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Agache I, Canelo-Aybar C, Annesi-Maesano I, Cecchi L, Biagioni B, Chung F, D'Amato G, Damialis A, Del Giacco S, De Las Vecillas L, Dominguez-Ortega J, Galàn C, Gilles S, Giovannini M, Holgate S, Jeebhay M, Nadeau K, Papadopoulos N, Quirce S, Sastre J, Traidl-Hoffmann C, Walusiak-Skorupa J, Sousa-Pinto B, Salazar J, Rodríguez-Tanta LY, Cantero Y, Montesinos-Guevara C, Song Y, Alvarado-Gamarra G, Sola I, Alonso-Coello P, Nieto-Gutierrez W, Jutel M, Akdis CA. The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma. Allergy 2024. [PMID: 38366695 DOI: 10.1111/all.16051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024]
Abstract
Systematic review using GRADE of the impact of exposure to volatile organic compounds (VOCs), cleaning agents, mould/damp, pesticides on the risk of (i) new-onset asthma (incidence) and (ii) adverse asthma-related outcomes (impact). MEDLINE, EMBASE and Web of Science were searched for indoor pollutant exposure studies reporting on new-onset asthma and critical and important asthma-related outcomes. Ninety four studies were included: 11 for VOCs (7 for incidenceand 4 for impact), 25 for cleaning agents (7 for incidenceand 8 for impact), 48 for damp/mould (26 for incidence and 22 for impact) and 10 for pesticides (8 for incidence and 2 for impact). Exposure to damp/mould increases the risk of new-onset wheeze (moderate certainty evidence). Exposure to cleaning agents may be associated with a higher risk of new-onset asthma and with asthma severity (low level of certainty). Exposure to pesticides and VOCs may increase the risk of new-onset asthma (very low certainty evidence). The impact on asthma-related outcomes of all major indoor pollutants is uncertain. As the level of certainty is low or very low for most of the available evidence on the impact of indoor pollutants on asthma-related outcomes more rigorous research in the field is warranted.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Carlos Canelo-Aybar
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Isabella Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, University of Montpellier and INSERM, Montpellier, France
| | - Lorenzo Cecchi
- Centre of Bioclimatology, University of Florence, Florence, Italy
| | - Benedetta Biagioni
- Allergy and Clinical Immunology Unit, San Giovanni di Dio Hospital, Florence, Italy
| | | | - Gennaro D'Amato
- Respiratory Disease Department, Hospital Cardarelli, Naples, Italy
- Medical School of Respiratory Allergy, University of Naples Federico II, Naples, Italy
| | - Athanasios Damialis
- Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Leticia De Las Vecillas
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Javier Dominguez-Ortega
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Carmen Galàn
- Department of Botany, Ecology and Plant Physiology, International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain
| | - Stefanie Gilles
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Stephen Holgate
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Cape Town, South Africa
| | - Kari Nadeau
- Department of Environmental Health, Center for Climate, Health, and the Global Environment, Climate and Population Studies, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Nikos Papadopoulos
- Allergy and Clinical Immunology Unit, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- University of Manchester, Manchester, UK
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Instituto Carlos III, Ministry of Science and Innovation, Madrid, Spain
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Center Munich -German Research Center for Environmental Health, Augsburg, Germany
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Josefina Salazar
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - L Yesenia Rodríguez-Tanta
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Yahveth Cantero
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Camila Montesinos-Guevara
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Yang Song
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Giancarlo Alvarado-Gamarra
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Ivan Sola
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Pablo Alonso-Coello
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Wendy Nieto-Gutierrez
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro Cochrane Iberoamericano, Sant Antoni Maria Claret, Barcelona, Spain
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, and ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
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Cai XY, Zheng SY, Lin ZS, Chen SZ, Zhu WY, Huang JJ, Zheng ZL, Zhou YH. Development and Application of Global Health Events-Mental Stress Scale for Assessment of Medical Staff's Acute Mental Stress Responses. Psychol Res Behav Manag 2022; 15:1809-1821. [PMID: 35898432 PMCID: PMC9309288 DOI: 10.2147/prbm.s369958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Medical workers have been increasingly involved in emergent public health events, which can lead to severe stress. However, no standardized, officially recognized, unified tool exists for mental distress measurement in medical workers who experienced the public health events. Purpose In the present study, we propose the Global Health Events-Mental Stress Scale (GHE-MSS), as a revised version of the Impact of Event Scale-Revision (IES-R), for assessment of medical workers’ acute mental stress responses within one month and their chronic mental stress responses within six months after major health events. Patients and methods The IES-R was slightly modified, developed, and its reliability and validity were tested using the Delphi survey, primary survey with 115 participants, formal survey with 300 participants, and clinical evaluation with 566 participants. Results Exploratory factor analysis and confirmatory factor analysis confirmed a promising validity of the scale. The values of Cronbach’s alpha coefficient, the Spearman-Brown coefficient, and the retested Cronbach’s alpha coefficient of the scale applied for the clinical evaluation were 0.88, 0.87, and 0.98, respectively, which confirmed a good internal consistency and stability. The results of the goodness-of-fit test indicated a good adaptation of the model. A correlation analysis was conducted to assess the correlation between the GHE-MSS and the PCL-C, which had a correlation coefficient of 0.68 (P<0.01). Conclusion GHE-MSS can be applied with a promising reliability and validity for the assessment of the acute mental stress response of medical workers experiencing public health events. This method can also be used for the screening of mental stress-associated disorders.
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Affiliation(s)
- Xin-Ying Cai
- Clinical Research Center, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Shao-Yan Zheng
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Zhen-Su Lin
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Su-Zhi Chen
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Wei-Yi Zhu
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Jia-Jia Huang
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Ze-Li Zheng
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
| | - Yu-Hua Zhou
- Nursing Department, Shantou Central Hospital, Shantou City, People's Republic of China
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Zhang Y, Hua L, Liu QH, Chu SY, Gan YX, Wu M, Bao YX, Chen Q, Zhang J. Household mold exposure interacts with inflammation-related genetic variants on childhood asthma: a case-control study. BMC Pulm Med 2021; 21:114. [PMID: 33810791 PMCID: PMC8019181 DOI: 10.1186/s12890-021-01484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of studies have examined the association between mold exposure and childhood asthma. However, the conclusions were inconsistent, which might be partly attributable to the lack of consideration of gene function, especially the key genes affecting the pathogenesis of childhood asthma. Research on the interactions between genes and mold exposure on childhood asthma is still very limited. We therefore examined whether there is an interaction between inflammation-related genes and mold exposure on childhood asthma. METHODS A case-control study with 645 asthmatic children and 910 non-asthmatic children aged 3-12 years old was conducted. Eight single nucleotide polymorphisms (SNPs) in inflammation-related genes were genotyped using MassARRAY assay. Mold exposure was defined as self-reported visible mold on the walls. Associations between visible mold exposure, SNPs and childhood asthma were evaluated using logistic regression models. In addition, crossover analyses were used to estimate the gene-environment interactions on childhood asthma on an additive scale. RESULTS After excluding children without information on visible mold exposure or SNPs, 608 asthmatic and 839 non-asthmatic children were included in the analyses. Visible mold exposure was reported in 151 asthmatic (24.8%) and 119 non-asthmatic children (14.2%) (aOR 2.19, 95% CI 1.62-2.97). The rs7216389 SNP in gasdermin B gene (GSDMB) increased the risk of childhood asthma with each C to T substitution in a dose-dependent pattern (additive model, aOR 1.32, 95% CI 1.11-1.57). Children carrying the rs7216389 T allele and exposed to visible mold dramatically increased the risk of childhood asthma (aOR 3.21; 95% CI 1.77-5.99). The attributable proportion due to the interaction (AP: 0.47, 95% CI 0.03-0.90) and the relative excess risk due to the interaction (RERI: 1.49, 95% CI 0-2.99) were statistically significant. CONCLUSIONS In the present study, there was a significant additive interaction between visible mold exposure and rs7216389 SNP on childhood asthma. Future studies need to consider the gene-environment interactions when exploring the risk factors of childhood asthma.
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Affiliation(s)
- Yu Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Li Hua
- Department of Pediatric Pulmonology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Quan-Hua Liu
- Department of Pediatric Pulmonology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shu-Yuan Chu
- Laboratory of Respiratory Disease, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Yue-Xin Gan
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Min Wu
- Department of Chinese Traditional Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yi-Xiao Bao
- Department of Pediatric Pulmonology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Qian Chen
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China.
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Cai J, Li B, Yu W, Yao Y, Wang L, Li B, Wang Y, Du C, Xiong J. Associations of household dampness with asthma, allergies, and airway diseases among preschoolers in two cross-sectional studies in Chongqing, China: Repeated surveys in 2010 and 2019. ENVIRONMENT INTERNATIONAL 2020; 140:105752. [PMID: 32371306 DOI: 10.1016/j.envint.2020.105752] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/12/2020] [Accepted: 04/18/2020] [Indexed: 06/11/2023]
Abstract
Many studies have investigated the associations between household damp indicators, and allergies and respiratory diseases in childhood. However, the findings are rather inconsistent. In 2010, we conducted a cross-sectional study of preschoolers aged three-six years in three urban districts of Chongqing, China. In 2019, we repeated this cross-sectional study with preschoolers of the same ages and districts. Here, we selected data for 2935 and 2717 preschoolers who did not change residences since birth in the 2010 and 2019 studies, respectively. We investigated associations of household damp indicators with asthma, allergic rhinitis, pneumonia, eczema, wheeze, and rhinitis in childhood in the two studies. The proportions of residences with household damp indicators and the prevalence of the studied diseases (except for allergic rhinitis) were significantly lower in 2019 than in 2010. In the two-level (district-child) logistic regression analyses, household damp exposures that showed by different indicators were significantly associated with the increased odds of lifetime-ever asthma (range of adjusted odds ratio (AOR): 1.69-3.50 in 2019; 1.13-1.90 in 2010), allergic rhinitis (1.14-2.39; 0.67-1.61), pneumonia (1.09-1.64; 1.21-1.59), eczema (0.96-1.83; 0.99-1.56), wheeze (1.64-2.79; 1.18-1.91), rhinitis (1.43-2.71; 1.08-1.58), and current (in the past 12 months before the survey) eczema (0.46-2.08; 0.99-1.48), wheeze (0.97-2.86; 1.26-2.07) and rhinitis (1.34-2.25; 1.09-1.56) in most cases. The increased odds ratios (ORs) of most diseases had exposure-response relationships with the cumulative number (n) of household damp indicators in the current and early residences. Our results indicated household damp exposure could be a risk factor for childhood allergic and respiratory diseases, although the magnitudes of these effects could be different in different studies.
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Affiliation(s)
- Jiao Cai
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Baizhan Li
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China.
| | - Wei Yu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Yinghui Yao
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Lexiang Wang
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Bicheng Li
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Yujue Wang
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Chenqiu Du
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Jie Xiong
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
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Wolkoff P. Comments to "Assessment of formaldehyde levels in relation to respiratory and allergic symptoms in children from Alba County schools, Romania" by Neamtiu et al. (2019). ENVIRONMENTAL MONITORING AND ASSESSMENT 2019; 191:682. [PMID: 31659491 DOI: 10.1007/s10661-019-7897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Peder Wolkoff
- National Research Centre for the Working Environment, NRCWE, Lersø Parkallé 105, 2920, Copenhagen Ø, Denmark.
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Cai J, Li B, Yu W, Wang H, Du C, Zhang Y, Huang C, Zhao Z, Deng Q, Yang X, Zhang X, Qian H, Sun Y, Liu W, Wang J, Yang Q, Zeng F, Norbäck D, Sundell J. Household dampness-related exposures in relation to childhood asthma and rhinitis in China: A multicentre observational study. ENVIRONMENT INTERNATIONAL 2019; 126:735-746. [PMID: 30878869 DOI: 10.1016/j.envint.2019.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 06/09/2023]
Abstract
During 2010-2012, we conducted an observational study on household environment and health outcomes among 40,010 preschool children from seven cities of China. Here we examined associations of six dampness-related indicators (visible mold spots, visible damp stains, damp clothing and/or bedding, water damage, condensation on windowpane, moldy odor) in the current residence and three dampness-related indicators (visible mold spots, condensation on windowpane, moldy odor) in the early residence with childhood asthma and rhinitis. In the multi-level logistic regression analyses, visible mold spots and visible damp stains in the current residence were significantly associated with the increased odds of doctor-diagnosed asthma and allergic rhinitis during lifetime-ever (adjusted odd ratios (AORs) range: 1.18-1.35). All dampness-related indicators were significantly associated with increased odds of wheeze and rhinitis during lifetime-ever and in the past 12 months (AORs range: 1.16-2.64). The cumulative numbers of damp indicators had positively dose-response relationships with the increased odds of the studied diseases. These associations for wheeze and rhinitis were similar between northern children and southern children. Similar results were found in the sensitive analyses among children without a family history of allergies and among children without asthma and allergic rhinitis. For 3-6 years-old children in mainland of China in 2011, we speculated that about 90,000 (2.02%) children with asthma and about 59,000 (1.09%) children with allergic rhinitis could be attributable to exposing to visible mold spots in the current residence. Our results suggested that early and lifetime exposures to household dampness indicators are risk factors for childhood asthma and rhinitis.
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Affiliation(s)
- Jiao Cai
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Baizhan Li
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China.
| | - Wei Yu
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Han Wang
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Chenqiu Du
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhuohui Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Key Lab of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
| | - Qihong Deng
- School of Public Health, Central South University, Changsha, Hunan, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Juan Wang
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala SE-751, Sweden
| | - Qin Yang
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Fanbin Zeng
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing, China; National Centre for International Research of Low-carbon and Green Buildings (Ministry of Science and Technology), Chongqing University, Chongqing, China
| | - Dan Norbäck
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala SE-751, Sweden
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
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Caillaud D, Leynaert B, Keirsbulck M, Nadif R. Indoor mould exposure, asthma and rhinitis: findings from systematic reviews and recent longitudinal studies. Eur Respir Rev 2018; 27:27/148/170137. [PMID: 29769295 DOI: 10.1183/16000617.0137-2017] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/15/2018] [Indexed: 12/22/2022] Open
Abstract
Starting from the Institute of Medicine (IOM) and World Health Organization (WHO) reports, this review provides an overview of the literature published from 2006 to 2017 on the associations between indoor mould exposure and asthma and rhinitis separately in children and adults with a focus on longitudinal epidemiological studies.A systematic search of peer-reviewed literature was performed, including systematic reviews and meta-analyses, longitudinal, incident case-control and panel studies. 61 publications were identified reporting visible mould or mould odour or quantitative assessment of culturable fungi or mould species.In children, visible mould and mould odour were associated with the development and exacerbations of asthma, providing sufficient evidence of a causal relationship. Results from population-based studies in adults were too few and divergent to conclude at more than a limited level of evidence. Exposure to mould in a work building was associated with the incidence and exacerbations of occupational asthma, and we concluded at a sufficient evidence for an association. Systematic reviews, meta-analyses and longitudinal studies on the relationships between mould exposure and allergic rhinitis provide sufficient evidence of an association.This review extended the conclusions of the IOM and WHO reports, and highlighted the need for further longitudinal studies on asthma in adults, and on rhinitis.
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Affiliation(s)
- Denis Caillaud
- Pulmonary and Allergology Dept, CHU Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benedicte Leynaert
- INSERM, UMR1152, Pathophysiology and Epidemiology of Respiratory Diseases. Epidemiology, Paris, France.,Univ Paris Diderot Paris 7, UMR 1152, Paris, France
| | - Marion Keirsbulck
- ANSES (French Agency for Food, Environmental and Occupational Health and Safety), Maisons-Alfort, France
| | - Rachel Nadif
- INSERM, U1168, VIMA: Ageing and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France.,Univ Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
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Liu W, Huang C, Cai J, Wang X, Zou Z, Sun C. Household environmental exposures during gestation and birth outcomes: A cross-sectional study in Shanghai, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 615:1110-1118. [PMID: 29751416 DOI: 10.1016/j.scitotenv.2017.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/28/2017] [Accepted: 10/03/2017] [Indexed: 05/21/2023]
Abstract
Several studies have reported that certain aspects of the household environments are associated with adverse birth outcomes, but associations have been inconsistent. Few of these studies have been conducted in China. During 2011-2012, we conducted a retrospective cross-sectional study and collected 13,335 parents-reported questionnaires for 4-6-year-olds children in Shanghai, China. We investigated associations of household environmental factors (environmental tobacco smoke (ETS), cooking fuel, dampness, pet-keeping, and home renovation) during gestation with preterm birth (PTB, gestational age<37weeks), low birth weight (LBW, birth weight<2500g), term low birth weight (T-LBW, LBW when the gestational age was ≥37weeks), and small for gestational age (SGA, birth weight<10th percentile of birth weight for gestational age). A total of 4.1% children were premature; 2.9% had LBW and 1.6% had T-LBW; 8.1% were SGA. In the multiple logistic regression analyses, home renovation during gestation was associated with PTB (adjusted odds ratio (OR), 95% confidence intervals (CI): 1.68, 1.11-2.54) and LBW (1.64, 0.99-2.72). Paternal smoking was associated with PTB (1.18, 0.98-1.43). No significant associations were found for SGA. Neither household dampness nor cooking fuel were significantly associated with birth outcomes. For boys, paternal smoking was associated with PTB (1.31, 1.02-1.69); home renovation during gestation was associated with PTB (2.14, 1.27-3.61) and LBW (2.19, 1.09-4.43). Among children whose mothers were ≥34-year-olds during gestation, paternal smoking (1.73, 1.04-2.76) and home renovation during gestation (1.80, 1.18-2.76) was associated with PTB. Our findings demonstrate that home renovation and ETS during gestation may be risk factors for adverse birth outcomes. Associations of these factors with adverse birth outcomes appear to be stronger in boys and among mothers older than 34years during gestation. Home renovation and ETS exposure should be avoided during gestation, especially for pregnancies with male fetuses and older pregnant women.
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Affiliation(s)
- Wei Liu
- Department of Building Science, Tsinghua University, Beijing, China; School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China.
| | - Jiao Cai
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China; School of Civil and Architectural Engineering, Yangtze Normal University, Chongqing, China
| | - Xueying Wang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhijun Zou
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Chanjuan Sun
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
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9
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Sundell J. Reflections on the history of indoor air science, focusing on the last 50 years. INDOOR AIR 2017; 27:708-724. [PMID: 28107552 DOI: 10.1111/ina.12368] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/13/2017] [Indexed: 06/06/2023]
Abstract
The scientific articles and Indoor Air conference publications of the indoor air sciences (IAS) during the last 50 years are summarized. In total 7524 presentations, from 79 countries, have been made at Indoor Air conferences held between 1978 (49 presentations) and 2014 (1049 presentations). In the Web of Science, 26 992 articles on indoor air research (with the word "indoor" as a search term) have been found (as of 1 Jan 2016) of which 70% were published during the last 10 years. The modern scientific history started in the 1970s with a question: "did indoor air pose a threat to health as did outdoor air?" Soon it was recognized that indoor air is more important, from a health point of view, than outdoor air. Topics of concern were first radon, environmental tobacco smoke, and lung cancer, followed by volatile organic compounds, formaldehyde and sick building syndrome, house dust-mites, asthma and allergies, Legionnaires disease, and other airborne infections. Later emerged dampness/mold-associated allergies and today's concern with "modern exposures-modern diseases." Ventilation, thermal comfort, indoor air chemistry, semi-volatile organic compounds, building simulation by computational fluid dynamics, and fine particulate matter are common topics today. From their beginning in Denmark and Sweden, then in the USA, the indoor air sciences now show increasing activity in East and Southeast Asia.
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Affiliation(s)
- J Sundell
- Department of Building Science, Tsinghua University, Beijing, China
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10
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Sharpe RA, Thornton CR, Tyrrell J, Nikolaou V, Osborne NJ. Variable risk of atopic disease due to indoor fungal exposure in NHANES 2005-2006. Clin Exp Allergy 2016; 45:1566-78. [PMID: 25845975 DOI: 10.1111/cea.12549] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 02/27/2015] [Accepted: 03/23/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exposure to damp indoor environments is associated with increased risk of eczema, allergy and asthma. The role of dampness-related exposures and risk of allergic diseases are yet to be fully explored in the US population. OBJECTIVE We assess whether exposure to fungi, house dust mites and endotoxin increases the risk of eczema, allergy and asthma in children and adults participating in NHANES 2005-2006. METHODS A total of 8412 participants (2849 were children aged between 6 and 17 years) were recruited in the 2005-2006 survey. We used multiple logistic regression to investigate whether mildew/musty odour and increased concentrations of Alternaria alternata allergen, Aspergillus fumigatus antigens, house dust mite and endotoxin antigens increase the risk of eczema, allergy and asthma. We stratified models by total IgE < 170 and ≥ 170 KU/L to assess allergic and non-allergic asthma outcomes. Exposure to multiple biological agents and risk of reporting eczema, allergy and asthma were also investigated. RESULTS Reporting of a mildew/musty odour was associated with increased risk of childhood asthma (OR 1.60; 95% CI 1.17-2.19), and adult eczema, allergy and asthma (OR 1.92; 95% CI 1.39-2.63, OR 1.59 95% CI 1.26-2.02 and OR 1.61 95% CI 1.00-2.57, respectively). Risk of asthma was associated with total IgE ≥ 170 KU/L in children (OR 1.81; 95% CI 1.01-3.25) and total IgE < 170 KU/L in adults (OR 1.91; 95% CI 1.07-3.42). Children and adults exposed to more than eight biological agents present in the home were at reduced risk of eczema (OR 0.17; 95% CI 0.04-0.77) and asthma (OR 0.49; 95% CI 0.25-0.97), respectively. CONCLUSION Exposure to a mildew/musty odour, as a proxy for exposure to fungus, was implicated in an increased risk of atopic diseases. Sensitisation may play a different role in children and adults, and exposure to multiple allergens may reduce the risk of atopic disease.
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Affiliation(s)
- R A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - C R Thornton
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - J Tyrrell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
| | - V Nikolaou
- University of Exeter Medical School, Exeter, UK
| | - N J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Department of Clinical Pharmacology, Sydney Medical School, University of Sydney, Sydney, N.S.W., Australia
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11
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Lin Z, Norback D, Wang T, Zhang X, Shi J, Kan H, Zhao Z. The first 2-year home environment in relation to the new onset and remission of asthmatic and allergic symptoms in 4246 preschool children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 553:204-210. [PMID: 26925732 DOI: 10.1016/j.scitotenv.2016.02.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/05/2016] [Accepted: 02/06/2016] [Indexed: 06/05/2023]
Abstract
The home environment can influence childhood allergies and respiratory health but there is little information on associations between early life exposure at home and new onset and remission of the asthmatic or allergic symptoms in preschool children. A questionnaire survey was performed in a random cluster sample of 4246 preschool children in Urumqi, China. Information on the home environment (perceptions of odors and indicators of pollution sources) and children's health (wheeze, rhinitis and eczema) was collected for the first 2 years of life and the last year (before answering the questionnaire) from one of the parents or another guardian of the child. Associations between the home environment the first 2 years of life and new onset and remission of childhood symptoms were analyzed by multiple logistic regression. Home environment factors reported for the first 2 years of life were consistently positively associated with new onset of symptoms and negatively associated with remission of symptoms. Visible mold (OR 1.46, 95% CI 1.12-1.90), moldy odor (OR 2.15, 95% CI 1.45-3.18), air dryness (OR 1.31, 95% CI 1.08-1.59), stuffy odor (OR 1.25, 95% CI 1.01-1.54) and parental smoking (OR 1.36, 95% CI 1.13-1.65) were associated with new onset of symptoms. These factors were negatively associated with the remission of symptoms. In conclusion, mold contamination at home (moldy odor/visible mold), poor indoor air quality (stuffy odor, air dryness) and exposure to environmental tobacco smoke (ETS) in the first 2 years of life can increase the incidence of asthmatic and allergic symptoms and decrease the remission from these symptoms in preschool children.
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Affiliation(s)
- Zhijin Lin
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China
| | - Dan Norback
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala SE-751, Sweden
| | - Tingting Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Xinjiang Medical University, Urumqi 830011, PR China
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan 030006, PR China
| | - Jingjin Shi
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, PR China.
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12
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Cai J, Liu W, Hu Y, Zou Z, Shen L, Huang C. Associations between home dampness-related exposures and childhood eczema among 13,335 preschool children in Shanghai, China: A cross-sectional study. ENVIRONMENTAL RESEARCH 2016; 146:18-26. [PMID: 26708528 DOI: 10.1016/j.envres.2015.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
From April 2011 to April 2012, we conducted a cross-sectional study in Shanghai, China. A total of 13,335 modified ISAAC questionnaires (response rate: 85.3%) were returned by parents or guardians for 4-6 year-old children. Six dampness-related indicators (visible mold spots, visible damp stains, damp bed clothing, water damage, window pane condensation, and moldy odor) were used to evaluate home dampness-related exposures. In the present study, we applied logistic regression model to reveal associations, dose-response relationships, and statistical interaction effects of these dampness-related exposures, with childhood eczema, during lifetime since birth (ever) and in the last 12 months before the questionnaire. The dampness-related indicators were frequently reported in the perinatal and current residences. Prevalences of eczema ever and in the last 12 months were 22.9% and 13.2%, respectively. The dampness-related indicators were robustly associated and dose-response related with increased risk of eczema ever and in the last 12 months in the logistic regression analyses, with adjusted for potential confounders. Specifically, in the perinatal residence, visible mold spots or damp stains could increase 46% (OR, 95% CI: 1.46, 1.29-1.66) odds of childhood eczema (ever); in the current residence, visible mold spots and visible damp stains could increase 34% (1.34, 1.14-1.58) and 38% (1.38, 1.22-1.56) odds of childhood eczema (ever), respectively. Associations were not appreciably different between boys and girls, nor were they different between children with and without parental history of atopy. In conclusion, perinatal and current dampness-related exposures in the residence perhaps are risk factors for childhood eczema.
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Affiliation(s)
- Jiao Cai
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai, PR China
| | - Wei Liu
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai, PR China
| | - Yu Hu
- Tongji Architectural Design (Group) Company Limited (TJAD), Shanghai, PR China
| | - Zhijun Zou
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai, PR China
| | - Li Shen
- R&B Technology (Shanghai) Company Limited, Shanghai, PR China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai, PR China.
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13
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Abstract
A gathering body of evidence has repeatedly revealed associations between indoor fungi and initiation, promotion, and exacerbation of allergic respiratory disease. The relationship between the exposure and outcome are complicated by the difficulties in measuring both exposure and outcome, the multifactorial nature of the disease, and the wide range of potential confounders. New technologies are becoming available that may enable better measurement of exposure and tighter case definitions so as to build more confidence in the associations discovered. The growing strength of the evidence base will aid the design of future public health interventions and generate new hypotheses on the cause of the rapid increase in allergic respiratory disease prevalence.
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14
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Kielb C, Lin S, Muscatiello N, Hord W, Rogers-Harrington J, Healy J. Building-related health symptoms and classroom indoor air quality: a survey of school teachers in New York State. INDOOR AIR 2015; 25:371-380. [PMID: 25196499 DOI: 10.1111/ina.12154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 08/27/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Most previous research on indoor environments and health has studied school children or occupants in non-school settings. This investigation assessed building-related health symptoms and classroom characteristics via telephone survey of New York State school teachers. Participants were asked about 14 building-related symptoms and 23 classroom characteristics potentially related to poor indoor air quality (IAQ). Poisson regression analysis was used to assess the relationship between these symptoms and each classroom characteristic, controlling for potential confounders. About 500 teachers completed the survey. The most frequently reported classroom characteristics included open shelving (70.7%), food eaten in class (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust (relative risk (RR) = 3.67; 95% confidence interval (CI): 2.62-5.13), dust reservoirs (RR = 2.13; 95% CI: 1.72-2.65), paint odors (RR = 1.73; 95% CI: 1.40-2.13), mold (RR = 1.71; 95% CI: 1.39-2.11), and moldy odors (RR = 1.65 95% CI: 1.30-2.10). Stronger associations were found with increasing numbers of reported IAQ-related classroom characteristics. Similar results were found with having any building-related allergic/respiratory symptom. This research adds to the body of evidence underscoring the importance to occupant health of school IAQ. PRACTICAL IMPLICATIONS Teachers play an important role in educating children, and teacher well-being is important to this role. Health symptoms among New York teachers while at work are common and appear to be associated with numerous characteristics related to poor classroom IAQ. Improving school Indoor Air Quality may reduce sickness and absenteeism and improve teacher performance.
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Affiliation(s)
- C Kielb
- NYS Department of Health, Center for Environmental Health, Albany, NY, USA
| | - S Lin
- NYS Department of Health, Center for Environmental Health, Albany, NY, USA
- University at Albany School of Public Health, Rensselaer, NY, USA
| | - N Muscatiello
- NYS Department of Health, Center for Environmental Health, Albany, NY, USA
| | - W Hord
- New York State United Teachers, Latham, NY, USA
| | | | - J Healy
- New York State United Teachers, Latham, NY, USA
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15
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Sharpe RA, Thornton CR, Nikolaou V, Osborne NJ. Higher energy efficient homes are associated with increased risk of doctor diagnosed asthma in a UK subpopulation. ENVIRONMENT INTERNATIONAL 2015; 75:234-244. [PMID: 25498485 DOI: 10.1016/j.envint.2014.11.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 11/03/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION The United Kingdom (UK) has one of the highest prevalence of asthma in the world, which represents a significant economic and societal burden. Reduced ventilation resulting from increased energy efficiency measures acts as a modifier for mould contamination and risk of allergic diseases. To our knowledge no previous study has combined detailed asset management property and health data together to assess the impact of household energy efficiency (using the UK Government's Standard Assessment Procedure) on asthma outcomes in an adult population residing in social housing. METHODS Postal questionnaires were sent to 3867 social housing properties to collect demographic, health and environmental information on all occupants. Detailed property data, residency periods, indices of multiple deprivation (IMD) and household energy efficiency ratings were also investigated. Logistic regression was used to calculate odds ratios and confidence intervals while allowing for clustering of individuals coming from the same location. RESULTS Eighteen percent of our target social housing population were recruited into our study. Adults had a mean age of 59 (SD±17.3) years and there was a higher percentage of female (59%) and single occupancy (58%) respondents. Housing demographic characteristics were representative of the target homes. A unit increase in household Standard Assessment Procedure (SAP) rating was associated with a 2% increased risk of current asthma, with the greatest risk in homes with SAP >71. We assessed exposure to mould and found that the presence of a mouldy/musty odour was associated with a two-fold increased risk of asthma (OR 2.2 95%; CI 1.3-3.8). A unit increase in SAP led to a 4-5% reduction in the risk of visible mould growth and a mouldy/musty odour. DISCUSSION In contrast to previous research, we report that residing in energy efficient homes may increase the risk of adult asthma. We report that mould contamination increased the risk of asthma, which is in agreement with existing knowledge. Exposure to mould contamination could not fully explain the association between increased energy efficiency and asthma. Our findings may be explained by increased energy efficiency combined with the provision of inadequate heating, ventilation, and increased concentrations of other biological, chemical and physical contaminants. This is likely to be modified by a complex interaction between occupant behaviours and changes to the built environment. Our findings may also be confounded by our response rate, demographic and behavioural differences between those residing in low versus high energy efficient homes, and use of self-reported exposures and outcomes. CONCLUSION Energy efficiency may increase the risk of current adult asthma in a population residing in social housing. This association was not significantly modified by the presence of visible mould growth, although further research is needed to investigate the interaction between other demographic and housing characteristic risk factors, especially the impact of fuel poverty on indoor exposures and health outcomes. STUDY IMPLICATIONS A multidisciplinary approach is required to assess the interaction between energy efficiency measures and fuel poverty behaviours on health outcomes prior to the delivery of physical interventions aimed at improving the built environment. Policy incentives are required to address fuel poverty issues alongside measures to achieve SAP ratings of 71 or greater, which must be delivered with the provision of adequate heating and ventilation strategies to minimise indoor dampness. Changes in the built environment without changes in behaviour of domicile residents may lead to negative health outcomes.
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Affiliation(s)
- Richard A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD United Kingdom
| | - Christopher R Thornton
- College of Life and Environmental Sciences, University of Exeter, Stocker Road, Exeter EX4 4QD, United Kingdom
| | - Vasilis Nikolaou
- University of Exeter Medical School, The Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, United Kingdom
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD United Kingdom; Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Melbourne, Australia.
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16
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Hu Y, Liu W, Huang C, Zou ZJ, Zhao ZH, Shen L, Sundell J. Home dampness, childhood asthma, hay fever, and airway symptoms in Shanghai, China: associations, dose-response relationships, and lifestyle's influences. INDOOR AIR 2014; 24:450-463. [PMID: 24571077 DOI: 10.1111/ina.12104] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/20/2013] [Indexed: 06/03/2023]
Abstract
Numerous studies of associations between dampness and respiratory diseases have been conducted, but their implications remain inconclusive. In this study of 13,335 parent-reported questionnaires (response rate: 85.3%), we analyzed associations between home dampness and asthma and related symptoms in 4- to 6-year-old children in a cross-sectional study of Shanghai. Indicators of home dampness were strongly and significantly associated with dry cough, wheeze, and rhinitis symptoms. In the current residence, children with visible mold spots (VMS) exposure had 32% higher risk of asthma (adjusted OR, 95% CI: 1.32, 1.07-1.64); damp clothing and/or bedding (frequently) was strongly associated with dry cough (1.78, 1.37-2.30); condensation on windows was strongly associated with hay fever (1.60, 1.27-2.01). In the early-life residence, VMS or damp stains (frequently) were strongly associated with dry cough (2.20, 1.55-3.11) and rhinitis ever (1.57, 1.11-2.21). Associations between dampness and diseases among children with or without family history of atopy were similar. The total number of dampness indicators had strong dose-response relationships with investigated health outcomes. Actions, including opening windows of the child's room at night and cleaning the child's room frequently, could potentially mitigate 25% of home VMS, thereby preventing more than 1.5% of attributable risk of the studied symptoms.
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Affiliation(s)
- Y Hu
- Department of Building Environment and Equipment Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
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17
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Sharpe RA, Bearman N, Thornton CR, Husk K, Osborne NJ. Indoor fungal diversity and asthma: a meta-analysis and systematic review of risk factors. J Allergy Clin Immunol 2014; 135:110-22. [PMID: 25159468 DOI: 10.1016/j.jaci.2014.07.002] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/06/2014] [Accepted: 07/01/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indoor dampness increases the risk of indoor fungal growth. A complex interaction between occupant behaviors and the built environment are thought to affect indoor fungal concentrations and species diversity, which are believed to increase the risk of having asthma, exacerbation of asthma symptoms, or both. To date, no systematic review has investigated this relationship. OBJECTIVE This review aims to assess the relationship between exposure to indoor fungi identified to the genera or species level on asthma outcomes in children and adults. METHODS Ten databases were systematically searched on April 18, 2013, and limited to articles published since 1990. Reference lists were independently screened by 2 reviewers, and authors were contacted to identify relevant articles. Data were extracted from included studies meeting our eligibility criteria by 2 reviewers and quality assessed by using the Newcastle-Ottawa scale designed for assessment of case-control and cohort studies. RESULTS Cladosporium, Alternaria, Aspergillus, and Penicillium species were found to be present in higher concentrations in homes of asthmatic participants. Exposure to Penicillium, Aspergillus, and Cladosporium species were found to be associated with increased risk of reporting asthma symptoms by a limited number of studies. The presence of Cladosporium, Alternaria, Aspergillus, and Penicillium species increased the exacerbation of current asthma symptoms by 36% to 48% compared with those exposed to lower concentrations of these fungi, as shown by using random-effect estimates. Studies were of medium quality and showed medium-high heterogeneity, but evidence concerning the specific role of fungal species was limited. CONCLUSION Longitudinal studies assessing increased exposure to indoor fungi before the development of asthma symptoms suggests that Penicillium, Aspergillus, and Cladosporium species pose a respiratory health risk in susceptible populations. Increased exacerbation of current asthma symptoms in children and adults were associated with increased levels of Penicillium, Aspergillus, Cladosporium, and Alternaria species, although further work should consider the role of fungal diversity and increased exposure to other fungal species.
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Affiliation(s)
- Richard A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Nick Bearman
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom; Department of Geography and Planning, University of Liverpool, Liverpool, United Kingdom
| | - Christopher R Thornton
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Kerryn Husk
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, United Kingdom; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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18
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Choi H, Byrne S, Larsen LS, Sigsgaard T, Thorne PS, Larsson L, Sebastian A, Bornehag CG. Residential culturable fungi, (1-3, 1-6)-β-d-glucan, and ergosterol concentrations in dust are not associated with asthma, rhinitis, or eczema diagnoses in children. INDOOR AIR 2014; 24:158-70. [PMID: 24016225 PMCID: PMC3992620 DOI: 10.1111/ina.12068] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 09/02/2013] [Indexed: 05/06/2023]
Abstract
Qualitative reporting of home indoor moisture problems predicts respiratory diseases. However, causal agents underlying such qualitative markers remain unknown. In the homes of 198 multiple allergic case children and 202 controls in Sweden, we cultivated culturable fungi by directly plating dust, and quantified (1-3, 1-6)-β-D-glucan and ergosterol in dust samples from the child's bedroom. We examined the relationship between these fungal agents and degree of parent or inspector-reported home indoor dampness, and microbiological laboratory's mold index. We also compared the concentrations of these agents between multiple allergic cases and healthy controls, as well as IgE-sensitization among cases. The concentrations of culturable fungal agents were comparable between houses with parent and inspector-reported mold issues and those without. There were no differences in concentrations of the individual or the total summed culturable fungi, (1-3, 1-6)-β-D-glucan, and ergosterol between the controls and the multiple allergic case children, or individual diagnosis of asthma, rhinitis, or eczema. Culturable fungi, (1-3, 1-6)-β-D-glucan, and ergosterol in dust were not associated with qualitative markers of indoor dampness or mold or indoor humidity. Furthermore, these agents in dust samples were not associated with any health outcomes in the children.
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Affiliation(s)
- Hyunok Choi
- Department of Environmental Health Sciences, University at Albany, School of Public Health, 1 University Place, Rensselaer, NY USA 12144
- Corresponding:
| | - Sam Byrne
- Department of Environmental Health Sciences, University at Albany, School of Public Health, 1 University Place, Rensselaer, NY USA 12144
| | - Lisbeth Suldrup Larsen
- Mycological Laboratory, Danish Technological Institute, Gregersensvej 1, DK-2630 Taastrup, Denmark; phone +72202336
| | - Torben Sigsgaard
- Department of Public Health – Section of Environment, Occupation and Health, Aarhus University, University Bartholin Allé 2 DK-8000 Aarhus C Denmark
| | - Peter S. Thorne
- Department of Occupational and Environmental Health, University of Iowa, 105 River Street, S-341A CPHB, Iowa City, IA USA 52242
| | - Lennart Larsson
- Lund University, Laboratory Medicine/Medical Microbiology Sölvegatan 23 223 62 Lund Sweden; phone +46 46177298SP
| | - Aleksandra Sebastian
- Lund University, Laboratory Medicine/Medical Microbiology Sölvegatan 23 223 62 Lund Sweden; phone +46 46177298SP
| | - Carl-Gustaf Bornehag
- Technical Research Institute of Sweden, Sweden
- Department of Public Health Sciences, Karlstad University, SE-651 88 Karlstad, Sweden
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Kennedy K, Grimes C. Indoor water and dampness and the health effects on children: a review. Curr Allergy Asthma Rep 2014; 13:672-80. [PMID: 24249387 DOI: 10.1007/s11882-013-0393-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Exposure to dampness and mold in indoor environments has received significant attention in recent research. This review focuses on studies looking at the impact of dampness, moisture and microbial agents on children's health. We then look more broadly at how research studies have tried to describe dampness and exposure to moisture. Papers published from 2010 onwards were reviewed and are briefly summarized. Most of the papers using dampness as a proxy for microbial exposure focused on respiratory tract infections, especially asthma. This review highlights new findings and also discusses the variety of approaches used to assess dampness in indoor environments.
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Affiliation(s)
- Kevin Kennedy
- Center for Environmental Health, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO, 64108, USA,
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Reponen T, Levin L, Zheng S, Vesper S, Ryan P, Grinshpun SA, LeMasters G. Family and home characteristics correlate with mold in homes. ENVIRONMENTAL RESEARCH 2013; 124:67-70. [PMID: 23683889 PMCID: PMC3714399 DOI: 10.1016/j.envres.2013.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 05/30/2023]
Abstract
Previously, we demonstrated that infants residing in homes with higher Environmental Relative Moldiness Index were at greater risk for developing asthma by age seven. The purpose of this analysis was to identify the family and home characteristics associated with higher moldiness index values in infants' homes at age one. Univariate linear regression of each characteristic determined that family factors associated with moldiness index were race and income. Home characteristics associated with the moldiness index values were: air conditioning, carpet, age of the home, season of home assessment, and house dust mite allergen. Parental history of asthma, use of dehumidifier, visible mold, dog and cat allergen levels were not associated with moldiness index. Results of multiple linear regression showed that older homes had 2.9 units higher moldiness index (95% confidence interval [CI]=0.4, 5.4), whereas homes with central air conditioning had 2.5 units lower moldiness index (95% CI=-4.7, -0.4). In addition, higher dust mite allergen levels and carpeting were positively and negatively associated with higher moldiness index, respectively. Because older homes and lack of air conditioning were also correlated with race and lower income, whereas carpeting was associated with newer homes, the multivariate analyses suggests that lower overall socioeconomic position is associated with higher moldiness index values. This may lead to increased asthma risk in homes inhabited by susceptible, vulnerable population subgroups. Further, age of the home was a surrogate of income, race and carpeting in our population; thus the use of these factors should carefully be evaluated in future studies.
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Affiliation(s)
- Tiina Reponen
- University of Cincinnati, Department of Environmental Health, Cincinnati, OH, USA.
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Wang T, Zhao Z, Yao H, Wang S, Norback D, Chen J, Ma J, Ji X, Wang L, Sundell J. Housing characteristics and indoor environment in relation to children’s asthma, allergic diseases and pneumonia in Urumqi, China. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s11434-013-5727-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhou C, Baïz N, Zhang T, Banerjee S, Annesi-Maesano I. Modifiable exposures to air pollutants related to asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study. BMC Public Health 2013; 13:506. [PMID: 23705590 PMCID: PMC3671198 DOI: 10.1186/1471-2458-13-506] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 05/21/2013] [Indexed: 12/13/2022] Open
Abstract
Background Studies have shown diverse strength of evidence for the associations between air pollutants and childhood asthma, but these associations have scarcely been documented in the early life. The purpose of this study was to evaluate the impacts of various air pollutants on the development of asthma phenotypes in the first year of life. Methods Adjusted odds ratios were estimated to assess the relationships between exposures to air pollutants and single and multi-dimensional asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study (n = 1,765 mother-child pairs). The Generalized Estimating Equation (GEE) model was used to determine the associations between prenatal maternal smoking and in utero exposure to traffic-related air pollution and asthma phenotypes (data were collected when children were at birth, and at 4, 8 and 12 months of age). Adjusted Population Attributable Risk (aPAR) was estimated to measure the impacts of air pollutants on health outcomes. Results In the first year of life, both single and multi-dimensional asthma phenotypes were positively related to heavy parental smoking, traffic-related air pollution and dampness, but negatively associated with contact with cats and domestic wood heating. Adjusted odds ratios (aORs) for traffic-related air pollution were the highest [1.71 (95% Confidence Interval (CI): 1.08-2.72) for ever doctor-diagnosed asthma, 1.44 (95% CI: 1.05-1.99) for bronchiolitis with wheezing, 2.01 (95% CI: 1.23-3.30) for doctor-diagnosed asthma with a history of bronchiolitis]. The aPARs based on these aORs were 13.52%, 9.39%, and 17.78%, respectively. Results persisted for prenatal maternal smoking and in utero exposure to traffic-related air pollution, although statistically significant associations were observed only with the asthma phenotype of ever bronchiolitis. Conclusions After adjusting for potential confounders, traffic-related air pollution in utero life and in the first year of life, had a greater impact on the development of asthma phenotypes compared to other factors.
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Affiliation(s)
- Cailiang Zhou
- Université Pierre et Marie Curie, Paris 6, Sorbonne Universités, UMR S 707: EPAR (Epidémiologie des maladies allergiques et respiratoires), Medical School Saint-Antoine, Paris, France.
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23
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Zhao Z, Zhang X, Liu R, Norback D, Wieslander G, Chen J, Sundell J. Prenatal and early life home environment exposure in relation to preschool children’s asthma, allergic rhinitis and eczema in Taiyuan, China. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s11434-013-5705-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Quansah R, Jaakkola MS, Hugg TT, Heikkinen SAM, Jaakkola JJK. Residential dampness and molds and the risk of developing asthma: a systematic review and meta-analysis. PLoS One 2012; 7:e47526. [PMID: 23144822 PMCID: PMC3492391 DOI: 10.1371/journal.pone.0047526] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 09/12/2012] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Studies from different geographical regions have assessed the relations between indoor dampness and mold problems and the risk of asthma, but the evidence has been inconclusive. OBJECTIVE To assess the relations between indicators of indoor dampness and mold problems and the risk of developing new asthma, and to investigate whether such relations differ according to the type of exposure. DATA SOURCES A systematic literature search of PubMed database from 1990 through March 2012 and the reference lists of recent reviews and of relevant articles identified in our search. STUDY SELECTION Cohort/longitudinal and incident case-control studies assessing the relation between mold/dampness and new asthma were included. DATA EXTRACTION Three authors independently evaluated eligible articles and extracted relevant information using a structured form. SYNTHESIS SIXTEEN STUDIES WERE INCLUDED: 11 cohort and 5 incident case-control studies. The summary effect estimates (EE) based on the highest and lowest estimates for the relation between any exposure and onset of asthma were for the highest estimates 1.48 (95% confidence interval [CI] 1.23-1.78, random-effects model, Q-statistic 38.75 (16), P = 0.001) ; and for the lowest estimates: 1.27 (95% CI 1.06-1.53, random-effects model, Q-statistic 38.12 (16), P = 0.000) [corrected].The summary effect estimates were significantly elevated for dampness (fixed-effects model: EE 1.33, 95% CI 1.12-1.56, Q-statistic 8.22 (9), P = 0.413), visible mold (random-effects model; EE 1.29, 95% CI 1.04-1.60, 30.30 (12), P = 0.001), and mold odor (random-effects model; EE 1.73, 95% CI 1.19-2.50, Q-statistics 14.85 (8), P = 0.038), but not for water damage (fixed-effects model; EE 1.12, 95% CI 0.98-1.27). Heterogeneity was observed in the study-specific effect estimates. CONCLUSION The evidence indicates that dampness and molds in the home are determinants of developing asthma. The association of the presence of visible mold and especially mold odor to the risk of asthma points towards mold-related causal agents.
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Affiliation(s)
- Reginald Quansah
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
| | - Maritta S. Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Respiratory Medicine Unit, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Timo T. Hugg
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Sirpa A M. Heikkinen
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Respiratory Medicine Unit, Institute of Clinical Medicine, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jouni J. K. Jaakkola
- Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland
- Institute of Health Sciences, University of Oulu, Oulu, Finland
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25
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Ukawa S, Araki A, Kanazawa A, Yuasa M, Kishi R. The relationship between atopic dermatitis and indoor environmental factors: a cross-sectional study among Japanese elementary school children. Int Arch Occup Environ Health 2012; 86:777-87. [PMID: 22955908 DOI: 10.1007/s00420-012-0814-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 08/23/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to determine that home environmental factors were associated with atopic dermatitis in Japanese elementary school children. METHODS In this cross-sectional study, a total of 4,254 children in 12 public elementary schools in Sapporo city in Hokkaido, Japan were examined. Atopic dermatitis was defined using the International Study of Asthma and Allergies in Childhood questionnaire. The questionnaires also contained 14 questions about the child's home environment. To obtain multivariate-adjusted ORs for atopic dermatitis in relation to the home environment, we controlled for possible confounders including gender, school grade, parental history of allergies, number of siblings, and whether the child was firstborn. The study participants were then divided into two groups according to gender, and a stratified analysis was performed to obtain adjusted ORs for atopic dermatitis in relation to the home environment. RESULTS The prevalence of atopic dermatitis in our sample was 16.7 %. Using fully adjusted models, the risk factors for atopic dermatitis were found to be the household use of a non-electric heating system without a ventilation duct to the outside (compared to the use of an electric heating system), having visible mould in the house, having a mouldy odour in the house, and condensation on the windowpanes in the house odds ratios (OR 1.25-1.54). In our stratified analysis, having visible mould and having a mouldy odour in the house were relevantly found to be risk factors for boys (OR 1.28-1.64). However, these associations were not found among girls. CONCLUSIONS To improve children's health, further study is needed to corroborate the findings.
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Affiliation(s)
- Shigekazu Ukawa
- Department of Public Health Science, Hokkaido University Graduate School of Medicine, Hokkaido, Sapporo, Japan
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