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The US CDC reports 26 million or one in 13 Americans have asthma, an illness causing restriction of breathing and air supply to the lungs, along with tightness in the chest, coughing, wheezing, and even fatality. (Ref. 1)

The prevalence of asthma creates huge costs to society and business.

The Annals of the American Thoracic Society reports: “Asthma places a significant economic burden on the United States, with a total cost of asthma, including costs incurred by absenteeism and mortality, of $81.9 billion in 2013.” (Ref. 2)

Costs are both direct, such as medical bills, and indirect, e.g., less productivity from missing work or school.

The Journal of Allergy and Clinical Immunology notes, “on the national scale, society loses approximately 14.41 million work days and 3.68 million school days per year because of asthma.” (Ref. 3)

Projected costs from productivity loss typically factor being absent from work or school, but they do not include losses from a lowered performance by asthmatics present at work or school, aka, “presenteeism.”

Per the Journal of Organizational Behavior: “There is considerable agreement across studies that presenteeism accounts for more aggregate productivity loss than absenteeism. On the face of it, this suggests an iceberg effect in which the more visible portion of work loss (absenteeism) is dwarfed by that portion beneath the surface (presenteeism).” (Ref. 4)

In 2002, Bill Fisk, of Lawrence Berkeley National Laboratory (LBNL), estimated the US yearly ROI from improved indoor air quality including asthma reduction equaled $20 to $200 billion in enhanced worker performance and that fiscal benefits may exceed costs by 900-1400%.

No Smoking Gun, But Triggers

What causes asthma? The cause of asthma is complex with many elements perhaps working in unison, including genetics, allergies, respiratory infections and environmental exposures.

And while there is no single “smoking gun,” businesses are wise to work where they have a measure of control: reducing environmental exposures or “triggers” linked to asthma.

These triggers include airborne:

  • Dust
  • Pollen
  • Molds
  • Insect and dust mite allergens
  • Chemicals and fragrances from cleaning, disinfecting and other products
  • Irritants from smoke and other sources

Reducing Work-Related Asthma

According to the peer-reviewed journal, Occupational and Environmental Medicine, “Work-related asthma (WRA) is an important public health problem affecting one quarter of adults with asthma.” (Ref. 5)

Reducing workplace asthma triggers involves applying the three EPA steps to improving indoor air quality:

1. Control sources

2. Ventilate

3. Purify the air.

Source Reduction or Control is Number One

Reducing dust can be as simple as increasing the size of entry matting to reduce tracked in road, pesticide and exterior dusts that can become airborne, and selecting dusting methods that remove rather than spread dust such as dampened microfiber cloths for wiping or well-filtered vacuums.

HEPA-filtered vacuums are recommended, but while HEPA media are excellent at the removal of small particles from the air, HEPA filters used in vacuum cleaners and air purifiers can provide a false sense of assurance as they may not be:

  1. Sized properly to filter the volume of air passing through them.
    HEPA media captures 99.97% of .3 micron and larger particles at a given rate of airflow in relation to the volume of media.
  2. Sealed properly to prevent particles from escaping from gaps in the mounting surface.

The exhaust of a vacuum cleaner is also not the only source of particles being emitted from the unit. When the vacuum head rolls across a carpeted surface, the wheels and rotating brush create a dust cloud at the tool/floor interface and those particles rise up into the breathing zone.

The best way to purchase a vacuum for asthma-trigger control is by buying one that has been tested as a system in a chamber so all sources of emitted dust are measured, not solely what exits the vacuum’s exhaust.

For example, the Carpet and Rug Institute (CRI) performs chamber testing of vacuums to determine overall impact on IAQ.

Other source control measures include:

  • Fixing water leaks and keeping relative humidity between 30 and 50 percent to limit mold growth.
  • Restricting eating to designated break rooms, keeping stored food sealed and refrigerated as needed, and thorough cleaning of these areas to minimize insect problems.
  • When choosing cleaning solutions, looking for Green Seal or UL Environment certified products vetted for lower toxicity, volatile organic compounds (VOCs), heavy metal content, and fewer ingredients contributing to asthma, skin irritation and other issues.
  • When buying disinfectants, seeking those certified by EPA’s Safer Choice (formerly Design for the Environment or DfE) as it is the only green certification covering disinfectants, and specifies “that all ingredients, including fragrances, be listed for all products.”
  • Consider Saturated Steam Vapor (SSV) equipment for cleaning and disinfecting in seconds without chemicals [].

Going fragrance-free in your facility is also a sound method of asthma-trigger source reduction.

In 2017, The Journal of Asthma reported "fragrance use in the workplace is associated with WRA [Work-related asthma]. Prevention methods include employee education, enforced fragrance-free policies, well-designed ventilation systems, and good building maintenance." (Ref. 6)

Reducing exposure to phthalates in fragrance, flexible plastics, paints, PVC flooring and other materials is wise, as a 2012 study reported “phthalates have been recognized as important environmental factors in the pathogenesis of asthma.” (Ref. 7)

Ventilation with Qualifiers

Ventilation is vital, and generally, the more the better, depending on outdoor conditions, and thermal/energy cost considerations.

However, when outdoor pollen, mold allergen and air pollution levels are high, it’s important to:

  1. Strictly control sources of indoor pollution while limiting ventilation when outdoor air is unhealthy.
  2. Filter incoming air where practical.
  3. Consider indoor air purification to remove airborne allergens and pollutants indoors (air purification is also the third leg of the IAQ improvement stool). Interestingly, “particle filtration consumes only 10% to 25% of the energy that would otherwise be required to achieve an equivalent amount of particle removal with ventilation.” (Ref. 8)

Air Purifier Pointers

Air purification has come a long way in recent decades. Modern HVAC systems can accommodate more robust filters (e.g., high-numbered MERV media) while moving more air than legacy configurations.System is the operative word. Filters should be sized and arranged to work with fans having enough capacity and run-time for sufficient airflow to purify all the indoor air in a consistently well-cleaned, -operated and -maintained system.

New technology in ionizing air purifiers works with existing HVAC systems to remove both particles and gases, while also removing ozone from the space [].

Portable air purifiers can be effective when sized for the space intended and when treated areas are closed off to enable effective processing of the air. Look for Clean Air Delivery Rate (CADR) for the rate of particle control in relation to room size.

Select models with adsorptive media − such as activated alumina or charcoal – for VOC reduction, and as with particle filters, these should be sized, proportioned and cleaned/replaced as needed for the job.

Allen Rathey is the principal of the Healthy Facilities Institute (HFI) and University, director of the Indoor Wellness Council (IWC), and author of articles about best practices in cleaning and indoor environmental management. Linked In:


  1. CDC – Asthma and [Accessed 27-Aug-18].
  2. The Economic Burden of Asthma in the United States, 2008–2013, Annals of the American Thoracic Society, Mar 01, 2018.
  3. Costs of asthma in the United States: 2002-2007, Journal of Allergy and Clinical Immunology, 2011.
  4. Presenteeism in the workplace: A review and research agenda, Journal of Organizational Behavior, 2009.
  5. Association between cleaning-related chemicals and work-related asthma and asthma symptoms among healthcare professionals, Occupational and Environmental Medicine, 2012.
  6. Fragrances and work-related asthma-California surveillance data, 1993-2012, The Journal of Asthma, 2017.
  7. The association between phthalate exposure and asthma, The Kaohsiung Journal of Medical Sciences, 2012.
  8. New Air Cleaning Strategies for Reduced Commercial Building Ventilation Energy, Lawrence Berkeley National Laboratory, 2010.

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