Sarath Raju, MD, MPH

Most clinicians are not considering poor home air exposure when treating persistent asthma or airway disease, Raju explains. That may be making a difference in outcomes.

Opportunities to Define and Treat Indoor Air Quality, with Sarath Raju, MD, MPH

Is it fair to suggest that the average clinician is not prioritizing indoor air exposures when working up a patient with 

? It very well may be, when one considers that the average person spends more than 80% of their time indoors.

The impact of indoor air quality on lung health is an understated subject in the growing field of environment-based medicine. What makes that fact frustrating is that indoor air quality is very modifiable for the individual — and could foster clinical breakthroughs for patients with chronic conditions like asthma and chronic obstructive pulmonary disease (COPD).

American College of Chest Physicians (CHEST) 2025 Annual Meeting

 in Chicago, IL, Sarath Raju, MD, MPH, Assistant Professor of Medicine at Johns Hopkins University School of Medicine, emphasized the need for clinician buy-in to indoor air quality intervention while he and his peers continue to assess and value modifiers to indoor living that can spell success for pulmonary patients.

Oftentimes, we can think of different ventilation approaches that may be expensive for someone with limited resources to think about. There are different kinds of air filters, including those with a carbon filter that can reduce exposures. But we really need to think about ways we can incentivize people, whether it be at a policy level or just from a knowledge perspective, to think about, 'Hey, this is an exposure that someone may have in the home. It may be a greater risk for someone with asthma. So, what can we do about it? And what can we propose as a solution that is feasible to implement along the way?'"

“We’re still figuring out what the best interventions are to modify the home environment, and that’s an area for growth and future research,” Raju said. “Some of the things we ask about and are attuned to are smoking inside the home…allergens, different cooking practices…and those are things we can modify with potentially different strategies to mitigate home exposures.”

Regarding the moments in practice when it may be best to prioritize indoor air quality questioning, Raju highlighted instances when patients report persistently uncontrolled asthma.

“We may often think about what new medicines we can add to change risk factors to modify disease — and obviously, that's important, but there may be some specific environmental things that we can take a comprehensive approach toward mitigating,” Raju said. “We’ll have many patients who actually feel worse inside their home than in different environments.”

Though the conversation around intervention is specific to environmental factors, Raju said climate change will inevitably force consideration into air quality-related prescriptions and drug indications, especially for pulmonary and allergic diseases.

“There's an important interaction between temperature and the indoor environment itself, and these two factors together can worsen respiratory symptoms, increase our risk for respiratory viruses and other diseases,” Raju said.

Nyenthuis S, Mahdavinia M, Commins S, Lam K. How Climate Change is Making Allergies Worse—And What Clinicians Can Do. 

. Published March 20, 2025. https://www.hcplive.com/view/how-climate-change-is-making-allergies-worse-and-what-clinicians-can-do

Iapoce C. Extreme Heat, Fine Particulate Pollution Associated with Fatal Heart Attack Risk. 

. Published online July 24, 2023. https://www.hcplive.com/view/extreme-heat-fine-particulate-pollution-associated-fatal-heart-attack-risk

Sarath Raju, MD, MPH

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