Helpful Tips for Chronically Ill Patients

Indoor air is often less healthy than outdoor air and it can affect your health in several ways [1]. This may be especially true for chronically ill people and those with environmental sensitivities or environmentally acquired illness.

Below is our compilation of budget friendly tips for maintaining healthy indoor air quality for sensitive, environmentally-ill people. If you have questions, contact us.

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Cleaning
Maintenance
Ventilation
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Disclaimer: One of the most effective ways to improve indoor air quality is to eliminate individual sources of pollution/exposure or to reduce emissions. This article mostly focuses on simple steps like cleaning, but this will not ‘fix’ exposures in your home like hidden mold, which can cause or complicate a variety of chronic illnesses.

Please see the Damp Buildings and Other Exposures section to learn how you can make a plan to eliminate or reduce individual exposure sources. The EPA’s very complete Guide to Indoor Air Quality is another option if you want to dig further into specific exposures like radon, etc.

ISEAI’s tips for maintaining your indoor air quality

First, consider a plan to handle major sources of exposure, such as mold.

Next, follow these tips:

1 – Clean your home regularly and thoroughly

Get in the habit of cleaning floors and flat surfaces in your home on a regular basis (at least weekly) and decluttering. This step alone can have a major impact on the health of your home as heavier particles like large pieces of dust and pollen tend to fall to the ground. Think about doing a deeper clean every 6 months.

Tips for sensitive people:

  • Have someone else (family member, friend) focus on the cleaning, and come back afterwards. This is especially true if you have physical limitations and/or sensitivities to dust, chemicals, etc.
  • Wear an N95 mask during and after cleaning
  • Air out the home after cleaning, especially after vacuuming. Also see the “Ventilation” tips further below. Open windows for 10 minutes, assuming a dry and low dust day, then run a portable high-efficiency particulate air (HEPA) filter and/or the HVAC fan afterwards.

What do I clean with?

Typically you don’t need to use any harsh cleaning chemicals. Instead, focus on physically removing buildup of dust, etc, using natural products and simple methods.

Don’t focus on chemical cleaning products that “smell good” since “clean” isn’t defined by a certain smell, but more of a lack of one. 

Natural cleaning product suggestions:

  • Water with a dab of dish soap (free and clear, fragrance free, or unscented)
  • Vinegar (for hard-to-clean messes like stovetop, oven, etc, try vinegar with baking soda)
  • Drains: Use a long cleaning brush, try vinegar with baking soda
  • For a more potent option, hydrogen peroxide (use medical-grade 3%) is a good alternative to bleach; use caution on porous or sensitive surfaces and use in a well-ventilated area while wearing gloves

Note: Some cleaning products, including those with chlorine and ammonia, contain volatile organic compounds (VOCs). Note that mixing chlorine and ammonia should never be done as it creates toxic gases called chloramines. Some paints, shellacs, and floor polishes may also contain VOCs. The compounds then go into the air as gasses. If you do want to use a commercial cleaning product look for “low/no VOCs” but be wary of “green” claims and research products thoroughly – honor your sensitivities.

Cleaning floors

A broom and dustpan is an inexpensive starting point, and highly effective for removing larger debris from hard floors. Don’t overlook this simple option. A more effective initial removal of larger debris/dust would be a HEPA vacuum. Sensitive patients may react to either one of these cleaning methods, in which case personal protective equipment or someone else’s help may be needed.

Carpets/rugs:

  • Vacuum regularly. Some vacuums have “true HEPA filters” – more on this topic below – and leak less air, so consider researching those the next time you need to purchase a vacuum.
  • You can also take area rugs outside and beat them with a stick prior to vacuuming. Wear gloves and a mask.

Hard flooring:

  • Mop (two sided washable microfiber fabric versions are a nice option)
  • Vacuum (on “hard floor” setting if available)
  • Dry Swiffer cloths – these are great at picking up the smallest dust (made of millions of tiny polyester fibers, dry Swiffer cloths are designed to use static electricity to pick up tiny pieces of dust). Suggested as a finishing step.

What about my pets?

Bathe/groom your pet regularly, if possible. If difficult to bathe, regularly wiping gently but thoroughly with a Swiffer cloth can be a helpful step. Keep your pet out of bed/bedroom, if possible (especially heavy shedders).

Are dust mites an issue in my home?

Dust mites are very small, insect-like pests that feed on dead human skin cells and thrive in warm, humid settings. You may be allergic or sensitive to them.

Tip: Wash sheets and bedding regularly. You may want to consider purchasing Allerease mattress and pillow protectors (or similar).

Monitor humidity levels

Maintain reasonable humidity levels (approx. 30-50%, especially when considering mold exposure), understanding that weather varies and your region has certain patterns. This will help limit mold growth, dust mites, etc.

  • There are $10 “hygrometers” on Amazon with a digital readout of current and ongoing humidity levels
  • Running your HVAC system during times of high heat and humidity is one simple way to maintain humidity levels
  • Another is to purchase a dedicated dehumidifier (either portable, or added onto HVAC system)

optimum relative humidity range for minimizing health effects

Optimum relative humidity range for minimizing health effects. Source PMC1474709.

2 – Maintain your home

Regular home maintenance can improve your indoor air quality and save you money in the long run.

Air Conditioner/Heater (HVAC)

Schedule regular professional maintenance to keep your HVAC system in tip-top shape and use less energy. Ask your technician what steps your maintenance will include (more tips here) and what the best schedule is (before Fall and Spring, or once a year). Having a professional technician clean and tune your system regularly can help you avoid costly repairs and improve your system’s efficiency.

Preventative HVAC maintenance

Changing the “furnace filter” regularly with a high quality option is a great idea and can deliver a massive “bang for your buck” because dirty filters can decrease system performance as well as re-introduce contaminants into the air. HVAC systems vary, so follow manufacturer suggestions, talk to your HVAC professional, and regularly inspect your filter.

HVAC furnace filter replacement

HVAC furnace filter replacement. Source Bigstock.

Suggestions for replacement filters:

  • Sensitive individuals may want to have someone else replace the filter. Wear gloves, a mask, and bag the old filter immediately and discard. Write the date on a new filter and install, then wash hands.
  • For large standard filters look for “high” MERV ratings (8-13) [3] if possible. See the EPA’s “What is a MERV rating” and Filtrete’s guide to MPR vs MERV. Ductless mini split, window AC units and other systems may have different requirements.
  • Before any purchase talk to your HVAC professional to make sure your system can handle higher rated filters (some units may be able to handle up to MERV 16, but don’t assume yours can, as this may damage your HVAC system).
  • You may want to order filters in bulk to save money.
  • One option is Nordic Pure AC & Furnace Filters with an option for a layer of carbon to further minimize odors

HVAC tips for apartment living

  • If the HVAC filter is changed by maintenance staff, ask if it can be changed regularly (or ask if you can supply your own). If the HVAC unit is accessible, look at the filter on a regular basis.
  • Ask what the maintenance schedule is for the HVAC system and follow up to make sure the schedule is followed.

Store chemicals safely

First, limit the number of chemical products you have in or near your home. Focus on storage and use of paints, adhesives, solvents and pesticides in well ventilated areas away from your living space if possible. Do not store chemicals near your air handler. Ensure that chemicals are tightly sealed such that they do not have an odor. If you can smell the chemicals, they are affecting your air quality.

Other maintenance

Cleaning your refrigerator coils, dryer vent, and bathroom fans should also be on your list. For a longer list of seasonal home maintenance tasks see this guide.

Home renovation supplies

Looking for healthier paints/stains, flooring and other non-toxic building supplies, or want to lower your EMF exposure? Here are some resources:

Tip: Be wary of “green” claims made by manufacturers and research products thoroughly. Ask about return policies in case you react to a product.

3 – Ventilation

If the outdoor air quality and weather is reasonable you might want to ventilate regularly. This dilutes the indoor air and often makes it healthier. One solution to pollution is dilution.

Easy ways to ventilate your home:

  • Open windows
  • Run a bathroom fan that exhausts to the outdoors. This can help circulate air through the home.
  • Advanced: Some HVAC systems have “mechanical ventilation”  which pulls outdoor air in, filters it, and distributes it throughout a building. This is often more common in commercial settings, so you may want to ask about it at your workplace.

Ventilate while cooking: 

  • Run the range/hood fan if you have one, and/or leave the kitchen window open a bit if the weather and outdoor air quality allows. This will help avoid nitrogen dioxide buildup from gas ranges, and will dilute cooking fumes.
  • Also, if possible, use stainless steel (or other healthy) cookware and avoid using plastic cooking utensils. Store leftovers and bulk food in glass containers. 

4 – Filter your air

Aside from cleaning your home regularly, keeping it maintained, and focusing on ventilation, filtering your air can have a major impact on your indoor air quality.

HVAC system

An HVAC system potentially filters a very large amount of air each day, so your HVAC system can have a major impact on your indoor air quality – which is why it is first on our list. As mentioned above, you can inspect and change your HVAC filter on a regular basis and have regular maintenance performed.

Tip: You may also want to adjust your thermostat and turn your fan to “circulate” or “on” mode more regularly, to further filter the air. Pay attention to how this makes you feel, if turning on your HVAC fan makes you feel worse, this is a clue.

Portable HEPA filter

If your budget allows for it, a portable HEPA filter may be a helpful addition to your bedroom (or in any area of the home you regularly occupy).

Tip: An inexpensive DIY portable filter option is a box fan combined with HEPA filters; a Corsi–Rosenthal Box (video).

There are many portable HEPA filters on the market. Be wary of marketing claims, special technologies, and high prices. Some thoughts:

  • You may want to size up. One small unit may do a good job at filtering the air in a bedroom, but a larger unit can often do a better job.
  • How much does it filter? You may see clean air delivery rate (CADR), which sort of a complex formula, or cubic feet per minute (CFM) which is how much air the unit processes. Typically you’ll want higher numbers and you’ll want to run the fan on a high setting. 
  • Consider: Initial cost, reviews, cost of filter replacements, technical specifications, noise level, energy efficiency (look for Energy Star rating), and more.
  • Check the manufacturers claims for the portable HEPA filter you are interested in, as the term “HEPA” may be used loosely.
air pollutants

Relative size of particles. Source Consumer Reports.

HEPA explained: A HEPA air filter can theoretically remove at least 99.97% of dust, pollen, mold, bacteria, and any airborne particles with a size down to 0.3 microns (far smaller than the diameter of a human hair). [4] See the Consumer Reports explanation of what air filters catch.

Remember: Dust often carries smaller particles along with it, including mold. A HEPA filter captures dust efficiently so long as the dust is within the capture zone of the unit (i.e. nearby). Operating recirculating fans may help increase removal of airborne particles.

Initially look for models with HEPA filters and not a lot of other bells and whistles. Honeywell and BlueAir are a few options that can often be found on sale at Walmart and Amazon.

Air purification

You’ll find that many portable filtration units are marketed as “air purifiers”, but ISEAI suggests you focus initially on models that physically remove contaminants with a HEPA filter, versus those that rely on “purification technologies” like UV lights, ionization, ozone, PCO, etc.

Some of those purification technologies may be touted for their ability to “kill” contaminants like mold but at this point we are unsure if they might produce any byproducts that could affect a sensitive person. So, “purification technologies” might be something you want to explore later on, for specific reasons.

Focus on your bedroom

Your body does much of its healing each night while you sleep and focusing on the quality of your bedroom’s indoor air may help with your health recovery. 

Tips: Keep your bedroom clean, uncluttered, and use a HEPA filtration unit if possible. 

Did you know that Americans, on average, spend approximately 90 percent of their time indoors, where the concentrations of some pollutants are often 2 to 5 times higher than typical outdoor concentrations? And that every day, you breathe in just over 2,000 gallons of air—enough to almost fill up a normal-sized swimming pool?[2] That’s a lot of air.

Outdoor air quality

Outdoor air inevitably makes its way indoors. It is helpful to monitor the Air Quality Index (AQI) which tracks ozone (smog) and particle pollution (tiny particles from factories, vehicle exhaust, soil dust, pollen, etc), as well as four other widespread air pollutants. Keeping track of the current air quality can help you take steps to protect yourself, children, and others from unhealthy levels of air pollution.

Check your local weather reports and Airnow.gov or PurpleAir for air pollution information in your area. See the guide Using AirNow During Wildfires and the CDC outdoor air quality page.

5 – More considerations

Workplace

Most exposure to indoor air typically occurs in private homes, with less overall exposure occurring at work or in community spaces – simply due to the large time spent at home. So the main focus of this article is keeping your home clean. However, depending on your profession, your workplace may pose both air and other contaminant exposure risks. Read about indoor quality at work through OSHA.

Take a moment to reflect on the type of work you do and what your exposures may be and talk to your manager and advocate for healthy working conditions. See the EPA’s “What to Do if You Suspect a Problem”.

Schools and dorms

From preschools through college dorm rooms and classrooms, these environments are where our children and young adults learn and grow and we want to provide them with a foundation of health.

Unfortunately, many public schools have poor indoor environmental quality, especially in areas of lower socioeconomic status, and this negatively affects student health, attendance, and performance. [5] [6] [7]

In 2014 the National Center for Education Statistics (NCES) estimated that U.S. schools needed $197 billion of investment for repairs, renovations, and modernizations, or $4.5 million per school. [8] Nationwide, asthma is the leading cause of absenteeism for students and education employees report the highest levels of work-related asthma in the nation.

What can you do?

Damp buildings and other exposures

ISEAI suggests that exposure from damp buildings, leading to chronic inflammation, is often the primary exposure factor in the clinical presentation of individuals suffering from a variety of chronic health issues due to environmental exposures.[9]

So, if you know of or suspect significant mold or other problems in your home, there should be a plan to fix the root cause(s).

Is there mold in my home?

Ongoing exposure to elevated levels of mold (whether alive or dead) and other contaminants may affect your health. What are ‘elevated levels’? Think of ‘normal’ as the exposure you typically have outdoors in fresh air in your region. When mold grows indoors following water damage, this is considered abnormal.

Mold growing indoors is often in locations that are not easily visible, such as inside of walls, under cabinets, etc.

Do I have elevated levels of mold?

Ask yourself a few questions: Is there a musty or odd odor inside? Do you see signs of water damage, past or present, or remember water leaks or floods? Do you feel worse at home? Have you tried common cleaning and decluttering steps but still feel ill?

What if I rent?

Landlords are required to provide safe and livable housing. However, no federal law sets permissible exposure limits or building tolerance standards for mold in residential buildings. Some states do have guidelines, however.

  • If there are mold issues in your apartment you can take several steps. First, document the issue with photos and contact your landlord. Explaining your reactions to mold as a “severe allergy” (or other common language) may be better received than more complex terminology.
  • To better understand your rights and for help finding local and state contacts see NOLO’s “Mold in Rentals: Landlord Liability, Responsibility, and Prevention”
  • If there is an ongoing dispute regarding building maintenance, leaks, etc, you might consider a letter from your physician, explaining your diagnosis and exposure concerns

Resources for understanding mold exposure:

Remember, it’s not just mold

Also consider other common factors that influence indoor air quality, such as bacterial and other growth from water damage, cleaning supplies and household chemicals, VOCs from building products, radon from soils, secondhand smoke, carbon monoxide, toxicants in water, etc.

The EPA’s very complete Guide to Indoor Air Quality is another option if you want to dig further into specific exposures like radon, etc.

Summary

In conclusion, take action for a cleaner indoor environment for better health! Start by considering major sources of exposures in your home such as mold (which may be hidden). Think of ways you can clean and maintain your home on a regular basis and improve your indoor air quality. Many of the steps are simple and can become regular habit, helping you in the long run as you reclaim your health. ISEAI’s list of physicians and indoor environmental professionals is here.

References

  1.  “Indoor Air Quality | US EPA.” 7 Sep. 2021, https://www.epa.gov/report-environment/indoor-air-quality. 
  2. “How Your Lungs Get the Job Done | American Lung Association.” 20 Jul. 2017, https://www.lung.org/blog/how-your-lungs-work. 
  3. “What is a MERV rating? | US EPA.” 13 Mar. 2023, https://www.epa.gov/indoor-air-quality-iaq/what-merv-rating.
  4. “What is a HEPA filter? | US EPA.” 13 Mar. 2023, https://www.epa.gov/indoor-air-quality-iaq/what-hepa-filter.
  5.  “Evidence from Scientific Literature about Improved Academic ….” 3 Aug. 2020, https://www.epa.gov/iaq-schools/evidence-scientific-literature-about-improved-academic-performance. 
  6. “FOR HEALTH – Schools For Health.” https://schools.forhealth.org/wp-content/uploads/2020/02/DEC2019-Schools-for-Health.pdf. 
  7. “The Link Between School Attendance and Good Health – American ….” 28 Jan. 2019, https://pediatrics.aappublications.org/content/pediatrics/143/2/e20183648.full.pdf. 
  8. “Condition of America’s Public School Facilities: 2012-13.” https://nces.ed.gov/pubs2014/2014022.pdf.
  9. “WHO Guidelines for Indoor Air Quality: Dampness and Mould.” https://www.who.int/publications/i/item/9789289041683.