Prolonged exposure to damp and moldy workplaces and new-onset asthma

  • Kirsi Karvala
  • Elina Toskala
  • Ritva Luukkonen
  • Jukka Uitti
  • Sanna Lappalainen
  • Henrik Nordman
Original Article

Abstract

Purpose

Epidemiological evidence shows that indoor dampness is associated with respiratory symptoms, the aggravation of preexisting asthma, and the development of new-onset asthma. Follow-up studies indicate that symptoms compatible with asthma constitute risk factors for the future development of asthma. The aims of the study were (1) to assess whether asthma-like symptoms (cough, dyspnea, and wheeze) that occur in relation to exposure to damp and moldy work environments lead to the later development of asthma and (2) to assess the importance of continued exposure to indoor dampness and molds at work in the development of asthma.

Methods

We followed 483 patients with asthma-like symptoms related to damp workplaces but without objective evidence of asthma in baseline examinations. The development of asthma and present work conditions were established with the use of a questionnaire 3–12 years later.

Results

A total of 62 patients (13%) reported having developed asthma during the study period. Continued exposure to a damp or moldy environment was associated with a more than fourfold increase in the risk of asthma (odds ratio 4.6, 95% confidence interval 1.8–11.6). Working in a non-remediated environment at follow-up was the strongest risk factor for developing asthma. The remediation of damp buildings seemed to be associated with a decrease in the risk of asthma.

Conclusions

The results indicate that exposure at work to dampness and molds is associated with the occurrence of new-onset asthma. Exposed workers suffering from asthma-like symptoms represent a risk group for the development of asthma. The risk appears especially high if the exposure continues. Due to inherent weaknesses of patient series, the findings need corroborative studies.

Keywords

Asthma Asthma-like symptoms Dampness Mold Occupational exposure Remediation 

References

  1. 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
  2. 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
  3. Burge PS (1993) Use of serial measurements of peak flow in the diagnosis of occupational asthma. Occup Med 8:279–294Google Scholar
  4. Chiry S, Boulet LP, Lepage J, Forget A, Begin D, Chaboillez S et al (2009) Frequency of work-related respiratory symptoms in workers without asthma. Am J Ind Med 52:447–454. doi:10.1002/ajim.20695 CrossRefGoogle Scholar
  5. Dicpinigaitis PV (2006) Chronic cough due to asthma: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):75–79. doi:10.1378/chest.129.1_suppl.75S CrossRefGoogle Scholar
  6. Duodecim (2000) Astman diagnostiikka ja hoito [Diagnostics and therapy of asthma]. Duodecim; laaketieteellinen aikakauskirja, 116:2568–2584. http://www.kaypahoito.fi
  7. Engman LH, Bornehag CG, Sundell J (2007) How valid are parents’ questionnaire responses regarding building characteristics, mouldy odour, and signs of moisture problems in Swedish homes? Scand J Public Health 35:125–132. doi:10.1080/14034940600975658 CrossRefGoogle Scholar
  8. Fishwick D, Bradshaw L, Davies J, Henson M, Stenton C, Burge S et al (2007) Are we failing workers with symptoms suggestive of occupational asthma? Prim Care Respir J 16:304–310. doi:10.3132/pcrj.2007.00064 CrossRefGoogle Scholar
  9. Fisk WJ, Lei-Gomez Q, Mendell MJ (2007) Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. Indoor Air 17:284–296. doi:10.1111/j.1600-0668.2007.00475.x CrossRefGoogle Scholar
  10. Haahtela T (1999) Early treatment of asthma. Allergy 54(Suppl 49):74–81. doi:10.1111/j.1398-9995.1999.tb04392.x CrossRefGoogle Scholar
  11. IOM (Institute of Medicine of the National Academies of Science) (2004) Damp indoor spaces and health. National Academies Press, Washington DCGoogle Scholar
  12. Jaakkola MS, Nordman H, Piipari R, Uitti J, Laitinen J, Karjalainen A et al (2002) Indoor dampness and molds and development of adult-onset asthma: a population-based incident case-control study. Environ Health Perspect 110:543–547CrossRefGoogle Scholar
  13. Jarvis JQ, Morey PR (2001) Allergic respiratory disease and fungal remediation in a building in a subtropical climate. Appl Occup Environ Hyg 16:380–388. doi:10.1080/10473220117482 CrossRefGoogle Scholar
  14. Karvala K, Toskala E, Luukkonen R, Lappalainen S, Uitti J, Nordman H (2010) New-onset adult asthma in relation to damp and moldy workplaces. Int Arch Occup Environ Health 83:855–865. doi:10.1007/s00420-010-0507-5 CrossRefGoogle Scholar
  15. Kercsmar CM, Dearborn DG, Schluchter M, Xue L, Kirchner HL, Sobolewski J et al (2006) Reduction in asthma morbidity in children as a result of home remediation aimed at moisture sources. Environ Health Perspect 114:1574–1580. doi:10.1289/ehp.8742 CrossRefGoogle Scholar
  16. Ketola E, Kaila M, Honkanen M (2007) Guidelines in context of evidence. Qual Saf Health Care 16:308–312. doi:10.1136/qshc.2006.019752 CrossRefGoogle Scholar
  17. Koskinen OM, Husman TM, Meklin TM, Nevalainen AI (1999) The relationship between moisture or mould observations in houses and the state of health of their occupants. Eur Respir J 14:1363–1367CrossRefGoogle Scholar
  18. Kujala V, Remes J, Latvala J, Jarvelin MR (2005) Incidence of asthma in twelve thousand Finnish adults born in 1966. Int J Occup Med Environ Health. 18:255–258Google Scholar
  19. Nevalainen A, Partanen P, Jääskeläinen E, Hyvärinen A, Koskinen O, Meklin T et al (1998) Prevalence of moisture problems in Finnish houses. Indoor Air 8(Suppl 4):45–49. doi:10.1111/j.1600-0668.1998.tb00007.x CrossRefGoogle Scholar
  20. Patovirta RL, Husman T, Haverinen U, Vahteristo M, Uitti JA, Tukiainen H et al (2004) The remediation of mold damaged school–a three-year follow-up study on teachers’ health. Cent Eur J Public Health 12:36–42Google Scholar
  21. Pekkanen J, Hyvarinen A, Haverinen-Shaughnessy U, Korppi M, Putus T, Nevalainen A (2007) Moisture damage and childhood asthma: a population-based incident case-control study. Eur Respir J 29:509–515. doi:10.1183/09031936.00040806 CrossRefGoogle Scholar
  22. Piipari R, Keskinen H (2005) Agents causing occupational asthma in Finland in 1986–2002: cow epithelium bypassed by moulds from moisture-damaged buildings. Clin Exp Allergy 35:1632–1637. doi:10.1111/j.1365-2222.2005.02386.x CrossRefGoogle Scholar
  23. Puolijoki H, Lahdensuo A (1987) Chronic cough as a risk indicator of broncho-pulmonary disease. Eur J Respir Dis 71:77–85Google Scholar
  24. 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
  25. Remes ST, Korppi M, Remes K (1998) Outcome of children with respiratory symptoms without objective evidence of asthma: a two-year, prospective, follow-up study. Acta Paediatr 87:165–168. doi:10.1111/j.1651-2227.1998.tb00969.x CrossRefGoogle Scholar
  26. Rytila P, Ghaly L, Varghese S, Chung W, Selroos O, Haahtela T (2008) Treatment with inhaled steroids in patients with symptoms suggestive of asthma but with normal lung function. Eur Respir J 32:989–996. doi:10.1183/09031936.00062307 CrossRefGoogle Scholar
  27. Sovijarvi AR, Malmberg LP, Reinikainen K, Rytila P, Poppius H (1993) A rapid dosimetric method with controlled tidal breathing for histamine challenge. Repeatability and distribution of bronchial reactivity in a clinical material. Chest 104:164–170CrossRefGoogle Scholar
  28. Thorn J, Brisman J, Toren K (2001) Adult-onset asthma is associated with self-reported mold or environmental tobacco smoke exposures in the home. Allergy 56:287–292. doi:10.1034/j.1398-9995.2001.00805.x CrossRefGoogle Scholar
  29. Toren K, Brisman J, Jarvholm B (1993) Asthma and asthma-like symptoms in adults assessed by questionnaires. A literature review. Chest 104:600–608CrossRefGoogle Scholar
  30. Toren K, Palmqvist M, Lowhagen O, Balder B, Tunsater A (2006) Self-reported asthma was biased in relation to disease severity while reported year of asthma onset was accurate. J Clin Epidemiol 59:90–93. doi:10.1016/j.jclinepi.2005.03.019 CrossRefGoogle Scholar
  31. WHO (2009) WHO guidelines for indoor air quality: dampness and mould. WHO Regional Office for Europe, Copenhagen. http://www.euro.who.int/document/E92645.pdf
  32. Williamson IJ, Martin CJ, McGill G, Monie RD, Fennerty AG (1997) Damp housing and asthma: a case-control study. Thorax 52:229–234. doi:10.1136/thx.52.3.229 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Kirsi Karvala
    • 1
  • Elina Toskala
    • 2
  • Ritva Luukkonen
    • 3
  • Jukka Uitti
    • 4
  • Sanna Lappalainen
    • 5
  • Henrik Nordman
    • 6
  1. 1.Occupational Medicine TeamFinnish Institute of Occupational Health (FIOH)HelsinkiFinland
  2. 2.Control of Hypersensitivity Diseases TeamFinnish Institute of Occupational Health (FIOH)HelsinkiFinland
  3. 3.Statistics and Health Economics TeamFinnish Institute of Occupational Health (FIOH)HelsinkiFinland
  4. 4.Occupational Medicine TeamFinnish Institute of Occupational Health (FIOH)TampereFinland
  5. 5.Developing Indoor Environments TeamFinnish Institute of Occupational Health (FIOH)HelsinkiFinland
  6. 6.Occupational Medicine TeamFinnish Institute of Occupational Health (FIOH)HelsinkiFinland

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