asked to determine impairment resulting from a respiratory disease for insurance or benefit systems such as workers' compensation and social security disability. Finally, estimates of disease incidence or prevalence often result from epidemiological studies in which pulmonary function tests are used to ascertain disease.

Recommendation: Include pulmonary function tests in epidemiological studies to help improve estimates of disease incidence and prevalence. Because they are portable and can be self-administered, tests that utilize peak-flow measurements are most desirable for this purpose.

One drawback of many pulmonary function tests is that they must be administered by technicians. Peak flow measurements are less reliable but are highly portable, can be self-administered, and are therefore often more sensitive in the diagnosis of asthma.

Recommendation: Include objective measures of respiratory function in experimental protocols designed to determine the efficacy of therapeutic strategies (e.g., pharmacotherapy, environmental modification, avoidance) used to treat respiratory diseases caused by indoor allergens.

ASSESSING EXPOSURE AND RISK

Methods for determining the effects of indoor allergens can be divided into two general categories: patient testing and environmental testing. Data from both kinds of testing can be useful to the physician in directing the treatment, control, and prevention of allergic disease. There are, however, no effective means currently available to physicians or other medical professionals for obtaining quantitative information on environmental exposures.

Recommendation: Establish effective mechanisms for medical professionals to acquire assessments of potential exposure to indoor allergens in residential environments.

ENGINEERING CONTROL STRATEGIES

The fundamental objectives of environmental control are to prevent or minimize occupant exposures that can be deleterious and to provide for the comfort and well-being of the occupants. Well-designed and maintained HVAC systems will exclude most aeroallergens (e.g., pollen, fungal spores) from interior spaces. Poorly designed or maintained systems, however, can provide for amplification and/or infiltration and dissemination of allergens.



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