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Denver Health’s Pulmonary and Critical Care Medicine team provides multidisciplinary care with a focus on diagnosis and treatment of both complex and common respiratory problems as well as management of critically ill, hospitalized patients. Care is provided in both outpatient and inpatient settings.
Our services and procedures include some of the most prevalent respiratory issues, including:
In Tucson, Arizona, a study of 707 children born with heart defects revealed that 35 percent of them were born to parents living in a part of the city where the water supply was contaminated with industrial solvents (trichloroethylene and dichloroethylene).
The rate of birth defects of the heart was three times as high among people drinking the contaminated water, compared to people in Tucson not drinking contaminated water. Exposure to solvents and other organic liquids is one of the most common chemical health risk at places of work.
Most of the organic solvents are combustible, often highly volatile and extremely flammable, and they should always be handled with care. Some solvents produce vapors, which are heavier than air. These may move on the floor or ground to a distant ignition source, such as a spark from welding or caused by static electricity.
The vapors may also explode from smoking. Vapors of solvents can also accumulate in confined places and stay there for a long time, presenting risks for health and property. Solvents enter the body by inhalation, by swallowing and through the skin.
Many communities add fluoride to their drinking water to promote dental health. Each community makes its own decision about whether or not to add fluoride. The Environmental Protection Agency (EPA) has set an enforceable drinking water standard for fluoride of 4 mg/L (some people who drink water containing fluoride in excess of this level over many years could get bone disease, including pain and tenderness of the bones).
The EPA has also set a secondary fluoride standard of 2 mg/L to protect against dental fluorosis. Dental fluorosis, in its moderate or severe forms, may result in a brown staining and/or pitting of the permanent teeth. This problem occurs only in developing teeth before they erupt from the gums.
Children under nine should not drink water that has more than 2 mg/L of fluoride.
If there are enough tiny particles suspended in water, it becomes cloudy or turbid. Light bounces off the suspended particles giving the water a milky or muddy appearance. Gasses dissolved in water can also cause turbidity if they begin to come out of solution or "degas" (like the bubbles that form when a carbonated drink is opened).
Gas bubbles will eventually rise to the surface and disappear; the water will clear. Other materials suspended in water neither rise nor settle, so the water does not clear. 100+ years ago, cholera (caused by Vibrio cholera) and typhoid fever (caused by Salmonella typhi) were responsible for epidemics (caused by drinking contaminated water) that killed many thousands of people.
Today, in most parts of the world, because of chlorination and other water purification processes, we do not usually hear about cholera outbreaks unless an accident or natural disaster has disabled water purification plants. Today in the United States, the pathogenic bacterial contaminant most often encountered is fecal bacteria, or E. coli {MCL=0.0 bacteria}, which enters the water supply from human or animal wastes.
The EPA regulates the maximum allowable levels for these bacteria in drinking water, and most people most of the time either do not encounter these bacteria in their drinking water or do not get sick. The article "Tap Water at Risk by the Houston Chronicle" reported that in the USA in 1994-1995, there were 3,641 water purification utilities that reported violating the federal health standards for fecal bacteria contamination.
These utilities together served 11.9 million people. Despite these statistics, disease outbreaks (in people on municipal water) linked to E. coli in the U.S. appear to be quite rare. According to a note in the Denver Post (p. 4B), July 18, 1998, reporting that an E. coli outbreak that sickened at least 50 people in Alpine WY (population 470) was probably caused by a contaminated town water supply. The state epidemiologist said that it was only the second outbreak in the nation that has been linked to municipal water.
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Protection from sun exposure is important all year round, not just during the summer or at the pool. Any time the sun's ultraviolet (UV) rays are able to reach the earth, you need to protect yourself from excessive sun exposure. UV rays can cause skin damage during any season or temperature.
The hours between 10:00 a.m. and 4 p.m. during daylight savings time (9:00 a.m. - 3:00 p.m. during standard time) are usually the most hazardous for UV exposure in the continental United States. UV radiation is the greatest during the late spring and early summer in the Rocky Mountain Region.
UV rays reach you on cloudy and hazy days, as well as on bright and sunny days. UV rays will also reflect off any surface like water, cement, sand, and snow.
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Schools have four times as many people per unit area than the typical office building. Schools also support a variety of activities (from art to gym classes) and often have tight budgets and deferred maintenance. These factors make it difficult for schools to ensure good indoor air quality.
All states have schools with unsatisfactory environmental conditions. In a June 1996 General Accounting Office report to Congress on School Facilities, about 69 percent of schools nationwide reported at least one unsatisfactory environmental condition. Of these, 19 percent are attributed to unsatisfactory indoor air quality, 19 percent to unsatisfactory heating and 27 percent to unsatisfactory ventilation.
The Environmental Protection Agency (EPA) is especially concerned with Indoor Air Quality (IAQ) in schools because children spend a majority of their day there. EPA assists schools across the region in addressing indoor air quality problems using low-or no-cost techniques and existing school resources. The IAQ Tools for Schools program, for example, promotes the use of the Tools for Schools Action Kit. This kit serves as a model IAQ management plan for schools to use for increasing awareness and developing communication strategies. It is designed to help prevent indoor air quality problems from occurring and to guide schools through the quick and efficient resolution of problems if and when they do occur.
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Carbon monoxide is a colorless, odorless gas produced from the incomplete burning of virtually any combustible product. It may accumulate indoors as a result of tobacco smoking, poorly ventilated appliances and attached garages.
Carbon monoxide enters the blood from the lungs and combines with hemoglobin, blocking the blood's ability to carry oxygen to body cells. Symptoms of carbon monoxide exposure may mimic influenza and include fatigue, headache, dizziness, nausea and vomiting, mental confusion and rapid heart rate. Depending on the level of exposure, carbon monoxide can be immediately fatal. Long-term, low-level exposure to carbon monoxide by pregnant women have the potential to injure the developing fetus.
Exposure to secondhand smoke can increase the risk of allergic complications such as sinusitis and bronchitis. Common symptoms of smoke irritation are burning or watery eyes, nasal congestion, coughing, hoarseness and shortness of breath presenting as a wheeze. It is best not to smoke around children.
Radon is a cancer-causing, radioactive gas. You cannot see, smell or taste radon. However, it may be a problem in your home. When you breathe air that contains radon, lung cancer can develop. In fact, the Surgeon General has warned that radon is the second-leading cause of lung cancer in the United States today.
Only smoking causes more lung cancer deaths. If you smoke and your home has high radon levels, your risk of lung cancer is especially high.
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Cleaning supplies, cosmetics, personal care products, house plants and medications are all things around your home that can effect the health of your child. Especially with children under 6 years, these items should be kept out of reach and locked up to prevent accidental ingestion and exposure.
If you believe your child has tasted or eaten any of these household products, call your local poison center immediately at 1-800-222-1222.
Lead has long been recognized as a harmful environmental pollutant. In late 1991, the Secretary of the Department of Health and Human Services called lead the "number one environmental threat to the health of children in the United States." There are many ways in which humans are exposed to lead: through air, drinking water, food, contaminated soil, deteriorating paint and dust. Airborne lead enters the body when an individual breathes or swallows lead particles or dust once it has settled. Before it was known how harmful lead could be, it was used in paint, gasoline, water pipes and many other products.
Old lead-based paint is the most significant source of lead exposure in the U.S. today. Harmful exposures to lead can be created when lead-based paint is improperly removed from surfaces by dry scraping, sanding or open-flame burning. High concentrations of airborne lead particles in homes can also result from lead dust from outdoor sources, including contaminated soil tracked inside, and use of lead in certain indoor activities such as soldering and stained-glass making.
Lead affects practically all systems within the body. Lead at high levels (lead levels at or above 80 micrograms per deciliter (80 µg/dl) of blood) can cause convulsions, coma and even death. Lower levels of lead can cause adverse health effects on the central nervous system, kidney and blood cells. Blood lead levels even below 10 µg/dl can impair mental and physical development – there is no safe level of lead in the body.
The effects of lead exposure on fetuses and young children can be severe. They include delays in physical and mental development, lower IQ levels, shortened attention spans and increased behavioral problems. Fetuses, infants and children are more vulnerable to lead exposure than adults since lead is more easily absorbed into growing bodies, and the tissues of small children are more sensitive to the damaging effects of lead. Children may have higher exposures since they are more likely to get lead dust on their hands and then put their fingers or other lead-contaminated objects into their mouths.
Get your child tested for lead exposure. To find out where to do this, call your doctor or local health clinic. For more information on health effects, get a copy of the Centers for Disease Control's "Preventing Lead Poisoning in Young Children."
Steps to Reduce Exposure to Lead:
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Arsenic is a naturally occurring element widely distributed in the earth's crust. In the environment, arsenic is combined with oxygen, chlorine and sulfur to form inorganic arsenic compounds. Arsenic in animals and plants combines with carbon and hydrogen to form organic arsenic compounds. Inorganic arsenic compounds are mainly used to preserve wood. Organic arsenic compounds are used as pesticides, primarily on cotton plants.
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Children with allergies may be more sensitive to cigarette smoke than others, and research studies indicate that smoking may aggravate allergies. Smoking does not just harm smokers but also those around them. Research has shown that children and spouses of smokers tend to have more respiratory infections and asthma than those of non-smokers.
In addition, exposure to secondhand smoke can increase the risk of allergic complications such as sinusitis and bronchitis. Common symptoms of smoke irritation are: burning or watery eyes, nasal congestion, coughing, hoarseness and shortness of breath presenting as a wheeze.
Secondhand smoke is also known as Environmental Tobacco Smoke. Secondhand smoke includes both exhaled mainstream smoke from smokers and sidestream smoke from the end of a cigarette, cigar or pipe. Secondhand smoke contains more than 4,000 substances, including over 40 that are linked to cancer. Many of the compounds in tobacco smoke are released at higher rates in sidestream smoke than in mainstream smoke.
Does Secondhand Smoke Relate To Asthma?
Secondhand smoke may trigger asthma episodes and make asthma symptoms more severe in children who already have asthma. Moreover, secondhand smoke is a risk factor for new cases of asthma in children who have not previously exhibited asthma symptoms.
The means by which secondhand smoke triggers an asthma episode is believed to be through its irritancy effects. That is, smoke irritates the chronically inflamed bronchial passages of asthmatics. This is a different pathway from most of the other environmental triggers of asthma, like dust mites and pet dander, which trigger asthma episodes through allergenic effects.
Exposure to secondhand smoke is also known to cause a variety of other negative health consequences, including lung cancer, ear infections in children, and respiratory illnesses.
Many of the health effects of secondhand smoke (including asthma) are most clearly manifested in children. This is because children are particularly vulnerable to secondhand smoke. This is likely due to several factors, including the fact that children are still developing physically, have higher breathing rates than adults and have little control over their indoor environments. Children receiving high doses of secondhand smoke, such as those with smoking mothers, run the greatest relative risk of experiencing damaging health effects.
Actions You Can Take:
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The dust mite may be an important cause of asthma and some skin problems. The house dust mite can only be seen with a microscope, but it is a common and significant cause of sensitivity. It may make the nose run or cause sneezing and wheezing. The dust mite hides in the dust that can be found in even the cleanest bedroom - deep in carpets and curtains and in the seams of mattresses.
Bedding: The dust mite is choosy and prefers wool and cotton to artificial fibers. So you can deter it by using only synthetic bedding materials and by washing all sheets every week. A duvet reduces laundry, but feather, down or flock fillings must be avoided in these and in pillows. The dust mite's favorite haunt is bedding, particularly mattresses.
Measures to reduce the numbers of house dust mites:
Your pet’s dead skin flakes, urine, feces, saliva and hair can trigger asthma. Dogs, cats, rodents (including hamsters and guinea pigs) and other mammals all can trigger asthma in individuals with an allergic reaction to animal dander.
Proteins in the dander, urine or saliva of warm-blooded animals (e.g., cats, dogs, mice, rats, gerbils, birds, etc.) have been reported to sensitize individuals and can cause allergic reactions or trigger asthma episodes in individuals sensitive to animal allergens. The most effective method to control animal allergens in the home is to not allow an animal in the home. If you remove an animal from the home, it is important to clean the home (including floors and walls, but especially carpets and upholstered furniture) thoroughly.
Pet allergen levels are reported to stay in the home for several months after the pet is removed, even with cleaning. Isolation methods to reduce animal allergen in the home have also been suggested by reputable health authorities, (e.g., keeping the animal in only one area of the home, keeping the animal outside, or ensuring the allergic or asthmatic individual stay away from the animal) but the effectiveness of these methods have not been determined.
To the contrary, several reports in the literature indicate that animal allergen is carried in the air and by residents of the home on their clothing to all parts of the home, even when the animal is isolated. In fact, animal allergen is often detected in locations where no animals were housed. In these situations, it is assumed that the allergen was carried in on people that have animals or on people that have been around animals or people with animals.
Often, people sensitive to animal allergens are advised to wash their pets regularly. Recent research indicates that washing pets may only provide temporary reductions in allergen levels. There is no evidence that this short-term reduction is effective in reducing symptoms, and it has been suggested that during the washing of the animal, the sensitive individual may be initially exposed to higher levels of allergen.
Thus, the most effective method to control exposure to animal allergens is to keep your home pet free. However, some individuals may find isolation measures to be sufficiently effective. Isolation measures that have been suggested include keeping pets out of sleeping areas, keeping pets away from upholstered furniture, carpets and stuffed toys, keeping the pet outdoors as much as possible, and isolating sensitive individuals from the pet as much as possible.
Actions you can take:
Combustion pollutants are gases or particles that come from burning materials. The common fuels burned in household appliances are natural or LP gas, fuel oil, kerosene, wood or coal. The types and amounts of pollutants produced depend upon the type of appliance, how well the appliance is installed, maintained, and vented, and the kind of fuel it uses. Some of the common pollutants produced from burning these fuels in household appliances are carbon monoxide, nitrogen dioxide, particles (or particulate matter). Other pollutants that can be produced by some appliances are unburned hydrocarbons and aldehydes, and sulfur dioxide.
Combustion pollutants found indoors include: tobacco smoke, exhaust from car and lawn mower internal combustion engines, and some hobby activities such as welding, wood-burning, and soldering. Combustion pollutants can also come from vented or unvented combustion appliances. These appliances include space heaters, gas ranges and ovens, furnaces, gas water heaters, gas clothes dryers, wood or coal-burning stoves, and fireplaces.
Three combustion pollutants in particular could affect people with asthma. Both nitrogen dioxide and sulfur dioxide can cause irritation of the respiratory tract and cause shortness of breath. People with asthma may be more susceptible to the effects of nitrogen dioxide and sulfur dioxide. Also, particulate matter may decrease lung function in asthmatics.
Combustion always produces water vapor. Water vapor is not usually considered a pollutant, but it can act as one. It can result in high humidity and wet surfaces. These conditions encourage the growth of biological pollutants such as house dust mites, molds and bacteria.
Actions You Can Take:
Allergens, especially those containing biological matter, such as house dust mites, cockroaches, pet dander, pollen, molds, spores, bacteria and viruses, are known to cause or aggravate asthma. Allergic reactions often combine with and seriously aggravate the symptoms of asthma, the common cold, pneumonia and other conditions. Allergens also may cause eye, nose and throat irritation, shortness of breath, dizziness, lethargy and fever.
Allergens, especially those containing biological matter, such as house dust mites, cockroaches, pet dander, pollen, molds, spores, bacteria and viruses, are known to cause or aggravate asthma. Allergic reactions often combine with and seriously aggravate the symptoms of asthma, the common cold, pneumonia and other conditions. Allergens also may cause eye, nose and throat irritation, shortness of breath, dizziness, lethargy and fever.
Molds can be found almost anywhere; they can grow on virtually any substance when moisture is present. Outdoors, many molds live in the soil and play a key role in the breakdown of leaves, wood and other plant debris. Without molds, we would all be struggling with large amounts of dead plant matter. Molds break down plant materials by digesting them, using the plant material for food.
Molds produce tiny spores to reproduce, just as plants produce seeds. Mold spores waft through the indoor and outdoor air continually. When mold spores land on a damp spot indoors, they may begin growing and digesting whatever they are growing on in order to survive. There are molds that can grow on wood, paper, carpet, foods and even dynamite. When excessive moisture or water accumulates indoors, mold growth will often occur, particularly if the moisture problem remains undiscovered or unaddressed. There is no practical way to eliminate all mold and mold spores in the indoor environment; the way to control indoor mold growth is to control moisture.
Molds can trigger asthma episodes in individuals with an allergic reaction to mold. If mold is a problem in your home, you must clean up the mold and eliminate sources of moisture.
Wash mold off hard surfaces and dry completely. Absorbent materials, such as ceiling tiles and carpet, may have to be replaced if they are contaminated with mold. Fix leaky plumbing or other sources of water. Keep drip pans in your air conditioner, refrigerator, and dehumidifier clean and dry. Use exhaust fans or open windows in kitchens and bathrooms when showering, cooking, or using the dishwasher. Vent clothes dryers to the outside. Maintain low indoor humidity, ideally between 30-50% relative humidity. Humidity levels can be measured by hygrometers which are available at local hardware stores.
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Information Sheets
Water pipe or narghile smoking is an old practice that has experienced a resurgence in popularity, particularly in areas where cultures mix, such as in Israel with its large Jewish and Arabian cultures.
Europe has seen increasing narghile smoking, particularly in student populations. In the United States, little, if any, data is collected to assess the prevalence of water pipe smoking (WPS), but trends similar to Europe’s may be occurring. WPS may have a degree of perceived acceptability different from cigarette use due to mistaken beliefs that it is safer and non-addicting. More than 100,000,000 individuals are narghile smokers, concentrated in the Arabian Peninsula, Turkey, India, Pakistan, Bangladesh and China. Narghile smoking often occurs in groups, with several individuals sharing one pipe and passing the mouthpiece from person to person.
The water pipe is a device that allows the smoke from a combusting material (tobacco) to be pulled through water or another liquid, such as alcohol, and inhaled. The tobacco may be pure or mixed with varying amounts of honey or sugar, added oils, fruits or other flavors. The tobacco is burned by placing it next to ignited charcoal. Several additional concerns exist with this form of smoking in comparison to cigarette smoking. Using charcoal to burn the tobacco adds to the particulate load that is inhaled, may result in high carbon monoxide exposure, may have more nicotine content and may contain heavy metals such as chromium, arsenic or lead. The manufacture of tobacco used in WPS may be less regulated than that of cigarettes. Malignancies are well-described among WPS users, including tumors of the lungs, esophagus, throat and mouth. Pre-malignant states seen in cigarette smokers or user of smokeless tobacco are also seen in narghile water pipe smokers. Low birth weight, oxidative stress and dependence are described with WPS as well.
WPS is different from cigarette smoking in additional major aspects. A piece of the same pipe is passed from person to person, conferring an infectious risk. H. pylori has been noted in increased levels in narghile smokers. Marijuana smoking in a water pipe has transmitted tuberculosis. Pulmonary aspergillosis has been described as an adolescent narghile smoker who was undergoing cancer chemotherapy. WPS use may confer extra risk of transmission of hepatitis C, Epstein-Barr virus, herpes simples, other respiratory viruses and possibly HIV.
Narghile or water pipe smoking is not a benign practice and should not be viewed as safer than cigarette smoking. Many of the same risks exist along with additional risks unique to WPS. This may be an increasing important risky behavior in the United States, especially among adolescents. The social aspects of narghile smoking may provide an additional inducement to engage in the practice.
Ref: Knishkowy B, Amitai Y. Water-Pipe (Narghile) Smoking: An Emerging Health Risk Behavior. Pediatrics 116(1): e113--e119.
All medical information and content included on this website has been compiled by Denver Health and Hospital Authority’s Rocky Mountain Poison and Drug Safety (RMPDS). Although the RMPDS attempts to keep this information up to date and as accurate as possible, the RMPDS in no way warrants or guarantees the completeness of accuracy of the medical information of content contained on this website.
Below is a collection of information sheets and articles on topics to help parents, teachers, and healthcare providers better understand the impacts of certain environmental health issues on children.
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Information providing an overview of environmental illnesses.
Environmental Health Perspectives has launched a website featuring timely children’s health research and news as they are published in EHP as well as links to related material. Visitors can search a full library of children's health content.
4770 Buford Highway, NE
Atlanta, GA 30341-3724
Tel: (404) 498-0110 / Public Inquiries: (888) 422-8737
The Pediatric Environmental Health Specialty Units (PEHSUs) are dedicated to increasing knowledge about reproductive and children's environmental health among health care professionals. Many of the environmental risks that lead to poor health outcomes can be mitigated with proper health care provider education and preparation. Health care providers are well-positioned to deliver the education and care needed to protect children from environmental threats and to share relevant information with colleagues.
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