Special Investigation: Indoor Air Quality Crisis (Part Two)

NOTE: This is Part Two of a two-part Special TrustDALE Investigation. Part One of this Special Investigation detailed the indoor air quality crisis facing Americans. Part Two will focus on potential solutions to the indoor air quality crisis and what governments and individuals can and should be doing.

The Indoor Air Quality Crisis

The average American spends 90% of their time indoors, but current air pollution regulations only cover outdoor air. Meanwhile, the air indoors is often 2 to 5 times more polluted than outdoor air. To date, there is very little being done to protect and improve indoor air quality. However, improving indoor air quality could have a huge effect on quality of life as well as on the cost of healthcare in the U.S.

Recent studies have shown that even a small increase in the amount of particulate pollution in the air causes a spike in ER visits and hospitalization. Reducing indoor air pollution could reduce ER visits and hospitalization for a variety of pollution-related diseases, potentially saving hundreds of billions of dollars in U.S. healthcare costs. But solving the indoor air quality crisis will take a coordinated effort by medical professionals, policymakers, community leaders, and individuals.

How to Improve Indoor Air Quality

Although greater involvement from governments, the medical community, and other stakeholders may be required to affect widespread change, improving the air quality in a particular space is relatively simple. There are four main components of indoor air quality improvement:

  1. Filtration
  2. Humidity control
  3. Make-up air
  4. Better housekeeping1


The most effective way to remove particulate pollution from indoor air is with adequate filtration. Rich Johnson, founder of Air Allergen and Mold Testing, suggests a slight upgrade from the cheapest filters. Most air filters for home use are measured by their Minimum Efficiency Reporting Value (MERV). A higher MERV rating indicates a filter that can remove smaller particles from the air that passes through it. Johnson suggests homeowners “buy a MERV-10 filter. It costs maybe $12 or $15 instead of $5 for that fiberglass see-through useless thing that is statistically equivalent to no filter at all.” As MERV ratings increase, it takes more pressure to push air through the filter. However, a MERV-10 filter should work with any standard HVAC system.

It is also important to replace HVAC system filters regularly. As Johnson notes, “according to Consumer Reports, 25% of homes either don't have a filter or don't change it regularly.” According to the International Association of Certified Home Inspectors, filters should be changed at least every three months. Filters should be changed once a month in any of the following cases:

  • You run your unit six months a year to year-round.
  • You have pets. Pet dander can become airborne and circulate through the home’s ventilation system just as typical household dust does.
  • You have a large family. More activity means more household dust, dirt, and debris.
  • You smoke indoors.
  • You or someone in your household suffers from allergies or a respiratory condition.
  • You live in a particularly windy area or experience high winds for extended periods, especially if there are no nearby shrubs or trees to provide a natural windbreak.
  • You live in an area prone to or having recently experienced any wildfires. Airborne ash outdoors will eventually find its way indoors.
  • You have a fireplace that you occasionally use.
  • You live on a working farm or ranch. Dust and dirt that gets kicked up by outdoor work activity and/or large animals can be pulled into the home’s ventilation system, especially through open windows.
  • You have a large garden. Depending on its size and how often you work it, tilling soil, planting, pulling weeds, using herbicides and pesticides, and even watering mean that dirt, chemicals, and condensation can be pulled into your home’s ventilation system.
  • There is construction taking place around or near the home. You may be installing a new roof or a pool, or perhaps a neighbor is building a home or addition. Even if the activity is only temporary, dust and debris from worksites adjacent to or near the home can be sucked into the home’s ventilation system, and this increased activity can tax your HVAC system.2

Humidity Control

According to Johnson, “the second thing [an individual] can do is [to install] a dehumidifier…[If you can] hold the humidity below 50% at room temperature, you're going to severely retard microbial growth and mold spores in particular.” While air conditioners have some effect on humidity in the home, most air conditioners are sized for cooling, not dehumidifying. A separate dehumidifier can go a long way towards improving indoor air quality.

Make-Up Air

Many home HVAC systems are essentially closed systems. They recirculate the same air without adding any air from outside. Building codes require HVAC systems in commercial buildings to include a certain amount of make-up air, that is, air from outside that is introduced into the system. Bringing in new air can help refresh the air inside a building, allowing outdoor air, which is typically less contaminated than indoor air, to replace some of the indoor air that is circulating through the HVAC system. Residential systems can also benefit form make-up air.

Better Housekeeping

Keeping a clean home is one of the most effective ways of improving indoor air quality. Frequent dusting can remove much of the particulate matter that would become air pollution. Keeping areas in your home dry and clean also reduces the chances of mold and bacteria growth. If you notice a leak in your home, it is critical to address it immediately. When water infiltrates a home, there is a high risk of mold growth.

Solutions Within the Medical Community

Currently, there is little motivation in the medical community to improve indoor air quality. As Johnson recalls, “many times when we approached the medical community about [indoor air quality], they would say, ‘Yeah, yeah, yeah, that's nice,’ but they really would not act upon it or do investigations that we felt were appropriate.” However, with some changes to medical standards and some new practices, indoor air quality could become a much more central part of medical care.

The first step to take is to address the issue of repeated ER visits for breathing-related illnesses. New standards should be enacted that require hospitals to question patients who visit the ER for asthma and COPD about their indoor air quality. Medical professionals should be educated about the methods for improving air quality in a home and should share that information with patients. Hospitals should be staffed with professionals who can perform inspections of return patients’ homes when there is indication of home air quality issues.

In addition to new hospital practices, real money should be put towards improving indoor air quality. Medicare, Medicaid, and private health insurance companies should be required to cover indoor air quality testing and remediation as part of a prescription from a medical professional.

Regulatory Solutions

The power of policymakers to bring about change cannot be underestimated. Johnson is unequivocal about the need for political action. “The political community needed to become involved because the rest of the of the communities were all focused on their individual area of expertise associated with breathing difficulties and were really not addressing the root cause of a lot of the problems.”

New regulations can and should be enacted to protect indoor air quality. Building codes should be updated to include specific guidelines about indoor air quality. Guidelines should include MERV-13 air filters, humidity control to maintain humidity under 50%, and sufficient make-up air.

Residential landlords should be required to accommodate breathing problems and allergies as they would any other disability under the Americans With Disabilities Act. Accommodations should include at least MERV-10 filters in existing HVAC systems, as well as humidity control and make-up air.

Air quality remediation should be separated from air quality testing. Remediation contractors and maintenance workers performing remediation work should be prohibited from doing the testing to certify that the work is done correctly. This addresses an inherent conflict of interest.

Finally, labs performing indoor air quality sample testing should be required to report their basic analysis procedures, median findings, and uncertainty when reporting sample results.1 This will allow for baseline comparisons across testing sites.

Community Solutions

Besides the solutions that rely on the medical and political sectors, some changes can be made on a community level. Johnson recalls that when he started working with landlords and tenants who had indoor air quality issues, “some of it was just the lack of knowledge about it.” So Johnson set out “to help the community understand better those kinds of things so that the people that were inclined to take care of their tenants would have the information to be able to do so.” By better educating landlords and tenants, responsible people can make responsible choices and stop much of the damage before it gets to the point of medical emergencies.

Johnson also advocates media campaigns to make people more aware of indoor air quality issues. “We've got pharmaceutical ads on every station,” he explains. “They’re talking about the medication to solve all these problems,” but they are missing information about the root cause. Johnson suggests a broad media campaign to educate people about the crisis in indoor air quality and the ways they can act to improve the air around them.

Solving the Indoor Air Quality Crisis

There is no question that the current situation is unacceptable. People are being sickened by poor indoor air quality, and there is little action to attack the root of the problem. But the crisis is far from unsolvable. By taking concrete steps, medical professionals, policymakers, and individuals can play a part in improving indoor air quality. The only question left is who will make the first move and how long it will take.

1. Johnson, Richard. (2019). Position Paper.
2. Gromicko, N., & Tarasenko, K. (n.d.). HVAC Applications: Performance-Based Air Filter Change Out Frequencies. Retrieved from https://www.techstreet.com/ashrae/standards/hvac-applications-performance-based-air-filter-change-out-frequencies?gateway_code=ashrae&product_id=1994589

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