Indoor-Air Pollution: The invisible war on lungs

An Evidence-based Blog about Health, Compassion & our Environment

By Dr. Fern Moreno

Pollution is Declining! But not all pollution…

According to NASA, outdoor air pollution has noticeably decreased around the world, regardless of the time of year or weather changes 6, 16.  Experts are attributing this improvement to less fossil fuels burned for transportation and electricity due to stay-at-home orders 16. This is a significant silver lining if we consider that both outdoor and indoor air pollution are risk factors for respiratory viral infections 3. 

Though indoor air is generally protected from outdoor pollutants, Indoor Air Quality (IAQ) is an entirely new world of pollution and often times much worse than outdoor air! The World Health Organization reports household air pollution leads to 3.8 million deaths annually and causes 50% of pneumonia deaths in children under 5 years old 34. Energy-efficient homes and buildings further insulate indoor air and may keep pollutants locked inside 28.  Poor indoor air quality is associated with exacerbations of asthma, cough, cardiovascular disease and hospital admissions for acute coronary syndrome 27. With our increased time spent at home, it is important to evaluate indoor allergens and pollutants that could contribute to respiratory health and overall wellbeing. 

Whether a pollutant is toxic to your body depends on the amount of time exposed and the dose of the exposure.  Our bodies utilize various detox organs (lungs, liver, kidneys, skin, digestive tract) that help us break down and excrete chemicals we inhale.  However, when the exposure to potentially toxic chemicals happens often in small doses or less often in very large dose, our bodies’ detox pathways can become over-burdened. These same chemicals can irritate the lungs making them vulnerable to infections and/or accumulate in places, like our fat tissue, where they are stored long-term 3, 32.

It is nearly impossible to completely avoid all indoor pollutants, but it is possible to consciously decrease exposures. Once you are aware of the sources of different toxins, you can control for many of them by eliminating or replacing products with less toxic ones.  Even small changes lessen the burden on your organs of detoxification, allowing your body and mind to function optimally.

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I will discuss 5 common sources of indoor pollution that may be reduced with simple subtractions and/or additions to your home:

  1. Toxic Mold
  2. Volatile Organic Compounds (VOCs)
  3. Cleaning & Personal Care Products
  4. Dust
  5. Particulate Matter from Cooking & other Smoke

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1. Toxic Mold

Certain fungus/mold commonly found in water-damaged buildings can disrupt the communication between immune cells.  When an immune cell (ex. a neutrophil) detects an invader (bacteria, virus, fungus, etc.) that shouldn’t be present, that immune cell will release tiny messengers (ex. leukotrienes) that invite other immune cells to gather and join the fight against the invader.  This is one of the many first-line defenses by our immune system. Certain fungi, like the common Aspergillus fumigatus, release mycotoxins (ex. gliotoxin), which will switch off a specific enzyme that prevents immune cells from sending off their messengers, thus preventing the gathering of the immune troops.  This weakens the immune response and allows opportunistic viruses and bacteria to replicate in the body unchallenged 11.

A 2020 study investigated what the immune system would do in the presence of both fungal and viral infections.  Typically, immune cells will completely engulf a pathogen, say a virus, and digest it through a process called phagocytosis.  However, researchers found that when an immune cell engulfs a fungal pathogen, it will spit it back out through a reverse eating process called “vomocytosis”.  Researchers found that when a viral infection is also present, this expulsion process is accelerated, allowing even more fungal pathogens to continue to replicate and further compromise the immune response 19, 11.

Mold exposure from water-damaged buildings could be considered a risk factor for viral infections due to its impact on the immune system.  Recovering from mold exposure can become very involved, but I hope these tips will help you reduce and prevent potential exposure:

Clean Air Strategies:

  • If you suspect you have been affected by mold exposure, it is important to seek testing and treatment right away from a naturopathic and/or integrative doctor with experience in environmental medicine.  The first step will always be to immediately remove yourself and others from the moldy environment at home, work, or school, then test and remediate the building if needed.
    • If you have had water-damage that wasn’t dried within 48 hours, there is likely mold present. 
  • Get rid of any porous material with visible mold or musty smell.
  • Keep indoor humidity low (ideally between 30% and 50%)- measure with moisture or humidity meter. Use air vents, air conditioning, dehumidifier, or open windows to reduce humidity.
  • You may consider air duct cleaning if ducts have excessive mold, dust, debris or infestations.
  • Mold is not always visible on visual inspection; for example, it may be present behind dry wall, wallpaper, paint or paneling, under carpets or pads, around pipes, inside ductwork, above ceiling tiles from roof leaks.
    • You may consider hiring professionals to test your home for mold using the Environmental Relative Moldiness Index (EMRI) to identify presence and types of mold.
  • See the “EPA’s Guide to Mold and Moisture” for more

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FERN FACT:  Bats infected with a naturally occurring fungus that causes white-nose syndrome and also infected with a type of coronavirus (M. lucifugus-CoV) had about 60-fold more viral RNA & higher coronavirus antibodies than bats with the virus alone 4.

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2. Volatile Organic Compounds (VOCs)

VOCs are organic chemicals that are released into the air from household products covered in paint, varnishes, & waxes, and are also found in cleaning products & disinfectants, aerosol sprays, air fresheners, pesticides, printers & copiers, arts & crafts material, building material & furnishings (adhesives, carpets, foam), and cosmetic products.  VOCs are found inside homes at levels that are 5 times greater than outdoors 7. VOCs can cause mild symptoms such as headaches, irritated eyes & skin, common allergies, as well as, more serious and long-term concerns, such as hormonal changes, organ damage, respiratory illness and cancer 25, 7.

This may sound worrisome, but there is good news! There are many options to help decrease VOCs in your home. A recent study showed that indoor plants are effective in reducing specifically indoor VOCs in the air: certain plants reduced “ 9% of benzene, 75% of ethylbenzene, 72% of xylene, 75% of styrene, 50% of formaldehyde, 36% of acetaldehyde, 35% of acrolein with acetone, and 85% of toluene” 28. You may also consider plants at work; Indoor plants have been shown to improve wellbeing and reduce sick-leave by over 60% 31.

Clean Air Strategies:

  • Add beautiful plants that also act as air-purifiers, specifically for VOCs, but also for carbon monoxide (CO) and carbon dioxide (CO2) 31.  The most efficient plants at removing VOCs in the air are English Ivy, Purple Waffle, Purple Heart plant, Asparagus Fern, Variegated Wax plant, Weeping Fig 35.  
  • Air purifiers with a true High Efficiency Particulate Air (HEPA) filter may not be enough to filter VOCs.  A  carbon filter with a large carbon weight can help to get rid of VOCs, but will need to be replaced frequently to avoid re-releasing VOCs into the air.  Photo Electrochemical Oxidation (PECO) filter technology can also help to eliminate VOCs at the molecular level, best at low humidity 36, 22, 12.
    • One example of PECO technology is seen in the Molekule air purifier.
    • Continue to read for a list of HEPA + carbon air purifiers.
  • Fix rips in furniture so foam is not exposed.
  • Do your best to avoid products with foam in them (eg. Memory foam in pillows, mattresses, shoes).  Here is a guide to help you pick a nontoxic mattress!
  • Air out (off-gas) new products made of petroleum-based synthetic products outside or in garage for as long as you can (several days if possible) before bringing into home.
  • Purchase vinyl-free or PEVA/PVC-free shower curtains that do not off-gas.

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3. Cleaning & Personal Care Products

Antibacterial Products

This may sound counter-intuitive for cleaning, however “antibacterial” cleaning products are not recommended indoors by the American Medical Association 5. Antibacterial household cleaners, soaps and hand sanitizers have an active ingredient called, triclosan, which can cause bacterial resistance to antibiotics.  Triclosan has been found in drinking and ground water and can persist and bioaccumulate in the environment, leading to negative health impacts for humans and animals 5.

Fragrance Products

Chemicals released by products with “fragrances” or “perfume” such as, scented candles, air fresheners, laundry supplies, personal care products and cleaning products, are sources of indoor pollution and can be harmful to human health.  The ingredient “fragrance” can be made up of hundreds of unregulated chemicals that legally do not have to be listed on the product label or the material safety data sheet (MSDS) in the United States 29. Over 3000 synthetic compounds have been documented in “fragrance” products 29.  Over 550 of those chemicals are VOCs, such as benzene, toluene, acrolein, limonene (lime scent), alpha pinene (pine scent) and acetaldehyde; about half of those VOCs are classified as “toxic” or “hazardous”, yet over 97% are not disclosed to consumers on labels 29. These chemicals do not just disappear with time, they instead react with other molecules already in the air, long after the use of the product is over, and create harmful ultra-fine particles that cause respiratory irritation and hormone disruption 29, 8. For example, 2 molecules of limonene creates 1 molecule of formaldehyde, a known carcinogen (causes cancer) 29.

Fragrances have been shown to cause asthma-like symptoms in non-asthmatic persons even when completely avoiding nasal breathing and using carbon-filtered masks 15. New-onset asthma cases are significantly higher in people with work exposure to cleaning products compared to those not exposed to cleaning products 21.  You may have noticed that some indoor public places such as, hospitals, schools, and private work places are not only smoke-free but also fragrance-free; this is to prevent “secondhand scents” that can create or worsen health conditions 29.

Clean Air Strategies:

  • Limit use of products labeled antibacterial for indoor cleaning 17.
  • Purchase cleaning products, soaps, and laundry detergents without fragrance, phthalates, parabens, glycol ethers, cyclosiloxanes, BPA, alkylphenols, and triclosan.  Even “green” and organic products can contain fragrances and other hazardous chemicals; Always read the label. 
    • You may consider the Think Dirty app to help you choose safer cleaning products with more ease.
    • BONUS: Here’s a great Home-made All-purpose Cleaner Recipe: 2 tablespoon (tbs) Castile liquid soap (OR 1 tbs Castile oil + 1 tbs hydrogen peroxide) + 10 drops peppermint essential oil (EO) + 5 drops geranium EO + 5 drops lemon EO + 2-3 tbs water.  Add ingredients to small spray bottle. Shake well. Use within 2 weeks. Geranium & Lemon EO have been shown to prevent the binding of SARS-CoV-2 virus to epithelial cells.
  • Purchase personal care products (makeup, lotions, oral care, hair products, etc.) with the least amount of hazardous chemicals. You may consider the “Healthy Living” app by the Environmental Working Group (EWG), or Think Dirty mentioned above, to find personal products that are known to be less harmful to your health.
  • Avoid the use of fabric softener and dryer sheets! Try organic wool dryer balls instead—you can even add a few drops of essential oil to wool balls for a natural scent.
  • Avoid air fresheners and deodorizers!
  • Avoid products completely if they irritate your eyes, make you sneeze, give you a headache or migraine, cause nausea, asthma attacks or any difficulty breathing after the first or second exposure.
  • Avoid purchasing and burning paraffin wax candles (especially if scented), they produce more fumes and formaldehyde 23.
    • Consider soywax candles or beeswax candles that are unscented instead.  You may also make your own candles!
  • Encourage your work, schools, and daycare to use Certified-green or Green Sealed cleaning products and to make work space a fragrance-free zone.

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FERN FACT: Pheromones are subtle molecules we release and can consciously & unconsciously detect on others.  Pheromones help us to sniff out potential mates we are attracted to AND biologically more compatible with 14,  13. Perfumes, scented body sprays & scented deodorants can mask natural pheromones and trick our noses into choosing a mate that we may not be biologically compatible with 2.

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4. Dust

Dust particles can be carriers for harmful pollutants.  Mold and mold spores can latch on to dust particles and lay dormant until the right conditions (humidity and heat) present themselves again.  Mold may be harmful to human health whether it is dead or alive 33. Indoor dust can even be a carrier for outdoor pollutants, like hopanes, which are found in engine oil lubricants and vehicle exhaust 26. Dust particles can be a carriers for various classes of flame-retardants; these are chemicals added to man-made materials, coatings and finishes to prevent spread of fire if ignited 29. VOCs, discussed above, can be absorbed by dust particles; at higher rates with increased heat 24.

Clean Air Strategies:

  • Ask your building manager to install “high-MERV” air filters in the building ventilation (heating and cooling) system.  Ask your work and/or school building manager to do the same. (MERV 13 and greater helps filter viruses, bacteria, dust and mold).
  • If a whole-house filter is not possible, highly consider purchasing air purifiers with a true HEPA filter and a carbon filter.  Start with your bedroom and other rooms you spend most of your time. Some considerations:
  • Use a vacuum with a HEPA filter
  • Do not let dust accumulate- use a damp cloth to wipe down dusty surfaces
  • Mop instead of sweep when there is a lot of dust.
  • Avoid walking inside home with outdoor shoes, leave them at the front entrance or if possible in an outside area.
  • Indoor plants can help reduce dust (particulate matter) levels as well! 31
Choosing a whole house filter

5. Particulate Matter from Cooking & other Smoke

In the United States, we have access to gas or electric stoves which tend to emit less indoor pollutants compared to open fires or traditional cooking stoves that burn coal or biomass without chimneys or ventilation, as seen in less developed countries 27, 1.

However, precautions should still be taken to reduce airborne particulate matter (PM) and carbon monoxide (CO) from smoke, which can contribute to respiratory infections, such as pneumonia, tuberculosis and chronic obstructive pulmonary disease 1.

Clean Air Strategies:

  • Open windows when cooking
  • Use exhaust fan when cooking (have fan inspected to ensure it works properly)
  • Open windows and turn on exhaust fan over stove to circulate fresh outdoor air into the house and older indoor air out through the fan. Best to do this when Air Quality Index (AQI) is considered at least “Good” (50 or below)-  Local AQI is often a part of any weather app.
  • Avoid smoking inside
  • Light incense, sage and other plant-based smoke only with all windows open and leave windows open until all scent is gone.
  • Indoor fireplaces (wood burning and non-wood burning) can increase the amount of fine particles—”PM2.5, NOx, CO, CO2, formaldehyde, acetaldehyde, VOCs and benzo[a]pyrene (BaP)”—inside homes.  Fireplace season is associated with increased risk of adults asthma-related hospital encounters 20.
    •  This is tough for the 11.6 million impoverished homes in the US who use wood as a primary or secondary source of heat 18; if you have other options for heat, please consider those that do not emit smoke.
  • Air purifiers with a true HEPA filter and a carbon filter can help decrease particular matter (See #4 Dust section for more).  For HVAC or whole house systems, MERV 11 filters and greater help filter indoor-smoke—however, the higher the rating the better.

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One small change in the home, one giant difference in health outcomes.

         Begin making small adjustments in your home and watch your health improve!  Our health is intricately linked with our environment, especially the environments we spend the most time in (like our homes!).  Addressing any sources of indoor air pollution will help you get started at reducing invisible daily hazards. Changes in the home are investments, which become habits, which become standards; higher health standards can lead to health improvements and disease prevention.  By investing in safer and cleaner products you are utilizing your dollar to vote for products that are less hazardous to your health and the health of your loved ones.

Disclaimer: The information presented is not meant to diagnose, treat or provide medical advice.  Please consult your doctor or speak with a naturopathic or integrative doctor during an official consultation to receive medical advice.

References:

Read More
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