Jacob Fray’s West Philadelphia home has everything a toddler could want: lots of toys, his own playroom, and doting parents who love him to the moon and back.

Yet even all that couldn’t spare the bright-eyed 2-year-old from a several days’ stay last fall at Children’s Hospital of Philadelphia (CHOP), wheezing and fighting for breath. Like so many children, Jacob has asthma and his home contained a multitude of triggers.

Even homes tended with the best of intentions can be respiratory battle zones for little ones with allergic asthma — the type most common for young children. Nearly invisible dust mites, out-of-the-way mold, second- and even third-hand tobacco smoke, dander from household pets, such pests as cockroaches and mice, and other common household presences can be enough to trigger asthma attacks and aggravate inflammation-prone airways.

CHOP’s Community Asthma Prevention Program (CAPP) has been helping its young patients’ families identify and correct or reduce these home hazards for close to two decades. This year, however, they stepped up their game.

Since January, CHOP, in partnership with the Philadelphia Housing Development Corp., has embarked on a new campaign called CAPP+. In the pilot phase, homes of 10 CAPP patients were chosen for asthma-trigger removal, including home repairs and renovations, averaging about $20,000 a residence. Jacob’s home was one of them.

Keeping Household Asthma Triggers in Check

Asthma attacks can be triggered by many household sources that can be managed — if you know what to look for.

Bedroom

Bathroom

Kitchen

Living areas

Basement

Make sure doors and windows are sealed well to minimize intrusion from outside fumes, dust or pollen.

Don’t smoke in the home if your child has asthma, or, better yet, quit. Smoking residue sticks to clothes, shoes, etc. and particles are brought into the home even after the smoker is done smoking.

Cooking fumes can be an asthma trigger. Open a window during cooking if it’s safe to do so.

Fumes from cleaning products, deodorizers, perfumes, paints, nail polish and nail polish remover can all be asthma triggers. They should be kept away from the asthma sufferer and the area should be ventilated after use.

The stove exhaust fan should be vented to the outdoors.

Ovens or stoves should not be used as a home heating source.

Wash bedding and plush toys in the child’s room once a week. Avoid rugs, carpeting, and upholstered furniture in the child’s room. Use allergen-proof mattress and pillow covers.

Keep counters, sinks, tables and floors clean to discourage pest activity. Clean dishes, crumbs and spills right away. Store food in airtight containers.

Cockroaches and mice can produce fur, skin flakes, dander, and urine, which are asthma triggers.

Replace air conditioner filters every three months or as specified by the manufacturer.

Pets with fur should be avoided if possible. If you have pets, they should not sleep in the room with a child with asthma. Pets should be bathed regularly, once a week if possible.

Vacuum at least once a week.

The person with asthma should stay out of rooms while they are being vacuumed, swept or dusted.

Scrub mold off hard surfaces with white vinegar. If other chemicals are used, clean while the child is not in the home, and open a window to ventilate fumes.

Repair leaky pipes to prevent moisture and mold growth.

Use a dehumidifier to improve air quality and keep relative humidity at 30% to 50% indoors.

Clothes dryer should be vented to the outdoors. Regularly clean the lint trap. Check for and repair leaks.

SOURCE: Children’s Hospital of Philadelphia

JON SNYDER / Staff Artist

Keeping Household Asthma Triggers in Check

Asthma attacks can be triggered by many household sources that can be managed — if you know what to look for.

Bedroom

Bathroom

Kitchen

Living areas

Basement

Make sure doors and windows are sealed well to minimize intrusion from outside fumes, dust or pollen.

Cooking fumes can be an asthma trigger. Open a window during cooking if it’s safe to do so.

The stove exhaust fan should be vented to the outdoors.

Ovens or stoves should not be used as a home heating source.

Keep counters, sinks, tables and floors clean to discourage pest activity. Clean dishes, crumbs and spills right away. Store food in airtight containers.

Replace air conditioner filters every three months or as specified by the manufacturer.

Vacuum at least once a week.

The person with asthma should stay out of rooms while they are being vacuumed, swept or dusted.

Repair leaky pipes to prevent moisture and mold growth.

Use a dehumidifier to improve air quality and keep relative humidity at 30% to 50% indoors.

Don’t smoke in the home if your child has asthma, or, better yet, quit. Smoking residue sticks to clothes, shoes, etc. and particles are brought into the home even after the smoker is done smoking.

Fumes from cleaning products, deodorizers, perfumes, paints, nail polish and nail polish remover can all be asthma triggers. They should be kept away from the asthma sufferer and the area should be ventilated after use.

Wash bedding and plush toys in child’s room once a week. Avoid rugs, carpeting, and upholstered furniture in child’s room. Use allergen-proof mattress and pillow covers.

Cockroaches and mice can produce fur, skin flakes, dander, and urine, which are asthma triggers.

Pets with fur should be avoided if possible. If you have pets, they should not sleep in the room with a child with asthma. Pets should be bathed regularly, once a week if possible.

Scrub mold off hard surfaces with white vinegar. If other chemicals are used, clean while the child is not in the home, and open a window to ventilate fumes.

Clothes dryer should be vented to the outdoors. Regularly clean the lint trap. Check for and repair leaks.

SOURCE: Children’s Hospital of Philadelphia

JON SNYDER / Staff Artist

CHOP has committed to doing 100 homes next year and more in the next five years as part of CHOP’s Healthier Together initiative, a five-year, $25 million effort to tackle such community issues as hunger, violence, behavioral health, and asthma.

“One in four children in West Philadelphia suffers from asthma, which is a staggering statistic,” said Madeline Bell, CHOP’s president and chief executive officer. “It’s one of the top reasons why children come to our emergency department or are admitted to our hospital.”

Asthma, which affects an estimated six million children nationwide, is also one of the major reasons that they miss school.

With stakes like those, Tyra Bryant-Stephens, CAPP medical director, said the program takes a "holistic approach to helping families reduce triggers in their home.”

“Every child is not allergic to every, single trigger, but we do know that children who are allergic tend to develop allergies over time,” said Bryant-Stephens.

A big part of the battle is knowing what to look for – and where to look. Asthma triggers can lurk in the most seemingly innocuous places. That shaggy Dora the Explorer rug in your child’s room? It’s a dust magnet. Same for plush toys; keep them out of little asthma sufferers’ beds.

Donielle Darden and Markese Fray, Jacob’s parents, had already learned some of the anti-trigger tricks from their CHOP health worker before the CAPP+ inspectors came to their West Philly home last month.

“We used to let him sleep with his teddy bear. We don’t do that anymore,” said Fray.

Jacob Fray, of West Philadelphia, has asthma.
Courtesy of Donielle Darden
Jacob Fray, of West Philadelphia, has asthma.

But the young couple were nonetheless alarmed at some of the asthma triggers the inspectors found in their tidy home. Such as mold lurking in their basement and laundry area.

“I was surprised we were living in so much mold,” Darden said.

Fortunately for the couple and others in CAPP+, significant and potentially costly repairs such as removing mold-prone, water-damaged drywall and other improvements are covered by the new program.

Donielle Darden and Markese Fray at their home in West Philadelphia.
ANTHONY PEZZOTTI / Staff Photographer
Donielle Darden and Markese Fray at their home in West Philadelphia.

But as CAPP has taught numerous families over the years, many steps can be taken to reduce or remove asthma triggers, often at a minimal cost. What follows are some of the anti-asthma highlights.

The best place to start is the bedroom of the child with asthma. Remove dust-attracting rugs or plush toys. Wash bedding once a week. Curtains should be washed regularly, and shades should be wiped down. Blinds are probably too difficult to keep dust-free. But allergen-proof mattress and pillow covers are good investments.

In the home’s other rooms, carpets and floors should be vacuumed weekly, and it should be done while the person with asthma is not in the room.

Unwelcome household guests are also an issue. Everything about cockroaches is an asthma trigger. So are rodents’ fur, dander and urine. All the homes in the CAPP+ program are treated by an exterminator. In other homes, CAPP has suggested roach traps, and keeping such areas as kitchen counters and behind appliances clean and free of food residue.

Tobacco smoke is also a big asthma trigger. Adults in the home would do well to quit for their children, not to mention themselves. If they can’t, they shouldn’t smoke in the home, and Bryant-Stephens suggested they keep a “‘smoking jacket” or sweater to leave by the door that they use to go outside for a cigarette. That way they won’t bring third-hand smoke residue into the home’s other living areas.

You also want to keep such triggers as outside pollution and car exhaust from entering the home. CAPP advises making sure cracks or gaps around windows and doors are sealed.

Sheila Adkins of Adkins Management inspects the doors of Markese Fray and Donielle Darden's home in West Philadelphia.
ANTHONY PEZZOTTI / Staff Photographer
Sheila Adkins of Adkins Management inspects the doors of Markese Fray and Donielle Darden's home in West Philadelphia.

And then there is that nasty, old mold. Fixing plumbing leaks, replacing water-damaged surfaces, and using the bathroom fan can make your home a less mold-friendly place.

If you already have mold, you don’t need to invest in caustic chemical cleaning remedies that can aggravate a child’s airways. CAPP’s recommendation for home-cleaning, including hard surfaces where mold may grow and baseboards that harbor residue? Old-fashioned, inexpensive white vinegar.