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Respiratory Functions

Overview

Respiratory conditions affect children and adults with a range of breathing problems including chronic respiratory health problems such as emphysema, allergic reactions, asthma and multiple chemical sensitivity.

In November 1999, the Access Board issued a proposed rule to revise and update its accessibility guidelines. During the public comment period on the proposed rule, the Access Board received more comments from individuals with multiple chemical sensitivities (MCS) and electromagnetic sensitivities (EMS), than from any other type of limitation. They reported that chemicals released from products and materials used in construction, renovation, and maintenance of buildings, electromagnetic fields, and inadequate ventilation are barriers that deny them access to most buildings.

Multiple Chemical Sensitivity is a type of Environmental Illness in which the person has limited or no tolerance for chemicals or a particular class of checmicals. Some of the most common physical reactions in addition to breathing problems are: headaches, dizziness, nausea, short-term memory loss, persistent flu-like symptoms, and muscles aches. ¹

There is a growing appreciation of the number of people sensitive to poor indoor environmental quality and of the need to understand how to protect equal opportunity for people with this mix of respiratory and neurological conditions. People with respiratory issues may be vulnerable to exhaust fumes, pollen counts, chemical smells, may suffer intense reactions to molds or poly-vinyls and some people will be unable to tolerate the scents from perfume, perfume products or air fresheners.

At the extreme end of the spectrum of respiratory conditions is Chronic Obstructive Pulmonary Disease (COPD). COPD includes chronic bronchitis and emphysema - lung diseases which frequently coexist and are characterized by obstruction to air flow, making it difficult to breathe. Smokers are particularly at risk of developing COPD, however, it also been linked to workplace exposure to dust and fumes. Symptoms include chronic cough, increased mucus production, chest tightness, shortness of breath and difficulty breathing. ²

Who Is Affected

Respiratory conditions, like asthma, may not traditionally be thought of as disabilities, but in terms of impact, the Centers for Disease Control reports that respiratory conditions are the fourth most prevalent reason for adult functional limitations (that limit one or more daily activities). Asthma, chronic bronchitis, emphysema, and pneumonia, and multiple chemical sensitivities are among the leading causes. Asthma is the leading, serious, chronic illness among children in the US.

Asthma

Asthma affects nearly 20 million Americans and about half of them also suffer from allergies. Rates of asthma doubled during the 1990's and continue to increase. The highest rates of increase are among children less than five years of age. The rate of increase of babies being born with asthma is alarming as well with high prevalence, with high links between asthma in babies, poverty and premature births. ³

According to the latest analysis available from the Centers for Disease Control and Prevention (CDC), using the 2002 National Health Interview Survey which asked respondents if they were ever told by a health professional that they had asthma,

• 30.8 million people (111 people per 1,000) had ever been diagnosed with asthma during their lifetime.  Among adults, 106 per 1,000 had a lifetime asthma diagnosis (21.9 million) compared to 122 per 1,000 children 0-17 years (8.9 million). 
• Among all racial and ethnic groups, Puerto Ricans have the highest rate of lifetime asthma (196 per 1,000) and Mexicans the lowest (61 per 1,000).
• Prevalence of asthma among homeless children in New York City is approximately 40 percent, which is six times the national rate for children.26.9 percent had a prior physician diagnosis of asthma. In addition, 12.9 percent of the children without a prior physician diagnosis of asthma reported symptoms consistent with moderate or severe persistent asthma," the authors write. ⁴
• Chronic bronchitis, emphysema, and asthma as a group are the fourth-leading cause of death in the United States. Two to three out of 100 people have chronic bronchitis. ⁵

The U.S. Department of Health and Human Services reports that low-income populations and minorities experience disproportionately higher morbidity and mortality due to asthma. Among the reasons cited are lack of access to quality medical care, high levels of exposure to environmental allergens and irritants, language barriers, and lack of financial resources and social support to manage the disease effectively on a long-term basis. African-American and Hispanic children appear to be at especially high risk of not receiving adequate preventive treatment for asthma attacks.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is the fourth leading cause of death in the United States, claiming approximately 119,000 lives each year. In 2000, COPD caused 726,000 hospitalizations and 1.5 million hospital emergency room visits.

Multiple Chemical Sensitivity

In 1996, state departments of health in California and New Mexico respectively found that 6% and 2% of the state population were diagnosed with Multiple Chemical Sensitivity or Environmental Illness. Both states also reported that that 16% of the population responded that they were "unusually sensitive to everyday chemicals." ⁶

Tuberculosis

Another reason people become sensitive to air quality is tuberculosis. Tuberculosis is still an active disease in the United States. While in 2005 the Centers for Disease Control reported 14,093 cases of active TB in the United States. It is estimated that between 10 and 15 million people in the U.S. have latent TB. ⁷

Looking at the Impacts

Minimizing the triggers of respiratory attacks has become an important component of creating access for people with respiratory conditions. The U.S. Department of Health and Human Services (HHS) has identified many studies noting factors that exacerbate asthma in those who already have the illness. They report that reducing exposures not only reduces symptoms and the need for medication, but also, in some studies, improves lung function. ⁸ For example, asthma is a chronic, inflammatory disease in which the airways become sensitive to irritants and allergens (any substance that triggers an allergic reaction). Reducing irritants reduces the intensity of the respiratory condition.

There are a number of other conditions, including the common cold, that are aggravated by poor air quality. Inhaling irritating fumes or dusts, chemical solvents and smoke, including tobacco smoke, have been linked to activation of acute bronchitis.

High rates of respiratory conditions have been linked to buildings constructed by the U.S. Department of Housing and Urban Development (HUD) in the 1970s. More than twenty years later, they were decomposing to create airborne dust and chemical agents. Also, chemical out-gassing of new building products coupled with insufficient ventilation have led to the identification of "sick building syndrome" in which people with no history of respiratory problems, acquire a number of persistent medical complaints, including respiratory conditions. These events have led to changes in building construction.

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