New-onset adult asthma in relation to damp and moldy workplaces
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Damp and moldy indoor environments aggravate pre-existing asthma. Recent meta-analyses suggest that exposure to such environments may also induce new-onset asthma. We assessed the probability of molds being the cause of asthma in a patient series examined because of respiratory symptoms in relation to workplace dampness and molds.
Altogether 694 such patients had been clinically assessed between 1995 and 2004. According to their histories, they had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms. The investigations had included specific inhalation challenge (SIC) tests with mold extracts and serial peak expiratory flow (PEF) recordings. Using internationally recommended diagnostic criteria for occupational asthma (OA), we categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). The clinical details of 258 patients were analyzed, and their levels of microbial exposure were evaluated.
The agreement between the serial PEF recordings and SIC tests (both being either positive or negative) was 56%. In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. At 6 months, the follow-up examinations of 136 patients with probable OA showed that the symptoms were persistent, and no improvement in spirometry was noted despite adequate treatment. Only 58% of the patients had returned to work.
Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.
KeywordsAsthma Dampness Indoor air Mold Occupational exposure Respiratory symptoms
The authors thank Tuula Suomela for collecting the patient files. Financial support was received from the Finnish Work Environment Fund.
Conflict of interest
The authors declare that they have no conflict of interest.
- Bernstein I, Chan-Yeung M, Malo J-L, Bernstein D (2006) Asthma in the workplace and related conditions, 3rd edn. Taylor and Francis, New YorkGoogle Scholar
- Bornehag CG, Blomquist G, Gyntelberg F, Jarvholm B, Malmberg P, Nordvall L et al (2001) Dampness in buildings and health. Nordic interdisciplinary review of the scientific evidence on associations between exposure to “dampness” in buildings and health effects (NORDDAMP). Indoor Air 11:72–86. doi: 10.1034/j.1600-0668.2001.110202.x CrossRefGoogle Scholar
- Bornehag CG, Sundell J, Bonini S, Custovic A, Malmberg P, Skerfving S et al (2004) Dampness in buildings as a risk factor for health effects, EUROEXPO: a multidisciplinary review of the literature (1998–2000) on dampness and mite exposure in buildings and health effects. Indoor Air 14:243–257. doi: 10.1111/j.1600-0668.2004.00240.x CrossRefGoogle Scholar
- Burge PS (1993) Use of serial measurements of peak flow in the diagnosis of occupational asthma. Occup Med 8:279–294Google Scholar
- Horner WE, Helbling A, Salvaggio JE, Lehrer SB (1995) Fungal allergens. Clin Microbiol Rev 8:161–179Google Scholar
- IOM (2004) Damp indoor spaces and health. Institute of Medicine, The National Academies Press, Washington, DCGoogle Scholar
- Newman Taylor AJ, Nicholson PJ, Cullinan P, Boyle C, Burge PS (2004) Guidelines for the prevention, identification & management of occupational asthma: evidence review & recommendations. British Occupational Health Research Foundation, London. http://www.bohrf.org.uk/downloads/asthevre.pdf
- Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC (1993) Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests, European Community for Steel and Coal. Official statement of the European respiratory society. Eur Respir J Suppl 16:5–40Google Scholar
- Quirce S, Contreras G, Dybuncio A, Chan-Yeung M (1995) Peak expiratory flow monitoring is not a reliable method for establishing the diagnosis of occupational asthma. Am J Respir Crit Care Med 152:1100–1102Google Scholar
- Sub-Committee on Skin Tests of the European Academy of Allergology and Clinical Immunology (1989) Skin tests used in type I allergy testing position paper. Allergy 44(Suppl 10):1–59Google Scholar
- Viljanen AA, Viljanen BC, Halttunen PK, Kreus KE (1982) Pulmonary diffusing capacity and volumes in healthy adults measured with the single breath technique. Scand J Clin Lab Invest Suppl 159:21–34Google Scholar