Abstract
ContextStudies 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.ObjectiveTo 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 sourcesA 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 selectionCohort/longitudinal and incident case-control studies assessing the relation between mold/dampness and new asthma were included.Data extractionThree authors independently evaluated eligible articles and extracted relevant information using a structured form.SynthesisSixteen 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 1.50 (95% confidence interval [CI] 1.25–1.80, random-effects model, Q-statistic 38.74 (16), P = 0.001) and 1.31 (95% CI 1.09–1.58, random-effects model, Q-statistic 40.08 (16), P = 0.000), respectively. 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.ConclusionThe 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.
Highlights
Indoor dampness and mold problems are common around the world, being one of the most important indoor problems globally
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 (randomeffects 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
Definition of asthma was based on lung function measurements, doctor-diagnosed asthma by clinical examination, reported doctordiagnosis, reporting of asthma attacks and/or the use of asthma medication, and reporting of wheezing and signs of asthma (Table 1)
Summary
Indoor dampness and mold problems are common around the world, being one of the most important indoor problems globally. In cold climate the prevalence of water damage and dampness problems has varied between 5% and 30%, while in moderate and warm climates the estimates have been between 10% and 60% [1,2,3]. The prevalence of indoor mold has been 5–10% in cold climate and 10–30% in moderate and warm climates [2,3]. Since the 1990s increasing number of studies from different geographical regions has addressed the health effects related to indoor dampness and mold problems. In a meta-analysis by Fisk and co-workers [5] the risk of current (prevalent) asthma and ever-diagnosed (prevalent) asthma were significantly increased in relation to any dampness or molds as a combined exposure, but the results on development of new asthma remained inconclusive, as only four studies had been published
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