What are the recommendations for washing bedding to manage asthma?

Recommendations for Washing Bedding to Manage Asthma

For individuals with asthma who have dust mite allergies, washing bedding in hot water (at least 55°C/131°F) weekly is recommended as part of a multicomponent allergen mitigation strategy, but washing bedding alone is insufficient to improve asthma outcomes. 1

Dust Mites and Asthma Management

Determining Allergy Status First

Before implementing specific bedding washing protocols:

1. Determine if the patient has dust mite sensitization through:

   • Clinical history of symptoms related to dust exposure
   • Allergy testing (skin prick or specific IgE) when appropriate

2. Important consideration: The 2020 National Asthma Education and Prevention Program guidelines clearly state that for individuals without confirmed dust mite allergies, allergen mitigation interventions are not recommended as part of routine asthma management 1

Bedding Washing Recommendations

For patients with confirmed dust mite allergies:

• Water temperature: Wash at minimum 55°C (131°F) to kill dust mites effectively 2
• Frequency: Weekly washing is recommended
• Pre-soaking: Consider a 4-hour presoak with detergent which can kill moderate numbers of dust mites even in warm water 2
• Detergents: Standard laundry detergents increase mite mortality over water alone 2
• Bleach: Adding chlorine bleach further increases effectiveness in killing dust mites 2

Comprehensive Dust Mite Control Strategy

Washing bedding alone is insufficient. The guidelines strongly emphasize that single-component interventions rarely work 1. Instead, implement a multicomponent approach:

1. Impermeable covers: Use dust mite-impermeable pillow and mattress covers (but only as part of a multicomponent strategy) 1

2. Regular cleaning:

   • Vacuum mattresses weekly (preferably with HEPA filter vacuum) 3
   • Wipe floors before vacuuming 3
   • Expose bedding to sunlight when possible 3

3. Humidity control: Maintain low indoor humidity to reduce mite proliferation 4

4. Additional measures:

   • Remove soft toys from beds
   • Consider removing carpets in bedrooms
   • Use HEPA air filters in bedrooms

Important Caveats and Considerations

• Evidence quality: The evidence supporting allergen mitigation strategies has lower certainty than evidence for asthma controller medications 1

• Individualized approach: Tailor allergen interventions only to patients with confirmed dust mite allergies who have symptoms related to exposure 1

• Early intervention: Start allergen avoidance measures as early as possible for better outcomes 5

• Realistic expectations: Even with optimal implementation, benefits may be modest 1

• Common pitfall: Many patients rely solely on mattress/pillow covers, which alone have not shown improvement in validated asthma outcome measures 1

• Threshold levels: Risk for asthma attacks increases with dust mite allergen concentrations above 10 μg/g dust 1

• Comprehensive asthma management: Allergen avoidance is only one component of asthma management and should not replace appropriate pharmacotherapy

For optimal results, implement the complete multicomponent strategy rather than focusing exclusively on bedding washing, as the combined approach is more likely to achieve clinically meaningful reductions in dust mite exposure and improvements in asthma outcomes.