Long-term management of the home environment is the critical form of prevention of development of medical problems or exacerbation of disease previously caused by a contamination.

These approaches must become a way of life, particularly, for patients with the interstitial lung diseases to insure non-progression of their disorder, those with life-altering symptoms of asthma and chronic coughs, and those with nuisance symptoms that are simply bothersome.

General Maintenance

Surface Drainage: The surface around the home should slope to prevent ground water from rushing into the home, or pooling around the foundation during heavy rainfall.

Gutters and downspouts: Gutters should be routinely checked for blockages from leaves and other debris to insure proper flow to the downspout. Downspouts should channel water away from the foundation.

Roof Leaks: Leaks through the roof should be quickly repaired. Minor leaks are often more difficult to detect and may be present for extended periods. Minor leaks tend to cause more problems because microbial growth may become extensive before discovery. Leaks that potentially drain into a wall space cause the most problems because they may require extensive repair.

Foundations: Concrete foundations may bend, crack, or break leading to disruption of plumbing lines. Slabs for additions built onto a home are often not tied to the existing foundation allowing for separation. These become major problems and generally need qualified plumbers to determine if a leak is present and develop an effective approach to repair.

Plumbing Problems: Much like roof leaks, plumbing problems are more dangerous when they are minor. In certain areas, plumbing is placed in the concrete slab foundation of the home where shifting of soil during wet to dry periods may lead to rupture. Minor leaks inside wall spaces, behind washer-dryer systems, and beneath sinks are generally hidden from view and may become extensive before recognition.

Basements: Basements, if present, are well recognized to be the most likely cause of a home contamination. Moisture may move across basement walls and through the concrete floor. Equipment may be located in the basement that would contribute to moisture problems including heating and air conditioning systems, washer-dryer systems, and plumbing systems.

Excessive Inside Humidity
Excessive inside humidity may occur in the home without any specific problems such as roof leaks, plumbing leaks, floods from outside water, or contaminated air conditioning systems. The operation and maintenance of the home during day-to-day living (mismanagement) may be the conditions that lead to excessive moisture and growth of microbes in small, close environments (poorly ventilated closets, behind furniture close to walls, behind wall hangings, beneath beds, etc.).

Bathrooms:
Preparation of Meals:Preparation of meals may add up to a pint of water vapor for each meal. Use of closed containers and adequate venting can help reduce this source of moisture.

Washing of Dishes and Clothes:These activities may also add significant moisture to the air with the use of sink washing and air drying. Aged machines with poor door seals that allow leaking of hot, moist air into the home should be serviced or replaced.

Plants: Most house plants do not directly impact upon the inside environment. Three to five plants may produce up to a pint of water vapor per day. These plants, however, must receive water to survive which adds to the water vapor. Many molds are not only prophytic (living on dead vegetation) but also parasitic (living on live plants). Molds may grow in the soil of the plant pot and also on the plant directly. House plants sitting or hanging over carpets should be checked to be certain that there are no leaks thru the containers. A leak could lead to growth of microbes beneath the carpet pad at the floor level.

Animals: Inside animals contribute to inside humidity by breathing and loss of moisture from other secretions. Kitty litters unless properly managed may contribute moisture and increased levels of microbes. Dogs in the inside environment have been associated with excessive levels of endotoxins (a bacterial product) that may lead to respiratory tract symptoms in the occupants.

Occupants:The occupants also contribute up to 3 pints per day per person simply by breathing.

Frost Free Refrigerator: Frost free freezers of refrigerators depend upon continuous drainage of condensate to a pan underneath. There is continual evaporation from this pan to add to the relative humidity levels. In humid climates, this pan may retain enough moisture to support growth of mold and bacteria.

Miscellaneous: Aquariums, inside fountains, vaporizers, humidifiers, etc. are devices that will contribute to the overall humidity within the home.

Hygrometer: This is an inexpensive instrument that can be used to measure relative humidity levels within the home when closed. Humidity should be maintained within the 40 - 50% range.

Air Conditioning Systems
Air conditioning, in warmer climates, may be operated for much of the entire year. Houses are kept closed during use of these systems with almost no fresh air entry into the home except thru opening of doors as the occupants come and go. There are many possibilities for moisture problems to occur as a result of use of air conditioning. In the "Sun-belt", malfunction of the air conditioning system is the most common cause of microbial contaminations leading to significant medical problems.

Over Air Conditioning
The capacity of the air conditioning system is calculated on the square footage of the home. This capacity is to cool the home environment and reduce relative humidity levels. If the thermostat is set at a relatively high level, e.g. 78 to 80 degrees F, and ceiling fans utilized to move air, the relative humidity increases, yet the occupant may remain comfortable. The net result, however, is excessive humidity in close, "micro" environments within the home including the spaces behind hanging pictures or paintings, poorly ventilated closets, furniture close to walls, beneath beds, etc. These "micro" environments may grow mild at levels that are difficult to detect by visual inspection.

Condensate Line Blockage
Condensate lines become plugged usually as a result of "sludge" draining from the condensate pan. This may cause water damage to the carpets and walls in the vicinity of the air conditioning closet. If the system is the horizontal-type, it is located in an attic space and has a overflow pan that will begin to drain. Should the overflow pan's drainage line becomes plugged, water will damage and often cause collapse of the ceiling beneath the air conditioning system. The condensate pan may begin to retain condensate water for many reasons including inadequate installation, warping or sagging of the pan, or primary design.

Plenum and Duct Contamination
The most common site of contamination of an air conditioned system is in the plenum (the large area of ducts just beyond the cooling, or evaporator, coil. This is most often cause by very moist air blown beyond the condensation pan when the fan is located too close to the evaporator coil. This mold often moves into the proximal duct areas. Evidence of an air conditioning system may first be noted by a dark dust exiting the registers. Microscopic examination of this dust will reveal mold spores or simply amorphous debris. Small plugs can be cut from the fiberboard of the plenum to reveal the internal surface.

Poor Duct Design.
Poor duct placement leading to spot cooling on the interior surface may lead to mold growth in the wall cavity or behind vinyl wall paper in humid climates.