“The Link Between Cleaning Habits, Bleach Use and Asthmatic Presentation in Athletes”

Jessica Bullock
Mrs. Eve Harrison
Dr. Melanie Thomas
Central Magnet School
Graduation Date: May 16, 2019
 DEDICATION
To my mother, for believing in me when I didn’t believe in myself. To my father,
who always encouraged me to reach for the sky. To my sister, who I thank for putting up
with me and encourage to do a better job than I did.

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 ACKNOWLEDGEMENTS
Without a great deal of help, this thesis would not have been possible. For this, I
extend my thanks to my mentor, Dr. Les Newman for his help in structuring the
questionnaire, gathering responses, and taking the time to help me through this process. I
also thank my Field of Study advisor, Mrs. Eve Harrison and English teacher, Dr.
Melanie Thomas. Both of you have been so patient, and I have never felt uneasy about
asking for help from either of you. Thank you both. Last, but certainly not least, thank
you, Ms. Nancy Baty and Dr. Kyle Prince. Your aid in the statistical analysis of my data
was invaluable.

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 ABSTRACT
This study was initiated in order to find a connection between cleaning habits,
bleach use, and the diagnosis of asthma. In this manner, a practical method was sought
out by which asthmatic athletes could alleviate their symptoms and at-risk athletes could
avoid developing asthma by taking preventative measures. A total of 328 self-reported
surveys filled out by athletes, current and former, between the ages of 10 and 30, were
gathered, and their responses were analyzed for significance using chi-squared tests. A
few definitive connections were found within three subgroups. Among athletes who
played both types of sports, the frequency at which the home was vacuumed was found to
have a significant relationship with the respondent’s asthmatic status; when this subgroup
was further restricted by age groups, this same independent variable was shown to have a
significant relationship with presentation of asthma. The other three significant
relationships could both be found in the endurance subcategory. When the subgroup was
restricted by age, a p-value of 0.03843393 was linked with the frequency at which bleach
products were used. When the endurance subgroup was restricted by the respondents’
confirmation that asthma ran in their families, the use of a protective sleeve was linked
with a p-value of 0.045020881. When the subgroup was restricted by pet ownership, a p-
value of 0.027260335 was linked with the frequency at which the respondents’ home was
vacuumed. However, none of the other variables were found to have any statistically
significant relationship with the manifestation of asthma, implying that the relationships
are either spurious or influenced by another factor.

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 TABLE OF CONTENTS
LIST OF TABLES/FIGURES ...................................................................................................... vi
Chapter 1: INTRODUCTION ....................................................................................................... 1
Research Question(s) .................................................................................................................. 1
Research Purpose........................................................................................................................ 1
Background Information ........................................................................................................... 1
Possible Treatments or Solutions .............................................................................................. 4
Hypothesis ................................................................................................................................... 4
Chapter 2: REVIEW OF LITERATURE .................................................................................... 5
Mechanism .................................................................................................................................. 5
Risk Factors/Preventative Measures......................................................................................... 7
Questionnaire structure/Methodology ....................................................................................10
Athletes and Asthma ................................................................................................................12
Chapter 3: METHODOLOGY ....................................................................................................16
Data Acquisition: ......................................................................................................................16
Participant Pool: .......................................................................................................................16
The Process: ..............................................................................................................................17
Definitions: ................................................................................................................................19
Data Analysis: ...........................................................................................................................19
CHAPTER 4: RESULTS AND DISCUSSION ..........................................................................21
Results ........................................................................................................................................21
Discussion ..................................................................................................................................30
• Bleach Use ......................................................................................................................30
• Vacuuming, Washing of Bedsheets, Use of Protective Sleeve ......................................33
• Descriptive Statistics ......................................................................................................34
• Limitations ......................................................................................................................36
CHAPTER 5: CONCLUSION ....................................................................................................38
REFERENCES .............................................................................................................................39
APPENDICES ...............................................................................................................................44
APPENDIX A-Online Survey ..................................................................................................45
APPENDIX B-Hard-Copy Survey ..........................................................................................56

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 LIST OF TABLES/FIGURES

Figure 1.1. A table of a few of the variables evaluated in this study, as well
as the number of participants that fit within each category .............................................. 21
Figure 1.2. A continuation of the chart on the previous page.... ....................................... 22
Figure 2. A table representing the respective p-values associated with each independent
variable within the “endurance” group.... ......................................................................... 23
Figure 3. A table representing the respective p-values associated with each independent
variable within the "both sports” group.... ........................................................................ 23
Figure 4. A table representing the respective p-values associated with each independent
variable within the "power/speed” group.... ...................................................................... 24
Figure 5. A table showing the p-values associated with each independent variable when
the “endurance” subgroup was further divided by age.... ................................................. 25
Figure 6. A similar figure to Figure 5, as applied to the “power/speed” subcategory... ... 25
Figure 7. A similar figure to Figure 5, as applied to the “both sports” subcategory... ..... 26
Figure 8. A graph of the p-values associated with each independent variable when the
endurance subgroup was further subdivided by the respondents’ indication of a family
history of asthma... ............................................................................................................ 26
Figure 9. A similar figure to Figure 8, as applied to the “power/speed” subcategory... ... 27
Figure 10. A similar figure to Figure 8, as applied to the “both sports” subcategory... ... 27
Figure 11. A graph depicting the p-values associated with the “endurance” subgroup
when it is further subdivided by the respondents’ positive response to the ownership of
pets.... ................................................................................................................................ 28
Figure 12. A similar figure to Figure 11, as applied to the “power/speed” subcategory.. 28
Figure 13. A similar figure to Figure 11, as applied to the “both sports” subcategory.. .. 28
Figure 14. A depiction of the p-values associated with each independent variable as
applied to the “endurance” subgroup when only respondents designated as being elite are
evaluated............................................................................................................................ 29
Figure 15. A similar figure to Figure 14, as applied to the “power/speed” subcategory. . 29
Figure 16. A similar figure to Figure 14, as applied to the “both sports” subcategory…30

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 Chapter 1: INTRODUCTION
Research Questions

Are there controllable factors that could prevent, or lessen the severity of

asthmatic symptoms in endurance athletes? Can any controllable measures be taken in

adolescence or early adulthood and successfully inhibit symptoms, or do these systems

work solely when implemented in childhood?

Research Purpose

Through epidemiological data, new knowledge of factors that can alleviate airway

dysfunction should be gained. As such, this study will be undertaken in the hopes of

providing athletes with a viable set of proactive measures that, when taken, can improve

their health in the long run. The practices derived from this study might, in turn, prevent

them from suffering through bronchial flare-ups and having to pay for controlling

medications.

Background Information

The original purpose of this thesis was to determine the effects of exercise on the

manifestation of allergies, evaluating any possible benefits that could be conferred

through physical activity. Indeed, this theory seemed to be supported by the work of

Stefano del Giacco et al, whose 2012 study discerned that levels of cytokines dropped in

professional soccer players; this meant that the athletes presented with lower levels of

proteins contributing to allergic conditions such as rhinitis or eczema (Del Giacco,

Scorcu, Argiolas, Firinu & Del Giacco, 2014).

 However, for the sake of time and efficiency, the focus was made to shift towards

a more localized aspect of the study. The researchers found that in the athletes who self-

reported a history of asthma, levels of circulating cytokines-proteins that help induce an

inflammatory response and are involved in allergic reactions-decreased over the course of

the study (Del Giacco et al, 2014). The decrease in the levels of one cytokine, interleukin-

4, was especially significant, as the study was the first of its kind to show “a reduction of

the IL-4 producing cells in professional athletes over a long period of observation” (Del

Giacco et al, 2014). After finding that a study using non-professional athletes and more

closely controlled settings produced results stating that levels of IgE, another

inflammatory protein, rose in asthmatics, the subject of the effects of exercise on

asthmatic presentation became far more interesting (Aldred et al, 2010).

Upon further investigation, it became apparent that bronchial disfunction is a

common trait in athletes who perform at the competitive or elite level (Lomax 2016;

Romberg, Tufvesson & Bjermer, 2017). It has been found that athletes participating in a

sport for a long period of time(Lomax states that swimmers competing for 4 or more

years are at higher risk for developing airway dysfunction, while Romberg defines an

elite athlete as one who has been training for 6 years or more) are more likely to develop

asthma due to either an increased sensitization to allergens in the environment or the

progression of a process called airway remodeling, which occurs when the upper

respiratory system becomes damaged after repeated stress (Lomax 2016; Romberg et. al

2017; Frangella et. al 2011). Controlling the effects of such damage can become costly,

and one’s daily functions may still be impaired, regardless of treatment (Lomax, 2016).

These parameters shaped the direction that the background research took, leading to a
2
further investigation of practices that have been linked to a lower incidence of asthma

and/or allergies.

Two primary schools of thought surround this issue: the first has been collectively

dubbed the hygiene hypothesis, and the second will, for the purpose of this study, be

called the prophylactic theory. The hygiene hypothesis states that individuals exposed at

an early age to microbial stressors can build up higher levels of immunity and are thus

less likely to develop allergic diseases. Several studies support this theory; in one case an

exposure as commonplace as washing the dishes by hand was concluded to be correlated

to some level of protection against allergic diseases (Hesselmar, Hicke-Roberts &

Wennergren, 2015). The prophylactic theory focuses more on the removal or

minimization of allergic stressors early on, reducing chances for allergic sensitization in

order to prevent the incidence of allergy later in life (Kalogeromitros, Makris, Gregoriou,

Katoulis & Straurianeas, 2006). Due to these parameters, many of the studies testing this

theory use groups of young children or infants, controlling their environments to see the

effects, if any, of a sterile environment on the development of allergic diseases (Arshad,

Bateman, Sadeghnejad, Gant & Matthews, 2007).

Both theories focus on preventative measures; however, very little research has

been done about how such measures can specifically prevent allergic presentation in

athletes. Additionally, the effects of such prophylactic measures when initiated in

adolescence or adulthood is not well known. This study aims to offer some insight about

the subject, specifically in the examination of measures that could decrease the chance of

3
developing asthma or reduce the severity of symptoms, as well as help an identifiable

demographic improve their respiratory health.

Possible Treatments or Solutions

Currently, the most common means of controlling asthmatic symptoms is through

the use of medications such as beta-agonists (Ex: albuterol) or corticosteroids (a select

few, like budesonide) (Del Giacco, Manconi & Del Giacco, 2001). Additionally, the

implementation of non-medicinal measures such as the use of an athletic mask can also

help manage the exercise-induced form of asthma (Del Giacco et al, 2001). That said, a

package of Pulmicort can cost more than $170, and the use of measures such as masks

may be impractical (Del Giacco et al 2001; Lomax 2016; Rosenthal 2013). As such, an

effective, inexpensive, universal method of prevention could be quite useful. A few of the

practices that fit this criteria include consistent cleaning habits, such as washing sheets,

vacuuming carpets, using impermeable covers with mattresses, and abstaining from the

use of bleach-based products (Matulonga et al. 2016; Arshad et al. 2007; Bemt et al

2006). As such, the implementation of these habits as a part of an athlete’s general

routine might serve to limit the severity of their symptoms or prevent them from arising.

Hypothesis

If there are controllable factors that relate to the prevention of asthma symptoms

in athletes, then they will most likely be correlated with altering conditions of one’s

living space such as regularly washing sheets and pillows and using impermeable covers

with mattresses. If this is the case, then the strongest effects of these factors might be

conferred when implemented in childhood.

4
 Chapter 2: REVIEW OF LITERATURE

Mechanism

To implement this study, an understanding of how asthma worked was necessary.

One source, while intended by the creators to be used to evaluate the existence of a

possible biomarker indicating white blood cell activation, provided a wealth of

information regarding the compounds governing allergic disease. This review piece

written by Kenji Kabashima and his team elaborates on the types of chemicals released

by cells involved in the allergic process (Kabashima et al, 2018). Specifically, the

writer`s evaluate each compound’s shelf life, specificity, and overall effectiveness if used

as an indicator for the activation of mast cells and basophils. These cells typically

degranulate to release histamine, the primary instigator of allergic reactions, and

Kabashima et al. draw from more than 80 sources to categorize the proteins that could

specifically be used to test for their activities. While they unfortunately are unable to

draw conclusions as to which compound could be used as a reliable biomarker, they do

elaborate on the mechanisms that the compounds facilitate. For example, the writers

address the significance of IL-4, or interleukin protein 4, which is a protein strongly

associated with instigating the inflammation associated with allergic asthma; meanwhile,

IgE (immunoglobulin E), while not necessarily indicative of mast cell or basophil

activation, is a type of antibody that initially binds to an offending substance and signals

for the immune system to launch a response. Through their extensive analysis, the writers

successfully illustrate how an allergic reaction occurs.

5
 A person can develop an allergy through the process of sensitization, or the

gradual buildup of an immune response to a stimulant. There is a heavy genetic

component involved in the sensitization process, but studies have shown that multiple

exposures to an irritant are what allow an allergic reaction to intensify and/or fully

manifest. Additionally, a person with a singular allergy may become sensitized to other

substances producing similar antigens. This principle is exhibited in a study from Greece

performed by Dimitrios Kalogeromitros and his team (Kalogeromitros, Makris,

Gregoriou, Katoulis, & Straurianeas, 2006). Here, the connections between the

introduction of a specific allergen to a system and subsequent cross-sensitization to other

allergens are explored. The scientists observe the effects of an allergen in grapes using

the clinical histories and then-current presentations of 61 allergen-specific atopic people.

Using a battery of tests, including a skin prick test (lab grade allergens are introduced to a

person’s system), a prick-to-prick test (the food/substance is directly placed on a needle

and introduced to a person’s system), and a grape allergen specific test (as a baseline), the

scientists were able to determine that a number of people who were allergic to grapes also

exhibited sensitivity to a number of other foods such as peaches, cherries, and peanuts.

While the sample size was admittedly small in scale, Kalogeromitros’ study provided a

new insight as to how allergic conditions (at least regarding food allergies) may develop.

In most cases, an allergen, which is typically a protein or other naturally derived

substance, will elicit the initial reaction, causing the symptoms characteristic of asthma –

wheezing, shortness of breath, and a tightness in the chest. This condition would be

categorized as allergic asthma. However, if any substance that is not categorized as an

allergen elicits these same symptoms, the condition would be categorized as non-allergic
6
asthma. According to a brief article produced by The Asthma Center Education and

Research Fund, individuals with this form of the disease typically have a negative skin

prick test (a method by which allergies can be diagnosed) (The Asthma Center Education

and Research Fund, 2005). As such, these individuals may present with symptoms that

do not fit the typical atopic profile, which may lead to an incorrect diagnosis and

treatment plan.

Risk Factors/Preventative Measures

Research suggests that many of the elements needed for hypersensitivity are

present at birth, as genes can be passed from a parent to a child that lend to susceptibility

to asthma development in the same manner that traits such as eye color can be inherited.

Indeed, a study done by S. Tolga Yavuz found that one of the primary factors linked to

the development of asthma in a child was the presence of asthma in the parents; upon

analysis, it was found that children with allergic rhinitis and asthmatic parents were 2.37

times as likely to develop asthma as an individual with the same condition, but no history

of the disease in their immediate family (Yavuz et al, 2018). Moving away from the

genetic perspective, the physical characteristics of the home can also affect one’s

respiratory function. For example, a study performed by Dr. L. van de Bemt et al. showed

that the composition of one’s mattress can affect the levels of allergens and irritants in the

home. Drawing from a sample of 175 participants, van de Bemt found that people who

had mattresses containing a cotton upper layer had lower levels of dust mite allergens

located on the mattress itself, and thus in the surrounding environment (Bemt et al, 2006).

Given that van de Bemt and his team physically took dust samples from the beds of the

participants, purifying and analyzing the samples before reaching their conclusions, it
7
would stand to reason that their assessment is fairly accurate, or at the very least, has a

great deal of evidence to support it.

That said, neither of the factors mentioned previously can be easily controlled or

altered. However, there are a few factors that, while more localized, could still confer a

great level of improvement on the respiratory health of the patient. Such factors include

control of the level of bleach exposure and the elimination of irritants from the living

space.

Interestingly enough, the use of bleach seems to have a dualled effect depending

on which type of asthma manifests. Bleach exposure has been linked with the

development of non-allergic asthma and respiratory symptoms, which is thought to be

due to the inhalation of chlorine derivatives, which can damage the lining of the

respiratory tract. Indeed, it has been found that women that regularly use bleach to clean

their homes, or occupational cleaners such as housekeepers are more likely to develop

respiratory symptoms (Matulonga et al, 2016). The study performed by Dr. B Matulonga

utilized both surveys and biological data in order to determine the prevalence of asthma

among a group of women participating in the larger epidemiological project, the

Epidemiological Study on the Genetics and Environment of Asthma. Though the

questions on bleach use were self-reported, the data gathered from skin-prick tests, white

blood cell counts, and bronchial responsiveness challenge tests supported the notion that

higher levels of bleach exposure could lead to a higher likelihood of developing non-

allergic asthma. However, the level of exposure may simply be a matter of frequency;

there was a study performed by Ahmed Arif and George Delclos that proved that medical

8
professionals who use bleach to clean their tools are at a higher risk for developing

asthmatic symptoms (Arif & Delclos, 2012). As such, one might think that in order to

prevent exacerbating asthma symptoms, one might just not use bleach, or not use the

substance as often.

That said, bleach can also play a role in denaturing allergens, binding to them so

that the immune system will not register them as threats and elicit a response. In fact, a

2008 study done by Charles S. Barnes showed that the use of sodium hypochlorite-based

bleach was associated with a reduced level of allergens in the homes of members of the

experimental group, as well as an increased quality of life for asthmatic participants who

utilized the bleach-based products provided in the study (Barnes et al, 2008). As such, a

person with allergic asthma might actually benefit from bleach use in the home.

While the nature of the previous factor is somewhat contradictory, the elimination

of allergens and/or irritants seems to have a consistent positive effect on the physiology

of the patient. There are several studies in which a program limiting the exposure of the

participants to allergens has been successfully implemented and effected a lower

incidence of atopy (an allergic response that manifests in an area other than the point at

which the allergen makes contact). For example, a preventative program initiated by Dr.

Syed Arshad utilized a methodology designed to showcase the differences made in a

child’s health with the implementation of a few dietary and environmental restrictions

(Arshad, Bateman, Sadeghnejad, Gant & Matthews, 2007). Gathering a sample size of

120 children and gaining consent from the parents of each child, the scientists set up two

groups; one that placed dietary restrictions on breastfeeding mothers and attempted to

9
limit exposure to dust mites (prophylactic group)for the first year of the child’s life, and

one that had no restrictions whatsoever, serving as a control group. The children were

monitored from infancy to eight years of age, and it was found that, as they aged, the

group of children that had environmental and dietary restrictions during infancy had

statistically lower levels of allergic presentation as they aged. Therefore, the scientists

conclude that early intervention has a positive effect on how a child might develop

allergies later (Arshad et al, 2007). While this study targeted babies and young children,

other experiments, such as the one performed by Barnes and his team, used participants

that were in adolescence (Barnes et. al, 2008). As such, it seems that such measures could

be taken later in life and still reduce the development of asthma symptoms.

Questionnaire structure/Methodology

With the parameters set, a method of data collection needed to be established.

Since this study examines the factors linked to the development of asthma in athletes,

correlational studies were favored in the search for a suitable structure. Case in point: a

study performed by S. Yavuz, et al. assembled a group of 293 children who had been

diagnosed as being allergic to grass pollen in order to figure out what might cause these

children to develop asthma later in life (2018). This done, they followed these children

for around 3 years after their initial diagnosis, documenting two pieces of evidence

crucial to their study: pulmonary function and the circumstances surrounding each

patient’s birth and childhood. In doing so, the scientists were able to gather their data,

later analyzing it with chi-squared tests that examined the independence/interdependence

of their independent variables, as well as logistic regression tests (which is used to

analyze the relationships that one or more independent variables have on a binary
10
dependent variable - an effect with only two possible outcomes), which specifically

examined “the association between prenatal factors and asthma” (Yavuz et al, 2018). At

the end of it all, the team concludes that factors such as a premature birth, early formula

feeding, and parental asthma (the disorder runs in the family) all contributed to the

development of asthma later in life for children with allergic rhinitis. The team gathered

data such as peak expiratory volume and forced vital capacity in order to corroborate

their findings from a survey they distributed to the families of the participants (Yavuz et

al, 2018). The first of its kind to specifically examine allergic rhinitis patients regarding

their likelihood of developing asthma, the far-reaching study had a very thorough

methodology. However, it also required a great deal of time and resources.

To circumvent obstacles such as these, many other studies took an indirect

approach. To do this, researchers successfully obtained information regarding the

subjects’ habits and allergic symptoms using nothing but questionnaires. For example, in

a study done by Bill Hessselmar and his team, the researchers attempted to find a

correlation between microbial exposure and allergic disease (Hesselmar, Hicke-Roberts

& Wennergren, 2015). A questionnaire was used to evaluate what allergies the subjects

presented with, whether or not they ate fermented food and how they washed their dishes

– the reasoning behind adding the last two details was that children who ate more

fermented food and washed their dishes by hand were more likely to be exposed to

microbes, which could possibly confer a level of protection to the child. After examining

the patterns of illness through a chi-squared test and a logistic regression analysis test, the

researchers were able to find a negative correlation between the method of dishwashing

and the incidence of allergy in spite of confounding variables such as the presence of pets
11
or daycare attendance (Hesselmar, 2015). While there is a possibility of recall bias when

a self-reported survey is used, Hesselmar et al attempted to account for this possibility

when defining the independent and dependent variables (Ex: asthma was defined as

having a positive response to the questions, “has your child ever had asthma?” and “has

your child ever had eczema?”, lessening the likelihood that a false positive would be

recorded and skew the data). In this manner, all of the data was gathered without the need

for a structured experiment. Such a procedure seemed like a promising option, so the

types of questionnaires utilized in studies like this were explored.

Several studies consistently used elements from the following surveys: the

ISAAC (International survey for allergies and asthma in childhood) questionnaire and the

ECRHS (European community respiratory health survey) questionnaire. According to the

official websites for the surveys, both the ISAAC and the ECRHS have been used in

conjunction with projects spanning decades; the first attempts to help discover the root

causes of allergies and asthma in children (ISAAC, 2017), while the second is used to

track patterns of behavior, such as eating habits or occupational factors that could lead to

the development of respiratory symptoms (ECRHS, 2014). Specifically, questions are

asked regarding when the participant’s symptoms arise, their family history, and the

cleaning schedule.

Athletes and Asthma

Initially, the study was intended to cover how exercise in general affected

asthmatic presentation, but an interesting trend was uncovered in the research of this link.

Studies done by Stefano del Giacco and Sarah Aldred showed that exercise can lead to an

12
immediate drop in cytokine (chemical attracting white blood cells to attack an offending

molecule, in this case, an allergen) production and white blood cell counts (Del Giacco,

Scorcu, Argiolas, Firinu & Del Giacco, 2014; Aldred, 2008). Both studies had relatively

small sample sizes(Giacco focuses on 29 players of an Italian soccer team, while Aldred

conscripts 21 participants for her experiment), but their respective results provide

interesting insights regarding how the immune system responds to exercise. Giacco’s

study, spread over 11 months and implementing testing on the participants as they

performed their normal training regimens, showed that cytokine-producing cell levels

dropped, especially for athletes with a known history of allergy (Del Giacco et al, 2014).

Meanwhile, Aldred’s study, which involved the participants exercising at a moderate

pace on an ergometer, and having their blood drawn in order to observe how the exercise

affected their levels of circulating IgE, showed that IgE levels dropped significantly for

those with food allergies (Aldred, 2008). Both studies show that allergic reaction

inducing factors can be decreased following aerobic exercise; logically, this would mean

that an athlete would be less likely to develop allergic diseases.

However, as shown through meta-analyses such as the one performed by Jacob

Burns and his team, asthma actually tends to be more common in competitive athletes as

compared to the general population. In Burns’ study, which focuses on the asthmatic

presentation of Olympic athletes, participant records were analyzed from the ECRHS and

GA^2LEN databanks. The ECRHS data was used to form a profile of the general

population, while the GA^2LEN data was used to examine the prevalence of asthma

among participants in the 2008 Beijing Olympics. The data from the two groups was then

compared, and it was found that individuals who participated in high level endurance
13
sports (activities which don’t require one’s full strength, but are performed over a

prolonged period of time) had especially greater odds of having doctor-diagnosed asthma,

asthma symptoms, and the use of asthma medication (Burns et al, 2015).

Another paper by Claudia Frangella and her team supports these findings. In this

systematic review, Frangella states that between 25 and 79% of endurance athletes suffer

from bronchial hyperresponsiveness, contending that the “high training load” and

“training environment’ may contribute to the development of such symptoms (Frangella,

2011). Indeed, an article published in the journal Minnesota Medicine agree with this

assertion, stating that endurance athletics involve the rapid inhalation of dry air, and that

endurance athletes were the group most likely to affected by respiratory illness – even

more so than non-endurance athletes (Piccionatto, Ross & Carlson, 2010). When this

occurs, the airways may be more prone to damage due to the damage of epithelial tissue,

leading to respiratory difficulty.

The exception to this principle is the state of the swimmer; according to Mitch

Lomax in a 2016 paper, 50% of elite or highly trained swimmers suffer from some sort of

bronchial tone disorder. The moisture in the air surrounding the pool should alleviate

some of the symptoms associated with asthma, and when done recreationally, it can serve

as an alternative for asthmatics who want to become involved in sports. However, when

practiced over a series of years at the competitive level, the swimmer may begin to

develop damage in their airways. In Lomax’s analysis, which spans decades of literature,

one hypothesis persists regarding this phenomenon: repeated exposures to both ambient

and environmental chlorine may damage the tissue in a swimmer’s airways, resulting in

14
asthmatic symptoms. That said, these symptoms have been known to dissipate after

several years of retirement (Lomax, 2016).

Aside from these specific factors, the average athlete will simply come into

contact with more allergens than the average person. Practices may go on irrespective of

pollen counts, and the players in turn, may be more inclined to ignore or downplay their

symptoms for the sake of putting up a brave front. That said, an athlete’s symptoms can

be controlled by medications vetted by the WADA, or World Anti-Doping Association,

but such medications can be costly (Lomax, 2016; Del Giacco, Manconi & Del Giacco,

2001). For example, according to an article published in the New York Times, one type

of albuterol inhaler, ProAir HFA, can cost upwards of $170 for a two-pack (Rosenthal,

2013). As such, finding a few controllable measures that could prevent or diminish the

symptoms could help alleviate the medical and financial worries of a great number of

people.

15
 Chapter 3: METHODOLOGY

Data Acquisition:

All questionnaires were distributed to students and faculty at Central Magnet

School of Murfreesboro; patients at the Allergy and Asthma Center network in

Murfreesboro, Smyrna, and Brentwood; and attendants at First Baptist Church (E. Castle

Street) in Murfreesboro.

Participant Pool:

Taken from a population of current and former athletes between the ages of 10

and thirty, 328 viable responses were gathered from this study. The age group was chosen

in an attempt to ensure that the symptoms from the athletic activity had the highest

likelihood of being present in the individuals; the average professional or elite athlete

retires before they reach 30, and according to a paper by Mitch Lomax, the respiratory

symptoms may fade after less than of retirement (Lomax, 2016; The Stats Zone, 2016).

To establish a basis for comparison, samples were taken from participants who

both did and did not present with asthma. Participants were further divided by the types

of sports that they played; each response was placed into the categories of “endurance

sports”, “power/speed sports”, or “both sports played”, depending on which type of sport

16
the respondent selected. Different types of sports have been shown to have varying

effects on the manifestation and presentation of asthma symptoms, so these categories

were created so that each of these factors could be evaluated independently (Burns et al,

2015). In order to limit confounding factors present in the data, all participants with BMI

measurements indicating obesity were removed from the sample pool, as well as all self-

reported users of tobacco products or vape pens; excessive levels of fat in the body have

been linked to an increase in one’s odds of developing asthma, as has tobacco use (for

obvious reasons) (Fenger, R.V. et al, 2012). Other possible confounding variables include

the presence of a large number of siblings or other people in the home, the setting in

which one lives, and the presence of animals in the home, but these parameters were

included in the data; these parameters are significantly harder to alter.

The Process:

The survey was distributed between November 19, 2018, and January 15, 2019.

Unfortunately, due to an error found in the survey, the distribution was placed on hiatus

from December 2nd through December 19th so that the questionnaire could be revised.

However, the survey was distributed uninterrupted for the remainder of the time period.

For the sake of maintaining homogeneity in the types of responses gathered, three

responses were eliminated.

The Survey:

Many of the procedures described in the literature based their surveys off of the

ERCHS and ISAAC questionnaires, which ask questions about the setting in which the

participant lives, a brief medical history, as well as about the actual symptoms that the

17
participant exhibits (ECRHS, 2014; ISAAC, 2017). Using this format allows for a more

complete understanding of the respondents’ lifestyles, in turn allowing for a better

understanding of how the designated independent variables - vacuuming frequency,

sheet-washing frequency, pillow sleeve use, and bleach-containing product use - would

affect a participant’s respiratory health under normal conditions. As such, these

parameters, as well as a few others particular to this study, are reflected in the

questionnaire.

For example, the questions “Do you have any pets?” and “In what setting do you

live?” both reflect the presence of two confounding variables that could possibly affect

the participant’s health in conjunction with the independent variables (Appendix A,

Appendix B). Variants of these questions are also found in the ECRHS questionnaire.

However, the questions “At what age did you start participating?” (in an indicated sport)

and “At what age did you stop?” were used to find a confounding variable specific to

athletes (Appendix A, Appendix B). With these questions, the number of years the

respondent participated could later be found; the number of years an athlete plays,

especially regarding endurance sports can have a significant effect on the participant’s

respiratory health over time (Lomax, 2016). Said number of years calculated by

evaluating the respondent’s initial and final ages of participation in relation to the median

of their indicated age range (Ex: If someone in the 22-25 age range said they started

playing at 14, and stopped at 20, then the reference age used would be 23.5 years). The

thirty-question survey was distributed both online and with a hard copy version, both to

accommodate participant preference and allow for greater accessibility and ease of

collection.
18
Definitions:

Doctor-diagnosed asthma was defined as a positive response to the question

“Have you been diagnosed with asthma?” (Appendix A; Appendix B). Allergic Asthma

was defined as a combination to the following responses to the question, “When do your

symptoms manifest?”: “Seasonally”, “After eating certain foods”, and/or “after any

outdoor exposure” (Appendix A, Appendix B) . Non-allergic Asthma was defined as two

or more of the following responses to the question, “When do your symptoms manifest?”:

“after intense exercise", “after sudden temperature drops”, and/or “after exposure to

strong scents” (Appendix A, Appendix B). Mixed Asthma was defined as a combination

of these responses –at least one from each category (Appendix A, Appendix B). Elite

Level was defined as having played a sport for 4 or more years, having stopped playing

within the last 4 years, and having participated at the competitive level.

Data Analysis:

In order to test for the relationships that the independent variables, as well as

possible confounders, have with asthma development, a series chi squared tests were

conducted. Each defined variable was first analyzed independent of confounding

variables, then in conjunction with said variables. This way, the correlations between the

independent variables and the manifestation of asthma were analyzed in a general sense,

as well as in specialized circumstances; for example, the existence of a relationship

between washing one’s sheets and the manifestation of asthma was evaluated in addition

to the relationship between those same two variables when the population was restricted

to those with a family history of asthma. Only participants 21 and under were grouped

19
into subcategories for later evaluation; less than 5 respondents were 22 and older, making

it hard to accurately perform a chi-squared analysis when the two groups were divided.

Purpose:

The purpose of this procedure is to ascertain what relationships exist between

cleaning habits and bleach exposure and the presentation of asthma in athletes, providing

insight as to whether or not certain commonplace habits, or the absence thereof, can

change one’s health for the better.

20
 CHAPTER 4: RESULTS AND DISCUSSION

Results

A total of 496 responses were gathered, 328 of which were viable (the remaining

168 were removed if the responses indicated an abnormally high BMI, an abnormally low

BMI, tobacco/e-cig use, duplicated answers, or did not indicate the types of products used

to clean the home). Around 86% of all respondents lived in the suburbs, followed by 14%

in an urban setting, and 6% in a rural setting. Nearly 60% of all respondents were female.

Additionally, around 60% of the respondents indicating that they had doctor-diagnosed

asthma were female. This was expected: females are more likely than males to develop

asthma and autoimmune diseases in general, for reasons currently unknown. 50.61% of

participants solely played a power or speed sport (non-endurance, high activity), with the

remainder playing either solely endurance sports or both endurance and power/speed

sports.

Category Count (%)

Female 197 (59.88%)

Power/Speed 166 (50.61%)

Endurance 75 (22.87%)

Both Sports Played 87 (26.52%)

Age
10 to 13 145 (44.21%)
14 to 16 134 (40.85%)
17 to 21 45 (13.72%)
22 to 25 1 (.3049%)
26 to 30 3 (.9146%)
Fig. 1.1- A table of a few of the variables evaluated in this study, as well

as the number of participants that fit within each category.

21
 Category Count (%)
Suburban 283 (86.28%)

Rural 20 (6.098%)

Urban 47 (14.33%)

Competitive Level 202 (61.59%)

Asthmatic 48 (14.63%)
Allergic 8 (16.67% asthmatic)
Non-allergic 16 (33.33% asthmatic)
Mixed 24 (50.00% asthmatic)
Fig.1.2- A continuation of the chart on the previous page

The chi-squared analysis began simply; each sport was treated as a subcategory in

an attempt to adjust for confounding variables. The numbers of respondents that

displayed the characteristics listed above were counted and placed into contingency

tables. With these models, chi-squared tests were run, and the correlational strength of

each independent variable in relation to the dependent variable, manifestation of asthma,

was established. The alpha value was set at p=0.05, and using that value as a baseline, the

significance of each possible correlation was established. Tables displaying the results

can be seen on the following page:

22
Fig 2. A table representing the respective p-values associated with each independent variable

within the “endurance” group.

Fig 3. A table representing the respective p-values associated with each independent variable

within the "both sports” group.

23
Fig 4. A table representing the respective p-values associated with each independent variable

within the "power/speed” group.

As you can see, only one of the correlations listed between the independent and

dependent variables could be deemed statistically significant: in the “both sports”

subsection, the chi-squared test analysis run, in relation to the frequency at which

participants vacuumed their homes, yielded a p-value of 0.032272901. As such, the null

hypothesis can be rejected; some relationship exists between the variables “vacuuming

frequency” and “asthmatic presentation” within the “both sports” subgroup. However,

regarding the other categories, the data provided failed to show any sort of relationship

between the independent and dependent variables.

A similar phenomenon occurred when the chi-squared analysis was run again.

Even as confounders such as age and a family history of asthma were added to the

characteristics of the subgroups, the correlations between the independent variables and a

person’s asthmatic status remained mostly insignificant. For example, when the categories were

divided by age, only two significant connections were found. The chi-squared analysis between

product usage and endurance athletes between the ages of 17 and 21 yielded a p-value of

24
0.03843393, indicating a strong correlation. Meanwhile, the chi-squared analysis between

vacuuming and athletes between the ages of 14-16 yielded a p-value of 0.043290026.

Fig 5. A table showing the p-values associated with each independent variable when the

“endurance” subgroup was further divided by age.

Fig 6. A similar figure to Figure 5, as applied to the “power/speed” subcategory.

25
Fig 7. A similar figure to Figure 5, as applied to the “both sports played” category.

Similarly, only one significant connection was found when the respondent’s

family history was accounted for; when the analysis was run within the “endurance”

subgroup, testing the relationship between one’s family history, use of a protective

sleeve, and asthmatic status, the resultant p-value was 0.045020881.

Fig. 8- A graph of the p-values associated with each independent variable when the endurance

subgroup was further subdivided by the respondents’ indication of a family history of asthma.

26
Fig 9- A similar graph to Figure 8, as applied to the “power/speed” subgroup.

Fig 10-A similar graph to Figure 8, as applied to the “both sports played” subgroup.

Even when the presence of animals in the home was accounted for, only one

significant correlation was present, again in the endurance subcategory. A p-value of

0.027260335 was found when a chi-squared test was run, combining the presence of pets,

the frequency at which the home was vacuumed, and the respondent’s asthmatic status,

indicating a non-random relationship.

27
Fig 11-A graph depicting the p-values associated with the “endurance” subgroup when it is

further subdivided by the respondents’ positive response to the ownership of pets.

Fig 12- A similar graph to that of Figure 11, as applied to the “power/speed” subgroup.

Fig 13-A similar graph to that of Figure 11, as applied to the “both sports played” subgroup.

28
 While adjusting for confounding variables seemed to do little to increase the

significance of the relationships between the independent variables and one’s asthmatic

status, it was thought that the relationships would be more significant within the smaller

category of “elite status”. However, this theory was quickly disproven, as not a single

relationship yielded a p-value low enough to be considered significant.

Fig 14- A depiction of the p-values associated with each independent variable as applied to the

“endurance” subgroup when only respondents designated as being elite are evaluated.

Fig 15-A similar graph to Figure 14, as applied to the “power/speed” subgroup.

29
Fig 16-A similar graph to Figure 14, as applied to the “both sports played” subgroup.

While a few significant relationships were found within subcategories of the

population, this study failed to consistently find significant relationships between the

independent variables and one’s asthmatic status.

Discussion

• Bleach Use

While there are many limitations to this study, when the data is taken at face

value, the lack of consistently significant relationships between the use of sodium

hypochlorite bleach and the presentation of asthma is an interesting finding. While not

explicitly implemented among athletes, the study performed by Charles Barnes et al

determined a direct correlation between the use of sodium hypochlorite-containing

products and improved quality of life in asthmatic minors (2008). That said, the

individuals involved in this study were able to perform a direct experiment involving the

minors, instructing their families to use the bleach-based products over a set period of

time. Using this method, the researchers were able to directly determine the acute effects

of bleach use in a select group of individuals, whereas in this study, the data was gathered

30
secondhand, reflecting general lifestyle habits of the participants. That said, many of the

products utilized in this particular study were as common as the ones asked about in my

study; a few products, such as Clorox Toilet Bowl cleaner, were even identical. Once

Barnes’ trial terminated, it was found that the scores indicated on the provided quality of

life questionnaires by asthmatic patients were higher if they had used the household

cleaning products in the study. However, participants were also given diaries to log the

frequency with which they used each product, and the structured nature of the study may

have persuaded families to use the products more frequently than they would have had

they not been participating. As such, the researchers were better able to assess the effect

of increased bleach exposure on the health of the participant, whereas in this study, the

rough estimates of frequency delineated by the answer choices may have led to possible

inaccuracies regarding the correlation between bleach use and asthma development.

Additionally, there may have been inaccuracies regarding the effect that product

use in a certain area of the home had on the participants’ respiratory health. That said,

few studies provide a basis for comparison. As mentioned earlier, there are instances in

previous literature in which the effects of the frequencies of sodium hypochlorite

exposure are analyzed. For example, in the survey-based study performed by Ahmed Arif

and George Delclos, healthcare professionals were asked to indicate how often they

believed themselves to be exposed to bleach within their workplace (2012). Granted,

there are set procedures for executing tasks in a medical setting, so the number of areas in

which bleach would be used is fairly limited, but regardless, the scientists did not ask the

participants exactly where they used the bleach-based products. Since the area in which

the product is used could affect the frequency of exposure to the irritant in said product
31
(Ex: a person who uses bleach to wipe down hard surfaces and disinfect tub toys would

be far more exposed to sodium hypochlorite than someone who might only use bleach

when trying to wash a load of clothes), it was surmised that the presentation of asthma

could be affected by such a variable and was therefore added to the survey itself.

However, the insignificant p-values associated with this value as measured across each

athletic subcategory (Endurance Sports, Power/Speed Sports, Both Sports Played) do not

support this hypothesis.

Regardless of these facts, the findings from this study contradict several other

studies performed in the literature. One such study, performed by Bobette Matulonga, et

al, even used a questionnaire in conjunction with biological data, using their methods to

show that women who more frequently used bleach to clean their homes were more likely

to have asthma and/or symptoms of respiratory dysfunction, such as a chronic cough

(2016). While it is possible, that, within the sample population used for this study, there

is no correlation between cleaning habits and asthmatic symptoms, further study will be

needed to confirm such an assertion.

• Competitive Sports

However, another aspect of the study is arguably more deserving of further research:

here, not a single significant relationship was found between the independent variables

and the respondents’ asthmatic presentation when the participant pool was limited to

those of elite status. A great deal of current literature concerning the link between

athletics and asthma supports the theory that athletes who participate in higher intensity

settings over longer periods of their lives are more likely to develop respiratory issues

32
(Burns, 2015; Lomax, 2016; Romberg, 2017). However, it appears that the athletes’

cleaning habits were unrelated to how airway dysfunction presented itself or whether it

developed at all. As such, it may be possible that simply changing one’s cleaning habits

may neither help an athlete in this select group nor harm them.

• Vacuuming, Washing of Bedsheets, Use of Protective Sleeve

The same principle applies to the lack of consistent significant correlations

between the types/rates of other cleaning habits and the presentation of asthma in the

respondents belonging to each subcategory, with the exception of vacuuming frequency.

The reason that each of these variables - frequency of vacuuming, frequency of bedsheet

cleaning, and the use or absence of a protective sleeve around the pillow – were selected

for use in this study was due to the fact that the reduction of dust mites and other

allergens from the home have been negatively correlated with the development or

exacerbation of respiratory illness (Bemt, et al, 2006). The rationale was that these

cleaning habits would lead to a reduction in irritants within the home, therefore

decreasing the likelihood that a person who executed such tasks would have a respiratory

illness.

One such habit, vacuuming frequency, presents a pattern across the respondent

pool. Out of all of the independent variables, vacuuming frequency is most frequently

correlated with asthmatic presentation, suggesting that it may be one of the more

significant factors included in this study. However, this variable, along with the other

five, fails to be significantly linked to asthmatic presentation across the board or even

within a subcategory. As such, it may be more likely that a series of specific conditions

33
must be met in order for these variables to have any sort of significant relationship with

asthmatic presentation. Regardless, further experimentation will be needed to clarify the

findings presented here.

• Descriptive Statistics

While the statistical analysis of the data overall may not have lent support to the

idea that a correlation consistently existed between the independent variables and the

manifestation of asthma, a few interesting trends arose regarding the descriptive statistics.

For example, only 14.63% of participants were reported as having asthma. Considering

that, at a national level, around 8.3% of children and 8.3% of adults have asthma, the

slightly higher local statistic begs questions (Asthma and Allergy Foundation of America,

2018). However, in some cases, asthma can be categorized as a childhood illness; many

people develop it as children and grow out of the disease as they enter adulthood

(Martinez, 2001). Since the largest age group of participants consisted of 10-to-13 year-

olds, and the second smallest age group consisted of 26-to-30 year-olds (the 21-25

category only had 1 viable respondent), a higher concentration of “at-risk” individuals

took part in this study, increasing the odds that the respondent would be asthmatic.

Another interesting pattern lies in the distribution of asthmatic individuals across

the three subcategories. Several studies, including one centered around the performance

of Olympic athletes, assert that endurance sports place sustained pressure on the body due

to the near-continuous workload (Lomax, 2016, Burns, et al, 2015, Romberg et al, 2017).

Therefore, people who play endurance sports are more likely to have asthma than those

that either don’t play a sport or play a non-endurance sport, such as football (Lomax,

34
2016, Burns, et al, 2015, Romberg, 2017). Because of this, one would expect to see the

highest concentration of asthmatics in the “endurance” subcategory. However, this is not

the case. It is actually the “both sports played” category, with a sample pool that has a

20.69% asthmatic population, that contains the largest concentration of asthmatics. As

neither the largest group nor the group that would appear to be most at risk, it is a bit

puzzling as to why this group had the highest percentage of asthmatic respondents. In

order to further explore the ramifications of this odd occurrence, a future cross-sectional

study might be constructed in which the only independent variables are the types of

sports played.

Additionally, the percentage of respondents who had mixed asthma, allergic

asthma, or non-allergic asthma, respectively, was found and evaluated. Interestingly

enough, the largest number of people categorized as having allergic asthma was found in

the “both sports” subsection – 7 of the 8 total allergic asthmatics were found in this

subsection. Meanwhile, the largest number of people categorized as having mixed asthma

was found in the endurance sports subsection - 10 of the 24 total mixed asthmatics were

found in this subsection. At the same time, the “power/speed” group contained the largest

number of non-allergic asthmatics - 7 of the 16 in the study. The comparatively larger

numbers of non-allergic or mixed asthmatics was expected; allergic, or atopic, asthma

depends on a specific combination of genetic predisposition and environmental exposures

and is therefore rarer (Kalogeromitros, 2006; The Asthma Center Education and

Research Fund, 2010). However, the distribution of each type of asthma across the

population subcategories warrants further discussion, particularly regarding the “both

sports” category. The comparatively high number of allergic asthmatics in this category
35
may simply stem from the higher levels of exposure to irritants that someone who plays

both types of sports might get. Indeed, a 2011 paper by Claudia Frangella et. al suggests

that elements as simple as sports equipment can induce allergic sensitization; therefore,

someone who utilizes more diverse types of equipment would be more likely to develop

an allergic disease. That said, further study would be needed to confirm this theory.

• Limitations

For the most part, this study failed to establish a relationship between cleaning

habits and the manifestation of asthma. That said, multiple factors present in this study

could have affected the outcome of the results. One glaring issue stems from the manner

in which the responses were collected. When the online survey, was first implemented, an

error in the form caused an “Other” option to be formed (Appendix A). When this

occurred, respondents were given the option of listing any product that they used in their

home, rather than indicating the five explicitly listed cleaning products or a lack of use of

any of the products. Since questions regarding the areas of the home in which the

products were used, as well as the frequency of use immediately followed questions

regarding the types of products used, there is a chance that for some of the responses, the

reported areas and frequencies of use may not accurately reflect the amount of exposure

to sodium hypochlorite that the respondents generally receive.

Additionally, the expected counts for each value in the contingency tables for

each independent variable did not satisfy Hubbard’s rule of 5; because of this, the chi-

squared tests performed may reflect discrepancies between the calculated and actual

strengths of correlation between the variables(the counts for the degrees of the different

36
variables could have been combined in order to make the data fit the chi-squared model,

but more specific categories were utilized in an attempt to more accurately portray the

increasing values of the variables used).

37
 CHAPTER 5: CONCLUSION

While a few leads were discovered, overall, the gathered data did not signify

relationships between cleaning habits/bleach use and the manifestation of asthma. All but

a few of the p-values derived from chi squared analyses lay above the alpha value.

Additionally, each of these p-values was linked with one of three independent variables:

the frequency of vacuuming, the frequency of bleach use, and the use of a protective

sleeve with one’s pillows. However, the lack of consistent significant relationships across

each of the subcategories suggests that there is either no relationship between cleaning

habits and asthmatic presentation, or that the relationships only exist in conjunction with

other variables. That said, the concentration of asthmatic individuals who lay within the

“both sports played” category warrants further discussion; perhaps other external factors

are at play which caused such a distribution. While this study could not definitively prove

anything to a significant degree, it should provide at least a stepping stone for future

research. If there truly is no consistent connection between cleaning habits and the

manifestation of asthma, then that avenue can be crossed off the list as medicine

continues to advance.

38
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APPENDICES

44
 APPENDIX A-Online Survey

A correlative study between

athletes and asthmatic
presentation
* Required

1. Age *

Mark only one oval.

10-13

14-16

17-21

22-25

26-30

2. Gender *

Mark only one oval.

Male

Female

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3. Height *

Mark only one oval.

4'1"-4'6"

4'7"-5'0"

5'1"-5'6"

5'7"-6'0"

6'1"-6'6"

4. Weight in Pounds *

5. What types of
sports have you
participated in? *
Check all that apply.

Endurance Sports(Ex: rowing, swimming/watersports, cross-

country, cross-country skiing, cycling)

Power/Speed Sports(Ex: basketball, soccer, hockey, tennis)

6. At what age did you start participating? *

46
 7. At what age did you stop(if applicable)? *

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3/15/2019 A correlative study between athletes and asthmatic presentation

8. Do/Did you participate on the competitive level(Ex:on a team, marathon,

national/international championship)? *
Mark only one oval.

Yes

No

9. In which setting(s) did you practice/play most

often? * Check all that apply.

Gymnasium

Open Field

Set track (Outdoors)

Set track (Indoors)

Pool (Indoors)

Pool (Outdoors)

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10. Have you been diagnosed with asthma?
* Mark only one oval.

Yes

No Skip to question 15.

11. If so, for how long have you had the condition?
* Mark only one oval.

Since Birth

6 months

1-5 years

5-10 years

>10 years

12. At what age were you first diagnosed? *

13. When do your symptoms manifest?

* Check all that apply.

After Intense Exercise

After Sudden Temperature Changes

Seasonally(Ex: Fall w/ragweed)

After any outdoor exposure

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 After eating certain foods

After exposure to strong scents

2/6

14. How often do they manifest?

* Mark only one oval.

Daily

Once or twice per week

Once every two weeks

Once per month

Once every three to six months

No symptoms for six or more months

15. Does your family have a history of asthma?

* Mark only one oval.

Yes

No After the last question in this section, skip to question 17.

16. On whose side of the family?

* Mark only one oval.

Mother

Father

Neither

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17. In which setting do you live?
* Mark only one oval.

Rural/Acreage

Suburban

Urban

18. Do you have any pets?

* Mark only one oval.

Yes

No

19. How many people live with you?

* Mark only one oval.

>5

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20. How many
siblings do you
have*Mark only one
oval.
0

>2

21. How often is your home vacuumed? * Mark only one oval.

Once per week

Once every two weeks

Once per month

Once every few months

22. How often are your

bedsheets cleaned? *
Mark only one oval.

Once per week

Once every two weeks

Once per month

Once every two months

 23. Do you use a protective sleeve
with your pillows/mattresses? *
Mark only one oval.

Yes

No

24. Indicate any and all products(or generic equivalents)that

are used to clean your home * Check all that apply.

Clorox Regular Liquid bleach

Fabuloso All-Purpose Cleaner with Bleach

Clorox Toilet Bowl Cleaner

Lysol Toilet Bowl Cleaner with Bleach

Finish Dishwasher Gel

None of the above

How are these products used? (List all situations that apply) * Check all that apply.

To wipe down surfaces

To Disinfect Toys/Baby Bottles

To Clean the Bathroom

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 To Clean Clothes/Towels

To Clean the Kitchen

To Clean the Washing Machine

Never

26.How often are these

products used? * Mark
only one oval.
More than once per week

Once per week

Once every two weeks

Once per month

Once every few months

Once or twice per year

Never

Untitled Section

27. Do you use any of the following products: E-cigarettes, vape

pens, snuff,
Mark only onecigarettes,
oval. cigars, juul pens? *
Yes

No

53
 28. How often have you had to take off of school or
work due to respiratory illness? * Mark only one oval.

Once or twice a week

Once or twice a month

Once or twice a year

One or two times over the past few years

29. Do you have

any other
allergic
conditions? *
Mark only one
oval.
Yes

No Stop filling out this form.

Untitled Section

30. If yes, what types? *

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31. List any allergy/asthma medications you currently take, or simply write N/A. *

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 APPENDIX B-Hard-Copy Survey
Asthma Development in Athletes
Please Circle/Write in Answers where applicable.
Age Range: 10-13 14-16 17-21 22-25
26-30

Height Range: 4’1”-4’6” 4’7”-5’0” 5’1”-5’6” 5’7”-6’0” 6’1”-6’6”

Gender: M / F Weight in Pounds__________________

What types of sports have you participated in(circle one or both categories)?
Endurance Sports(Ex: rowing, swimming/watersports, cross-country, cross-
country skiing, cycling)

Power/Speed Sports(Ex: basketball, soccer, hockey, tennis)

At what age did you start participating?______________________

At what age did you stop(if applicable)?___________________________

Do you/did you participate on the competitive level(Ex:on a team, marathon,

national/international championship)? Y / N

In which setting(s) did you practice/play most often?

Gymnasium
Open Field
Set Track (Outdoors)
Set Track (Indoors)
Pool (Indoors)

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 Pool (Outdoors)
Have you been diagnosed with asthma? Y / N

If so, for how long have you had the condition?

Since Birth 6 Months 1-5 Years 5-10 Years >10 Years
At what age were you first diagnosed?___________________________
When do your symptoms manifest?
After intense Exercise
After Sudden Temperature Drops
Seasonally(Ex: Fall w/ragweed)
After any outdoor exposure
After eating certain foods
After exposure to strong scents
How often do they manifest?
Daily
Once or twice per week
Once every two weeks
Once per month
Once every three to six months
No symptoms for six or more months
Does your family have a history of asthma? Y / N
On whose side of the family? Mother Father Neither
In which setting do you live? Rural/Acreage Suburban Urban

Do you have any pets? Y / N

How many people live with you?

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0
1
2
3
4
5
>5

How many siblings do you have?

0
1
2
>2

How often is your home vacuumed?

Once per week Once per month
Once every two weeks Once every few months

How often are your bedsheets cleaned?

Once per week Once per month
Once every two weeks Once every few months

Do you use a protective sleeve with your pillows/mattresses? Y / N

Indicate any and all products/generic equivalents, that are used to clean your
home
Clorox Regular Liquid Bleach

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 Clorox Wipes
Fabuloso All-purpose Cleaner With Bleach
Clorox Toilet Bowl Cleaner
Lysol Toilet Bowl Cleaner with Bleach
Finish gel
None of the above

How are these products used (list all situations that apply)?
To wipe down surfaces
To disinfect toys/baby bottles
To clean the bathroom
To clean clothes/towels
To clean the kitchen
To clean the washing machine
Never

How often are these products used?

More than once per week
Once per week
Once every two weeks
Once per month
Once every few months
Once or twice per year
Never

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Do you use any of the following products: E-cigarettes, vape pens, snuff,
cigarettes, cigars, juul pens?
Y/ N

How often have you had to take off of school or work due to respiratory
illnesses?
Once or twice a week
Once or twice a month
Once or twice a year
One or two times over the past few years

Do you have any other allergic conditions?

Y / N

If yes, what types?

_________________________________________________________________________________________________
________

List any allergy/asthma medications you currently take, or simply write N/A.
_________________________________________________________________________________________________
________

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