because we don't understand the causes of asthma, scientists and the medical community really don't have enough information yet to develop guidelines for how we prevent children from developing the disease in the first place," he continued. "This is an important point because what it means is that everything you're going to hear really is about how we control asthma among children who already have the condition. What's going on in the medical community is about medical management of the disease. ...There is also widespread consensus that appropriate medical care and self-monitoring of symptoms, along with measures to control indoor environmental triggers such as allergens, can substantially reduce the severity and frequency of asthma attacks. But the cases of asthma keep growing."

Among the federal initiatives currently in the marketplace:

• Asthma management guidelines established by the National Asthma Education and Prevention Program run by the National Heart and Lung Institute at the Department of Health and Human Services (HHS). Axelrod says that too many patients aren't being treated according to guidelines, which includes the management of environmental triggers such as environmental tobacco smoke
• First Lady Hillary Clinton introduced asthma strategy last year that was developed by the Presidential Taskforce. It parallels the HHS strategy introduced earlier this month which really focuses on asthma as it relates to the environment and children's health. Axelrod says these strategies try to get the whole federal government involved to increase research into environmental factors, expand state and local public health programs, and strengthen the surveillance of asthma data to examine the trends on the state and local level.

"We really need to focus on the integration of the environmental community and the public health community into a coherent team for developing strategies to deal with this problem," Axelrod said. "There's already is a large infrastructure at HHS. There is more than $120 million a year in research and other funding at HHS. Those appropriations really need to be harnessed; we need to work within them. We need to develop as much as we can from these relationships. We need to not reinvent the wheel. We need to use the current educational resources to build partnerships."