How a new program for Clevelanders could fix up your home and improve your kid’s asthma

Cleveland researchers are testing out a method to improve the city’s dismal asthma rates: fixing up residents’ homes to make the inside air cleaner. 

Efforts to improve air quality historically focused on reducing pollution from factories or vehicles.  But indoor air can carry its own allergens, like molds and pests, that trigger asthma attacks and make it more difficult to breathe. 

A new partnership is testing whether low-cost home repairs can improve indoor air quality and reduce children’s asthma symptoms. The group — which includes researchers at Case Western Reserve University, the local nonprofit Environmental Health Watch and lung doctors at the Cleveland Clinic — is gathering data using a $1 million federal grant from the Department of Housing and Urban Development. 

“The built environment is often ignored when doctors are thinking about, like, ‘Oh, my patient is suffering from asthma, like, what can be done?’” said Bridget Hegarty, an assistant professor at Case Western Reserve’s School of Engineering who is leading the study. “They’ll prescribe different medications, but sometimes it’s more like: You need to improve the whole environment.”

The program is small: Hegarty and Environmental Health Watch will work with about 60 homes where a child with asthma lives. But it’s part of a wider push to improve air quality to address high asthma rates in Cleveland. The Asthma and Allergy Foundation ranked Cleveland the fifth-most challenging city to live with asthma in the U.S. last year, based on asthma prevalence, asthma-related mortalities and emergency department visits. 

The city is working on the issue, too. Cleveland’s health department asked the City Council to pass stricter outdoor air quality rules last year. Cleveland also created an indoor air quality program in 2018. Last year, it opened an asthma management initiative called Breathe Easy Everyday, in which city staffers walk through residents’ homes to identify potential asthma and allergy triggers. The program does not provide funding for home improvements or modifications, though.

It’s not the first time indoor air quality came under the microscope in Cleveland. Several decades ago, doctors and researchers in the area received federal grants to help show the connection between housing and asthma. One small study in 2006 by researchers at Case Western found children with asthma had a significant decrease in symptomatic days after household repairs. In 2015, the Cleveland Plain Dealer reported that local doctors were using federal funding to clean up breathing hazards in homes and hoped to see the state’s department of Medicaid fund home visit programs.

The new study is unique because it will analyze the type of mold growing in homes. Laboratory experiments show that mold in more damp environments tends to have more allergens and be more toxic than mold in drier environments, Hegarty said. She wants to see whether that is true inside homes, as well, and whether home improvements make the type of mold safer.  

Plus, Hegarty said she hopes that the new study can keep pushing the focus on indoor air quality forward, since continuity has been a challenge in Cleveland. Dr. Maeve MacMurdo, a pulmonologist at the Cleveland Clinic who is involved in the project, said there still aren’t many affordable options for residents with asthma to improve their indoor air quality and fix up their homes. That leaves her with limited suggestions for her patients. She hopes the study will help prove to potential funders — like insurance companies and public health agencies — that investing in indoor air quality can reduce expensive treatments like going to the emergency room. 

“But without that data, it’s really hard to make that case,” MacMurdo said. 

Residents can get up to $1,000 in home repairs 

Homes in Cleveland are old — a vast majority were built before 1978. As they age, repair issues that might seem small can escalate quickly, said Donald Collins, the program manager of Healthy Homes and Workforce Development at Environmental Health Watch. Many residents can’t keep up. 

That’s where Environmental Health Watch’s decades-old healthy homes program comes in. Residents can hire people like Collins to inspect their homes for health hazards – like making sure they are dry, well-ventilated and pest-free. The program suggests what repairs need to be made and can help residents with smaller-scale improvements.   

After homes are fixed, Collins said he notices clear benefits: “I can almost see it immediately. Not only their health, but there’s certain psychological benefits as well. I mean, their attitude changes.”

Hegarty’s team will be collecting data to show how residents’ health is changed. When a family is selected, Hegarty’s team will start by collecting dust and air quality samples in their home and measuring how well their child with asthma can breathe. Then, Environmental Health Watch will assess the house for health hazards like mold or pests and fix what it can, like mold-damaged walls or leaks. Each home can get up to $1,000 in improvements.

Collins said even though it’s a small investment, it can go a long way. 

“Sealing the perimeter of the home, that’s not very expensive, but it has a tremendous effect on the health and safety,” he said. Sealing the perimeter of a home means filling any gaps or cracks in the home, where water or air can leak inside. 

The program will likely not be able to cover the cost of fixing severely damaged or unsafe homes, in which case the team will help residents figure out the best next steps, according to the program. A full-scale mold remediation in a basement can average around $2,500, Collins wrote.  

Three to four months after the home improvements are done, Hegarty’s team will return to take more dust and air quality samples and to test whether the child’s asthma improved. The test includes measuring how quickly kids can exhale air, a metric of how bad their asthma is, and asking how often they need to go to the emergency room or use an inhaler.