Come spring, Washington is both a nature lover's showcase and a pollen-choked crucible that sends allergy suffers scrambling for cover.
However, seeking relief indoors might be wishful thinking.
The Environmental Protection Agency has declared the air two to five times as polluted indoors than out, and placed it among the top five environmental risks to public health. The problem: Homes populated by mites, molds, bacteria, dander and volatile organic compounds, creating a hostile environment for the sensitive.
According to the EPA, since 1980, the biggest increase in asthma cases has been in children under 5. In 2000 alone, nearly 2 million emergency room visits and half a million hospitalizations were linked to asthma, at a cost of nearly $2 billion and 14 million missed school days.
Not that it's so great outside. In February, the Asthma and Allergy Foundation of America proclaimed Washington the fifth "most challenging place to live" for people with asthma, jumping 45 spots since last year. In the pollen-laden months of April and May, the land of cherry blossoms and manicured lawns seems practically designed to jump-start an allergist's practice.
When symptoms hit, instead of blindly buying allergy-relief products, the American Lung Association recommends several steps: Consult a medical specialist, know your triggers and symptoms, control the source, ventilate, and filter the air.
Controlling the source is key. "The best thing you can do to improve your indoor air quality is to put some elbow grease into it," said Angel Waldron, a spokeswoman for the American Asthma and Allergy Foundation of America. "Remove the source of allergens you are sensitive to: pets, carpet, fluffy furniture, stuffed toys and window treatments."
Relief may mean trading delicate designer labels for utilitarian fabrics that can withstand repeated laundering. "We recommend keeping surfaces inside the home clean and uncluttered, sweeping and mopping frequently, and washing bedroom linens in hot water weekly," Waldron said.
Robert Moffitt, a spokesman for the American Lung Association's Health House Program, echoed Waldron. Homes become breeding grounds for allergies, he said, by trapping pollutants inside. Adequate ventilation relieves the problem while also controlling moisture.
"So many indoor air issues are moisture related, such as mold," he said. "Dust mites and cockroaches are really the leading indoor allergens and asthma triggers, and they both like moist, humid homes."
Air conditioners and dehumidifiers can keep interior relative humidity at or below the association's target 50 percent maximum. "A huge amount of water enters the air just from taking showers or cooking," Moffitt said.
Running exhaust fans can make a huge difference.
A common mistake, Moffitt said, is turning down air conditioning in warm weather when no one is home. The motivation may be frugality, but the result is a critical increase in humidity and temperature, turning the home into a petri dish for bacteria and mold.
Carpeting can bedevil sensitive respiratory systems, said Albert Tompkins, an allergist with Allergy Care Centers, a medical practice with offices around the region. The culprit, household dust, is often more than a nuisance. "Dust is a mixture of dust mites, dead insect parts and fabric from clothing, upholstered furniture and carpeting," he said. "Dust-mite sensitivity is the leading cause of childhood asthma."