Damp Buildings Research Articles

TUBB1, TUBA4A and MAPK as Indicators of Die-Back Degenerative Central Nervous System Disease in Patients Sickened by Specific Exposure to the Interior Environment of Water- Damaged Buildings

Beginning with Possible Estuarine Associated Syndrome (PEAS) in 1998 and followed by numerous studies on similar types of exposures, patients with illness associated with biotoxin exposure routinely have had symptom rosters dominated by executive cognitive dysfunction, including recent memory deficits, difficulty in concentration, difficulty with word finding, decreased assimilation of new knowledge, confusion and disorientation, tremors, headaches, vertigo, and unusual pains. In addition, tremors, headaches, vertigo, unusual pains and metallic taste. Toxins involved variously have included those found in toxin-forming dinoflagellates, including Pfiesteria and ciguatera; cyanobacteria, including Microcystis, Cylindrospermopsis and Lyngbya wollei; post Lyme syndrome and Babesia; as well as organisms found in damp buildings, including Aspergillus versicolor and A. penicillioides, Stachybotrys chartarum, Chaetomium globosum, Wallemia sebi, Actinobacteria species, especially Corynebacteria tuberculostearicum and Propionibacterium acnes; as well as bacterial endotoxins and beta-glucans. These illnesses have been called chronic inflammatory response syndromes (CIRS). The mechanism of neurologic findings has remained elusive despite studies showing successful treatment with intranasal vasoactive intestinal polypeptide (VIP). Neurocognitive testing has only been performed in PEAS patients, showing profound deficits in learning and higher cognitive functioning. These CIRS patients have had brain imaging without consistent findings, including MRI, EEG, and CT of the brain. NeuroQuant has shown findings that fit a “fingerprint” found in patients with specific causation and confirmed exposure to Actinobacteria and endotoxins. Fungal exposure shows disproportionate enlargement due to interstitial edema in the forebrain parenchyma and cortical grey, with a diminished caudate nucleus size. These findings have not been found in controls. The recent inclusion of transcriptomic studies using GENIE has confirmed that specific causation can be identified for Actinobacteria (48% of total confirmed cases), bacterial endotoxins (28%) and fungi (7%) in CIRS patients. The combination of NeuroQuant and GENIE has implicated excessive production of cytoskeletal tubulin genes TUBA4A and TUBB1 as risk factors for specific fingerprints for die-back degenerative central nervous system (CNS) injury in patients with illnesses associated variously with exposure to Actinobacteria, fungi and endotoxins. This study seeks to implicate a causal abnormality of excessive expression of tubulin genes TUBA4A and TUBB1. Given the role of these genes in die-back CNS degenerative diseases, such as Alzheimer’s, amyotrophic lateral sclerosis and Parkinson’s disease, and anecdotal successful treatment of CIRS patients with elevated TUBA4A and TUBB1, we suggest the possibility of treatment of tubulin excess may have a role in clinical improvement seen in die-back CNS degenerative diseases. Elevated levels of MAPK are also risk factors when combined with elevated levels of TUBA4A and TUBBI.

Reliability Analysis of Stochastic System using Stochastic Spectral Embedding based Probability Density Evolution Method

This study presents a reliability analysis of stochastic system using the probability density evolution method (PDEM). The PDEM is formulated according to the principle of probability conservation where generalized density evolution equations (GDEEs) are completely decoupled. To estimate the probability density function accurately, a set of representative points of random variables are generated using the GF-discrepancy scheme. A large number of representative points is needed to obtain satisfactory accuracy, which becomes computationally expensive. To reduce the computation burden, a stochastic spectral embedding (SSE) is used as a surrogate model which approximates the original response surface. To illustrate the proposed SSE-based PDEM, two numerical examples are investigated, including the reliability analysis of four-branch problem, and the reliability-based design optimization of a shape memory alloy based damped outrigger tall timber building. Numerical results show that the proposed SSE-based PDEM can estimate failure probability using a very small number of representative points without compromising accuracy compared with Monte Carlo simulation, which leads to a reduction in computational costs.

Intelligent layout design of building damping structure based on ramp model

Intelligent layout design of building damping structure based on ramp model

Intelligent layout design of building damping structure based on ramp model

Intelligent layout design of building damping structure based on ramp model

Effects of mold, water damage and window pane condensation on adult rhinitis and asthma partly mediated by different odors

A questionnaire survey was performed in eight Chinese cities (40,279 adults participated; response rate 75%). There were questions on demographic information of the participants, allergic rhinitis, asthma, perceived odors and home environment. The majority were women (74.7%) and 12.2% were smokers; 6.6% reported allergic rhinitis and 1.6% reported asthma. Totally 38% reported stuffy odor; 24.6% unpleasant odor; 11.5% pungent odor and 10.4% mold odor. Reporting of condensation on window panes were common (62.1%); visible mold or dampness stains (21.9%) and water damage (14.7%) were less common. All dampness indicators were associated with allergic rhinitis and asthma (OR = 1.34–1.87) and all odors (OR = 1.79–6.17). All odors were associated with allergic rhinitis and asthma (OR = 1.23–4.51). Odor perception was partly a mediator of the effects of mold and dampness on allergic rhinitis (% of total effect mediated: 2.7–9.8%) and asthma (2.2–10.7%) when adjusting for other home environment factors. Increased mediation effects for allergic rhinitis (% of total effect mediated: 11.2–17.4%) and asthma (% of total effect mediated: 5.5–14.7%) were found for total odor score (0–8) as compared to the mediation effects for four single odors. In conclusion, mold and dampness in dwellings were associated with adult allergic rhinitis, asthma and odors. Different odors were related to allergic rhinitis and asthma. Some of the effects of mold/dampness on allergic rhinitis and asthma were indirect effect mediated by odors from damp buildings, but most of the effects were direct effects.

Validity of questionnaire survey in evaluating residence's characteristics, and dampness in contemporary human dwellings in Tianjin, China

Many researchers used questionnaires to evaluate associations between indoor environment and human health. However, research on validated occupant’s reported information using home inspections is still lacking. This study aims to validate the data regarding building characteristics and dampness signs obtained from a questionnaire survey in Tianjin, China. Kappa values were used to test the evaluation agreement between occupants and inspectors. A perfect to moderate concordances were reported between the occupants’ and the inspectors’ reports for building characteristics of the child’s room. The floor covering material was reported in almost perfect agreement (cement and stone: k = 0.860). There were substantial to moderate agreements for wall covering (wallpaper: k = 0.731, painting and latex paint; k = 0.408). Slight to moderate agreements were reported for dampness indicators in the child’s bedroom, and consistency was higher in homes with sick children. The findings of this study suggest that questionnaire surveys can give valid and reliable data regarding technical parameters of the home, but not mostly for visible signs of dampness in the home environment. To increase the validity of future questionnaires for studying dampness problems, clear digital photos, moisture-sensitive devices, or more details information should be used.

The design of nonlinear damped building isolation systems by using mobility analysis

Additional power law nonlinear damping has shown advantages in seismic isolation of buildings. The design of nonlinear damped building isolation systems can be conducted in the frequency domain based on the output frequency response function (OFRF) of the building’s frequency output responses. But this often requires many runs of simulations of nonlinear building systems, which will spend a long time when the finite element (FE) model or differential equation model of the building system is complex. In this study, the issue will be resolved by an integrated mobility analysis and equivalent linearization approach. In this approach, the complex linear building system without additional nonlinear damping is represented by several data-driven autoregressive with exogenous input (ARX) models. Mobilities of the building system can be evaluated from these ARX models, so that a mobility-based frequency domain representation of the linear building system can be achieved. After that, an equivalent linearization approach is applied to simulate the building system with additional nonlinear damping. Finally, the OFRF-based design can be conducted based on the proposed mobility analysis and equivalent linearization approach. A 4-degree of freedom (DoF) building system is discussed to demonstrate the advantages of the proposed method. The results indicate that the new approach can significantly increase the efficiency of the design and be effectively applied to the design of complex nonlinear building isolation systems.

Production of Satratoxin G and H Is Tightly Linked to Sporulation in Stachybotrys chartarum.

Stachybotrys chartarum is a toxigenic fungus that is frequently isolated from damp building materials or improperly stored forage. Macrocyclic trichothecenes and in particular satratoxins are the most potent mycotoxins known to be produced by this fungus. Exposure of humans or animals to these secondary metabolites can be associated with severe health problems. To assess the pathogenic potential of S. chartarum isolates, it is essential to cultivate them under conditions that reliably promote toxin production. Potato dextrose agar (PDA) was reported to be the optimal nutrition medium for satratoxin production. In this study, the growth of S. chartarum genotype S strains on PDA from two manufacturers led to divergent results, namely, well-grown and sporulating cultures with high satratoxin concentrations (20.8 ± 0.4 µg/cm2) versus cultures with sparse sporulation and low satratoxin production (0.3 ± 0.1 µg/cm2). This finding is important for any attempt to identify toxigenic S. chartarum isolates. Further experiments performed with the two media provided strong evidence for a link between satratoxin production and sporulation. A comparison of three-point and one-point cultures grown on the two types of PDA, furthermore, demonstrated an inter-colony communication that influences both sporulation and mycotoxin production of S. chartarum genotype S strains.

Mycobiota and mycotoxin-producing fungi in southern California: their colonisation and in vitro interactions

ABSTRACT Fungal contamination in water-damaged houses has become a major concern because of their potential health effects. During our survey in 100 water-damaged houses in southern California, we have reported 42 outdoor and 14 indoor fungal species throughout the year. Six commonly occurring indoor fungal species are Alternaria alternata, Aspergillus niger, Chaetomium globosum, Cladosporium herbarum, Penicillium chrysogenum and Stachybotrys chartarum. In the damp building materials, S. chartarum was found to be associated with A. niger, C. globosum and P. chrysogenum but not with A. alternata and C. herbarum. Stachybotrys chartarum showed strong antagonistic effect against A. alternata and C. herbarum and significantly inhibited in vitro growth of A. alternata and C. herbarum but had no effect on A. niger, C. globosum and P. chrysogenum. Two trichothecenes, produced by Stachybotrys sp., trichodermin and trichodermol, significantly inhibited spore germination and in vitro growth of A. alternata and C. herbarum but had no effect on A. niger, C. globosum, P. chrysogenum and S. chartarum. In the damp building materials (drywall, ceiling tile, and oak wood), S. chartarum significantly inhibited the growth of A. alternata and C. herbarum and had no effect on A. niger, C. globosum and P. chrysogenum in these substrata.

NIOSH Dampness and Mold Assessment Tool (DMAT): Documentation and Data Analysis of Dampness and Mold-Related Damage in Buildings and Its Application.

Indoor dampness and mold are prevalent, and the exposure has been associated with various illnesses such as the exacerbation of existing asthma, asthma development, current asthma, ever-diagnosed asthma, bronchitis, respiratory infection, allergic rhinitis, dyspnea, wheezing, cough, upper respiratory symptoms, and eczema. However, assessing exposures or environments in damp and moldy buildings/rooms, especially by collecting and analyzing environmental samples for microbial agents, is complicated. Nonetheless, observational assessment (visual and olfactory inspection) has been demonstrated as an effective method for evaluating indoor dampness and mold. The National Institute for Occupational Safety and Health developed an observational assessment method called the Dampness and Mold Assessment Tool (DMAT). The DMAT uses a semi-quantitative approach to score the level of dampness and mold-related damage (mold odor, water damage/stains, visible mold, and wetness/dampness) by intensity or size for each of the room components (ceiling, walls, windows, floor, furnishings, ventilation system, pipes, and supplies and materials). Total or average room scores and factor-or component-specific scores can be calculated for data analysis. Because the DMAT uses a semi-quantitative scoring method, it better differentiates the level of damage compared to the binary (presence or absence of damage) approach. Thus, our DMAT provides useful information on identifying dampness and mold, tracking and comparing past and present damage by the scores, and prioritizing remediation to avoid potential adverse health effects in occupants. This protocol-type article describes the DMAT and demonstrates how to apply it to effectively manage indoor dampness and mold-related damage.

Plaster beetle (psocid) infestation in buildings : Environmental management and control — a pragmatic approach

Plaster beetles (psocids) are active stocky and soft-bodied insects that are commonly found in new-build apartments, flats and housing blocks. They are also commonly called barklice or booklice because of their superficial resemblance to certain species of lice, and because they are found, sometimes in very large numbers, on mouldy books and papers in damp buildings or their basements and under loose, damp bark. Plaster beetles are either pale grey or pale brown in colour and may or may not have wings. They are common but harmless, unpleasant nuisance pests. Many live on bark and leaf surfaces feeding on algae, fungi or lichens. Others are found in leaf litter or in caves. A small number have extended their range to include buildings and building materials such as thatch, stored food stocks and museum exhibits. Plaster beetle infestation is mainly caused by damp and residual moisture, resulting in high levels of relative humidity (> 65–75 per cent) in the structural voids, ducting and insulation thereby allowing mould infestation. Psocids primarily feed on fungi and moulds for a few months in newly built houses after the completion of a building. Spraying with chemical treatments will deal with the symptoms of the problem but will not deal with the underlying causes of the infestation, namely damp, residual moisture and moulds. Heating treatment offered by some companies, whereby the building is heated to 45°C, should kill off psocids in the building; however, this does not address the underlying cause(s) of the problem and there is a risk of reinfestation. The author has advocated non-destructive investigations of buildings combined with correct diagnosis and identification of type and viability of both plaster beetle and mould infestation, as not all mould infestations are equally toxic or pathogenic. The author strongly believes, based on scientific, practical experience and successful case studies over the last 35 years, that environmental control of plaster beetle infestation and preventative maintenance are preferable to remedial conventional chemical spraying treatments. Rectifying building defects combined with drying out the building fabric and preventative maintenance should in most cases forestall the need for major interventions, and it is beyond doubt that these steps reduce the risk of reinfestation in buildings. The environmentally sustainable approach and the ongoing monitoring of the environmental conditions in buildings ensures the long-term health of building materials, health of the occupants and structures.

Lifetime seismic performance assessment on post-tensioned self-centering concrete frames considering long-term prestress loss

Prestressing force acts as the main provider of the moment resistance and self-centering capacity of post-tensioned self-centering (PTSC) concrete frames. As the constantly compressed members are subjected to long-term deformations induced by the shrinkage and creep of concrete, the prestress loss would inevitably arise in PTSC frames. This study presents a comprehensive approach to assess the long-term seismic performance of PTSC concrete frames, in which the prestress loss is estimated and considered as the major degradation effect. Time-dependent fragility functions are derived for each floor to detect the variations in the story performance and damage distribution of the structure. The proposed approach is applied to two PTSC concrete frames with and without appendant energy dissipators, respectively. Results indicate that the prestress loss imposes greater impact on the higher floors, and would change the position of the most vulnerable story. Moreover, the frame without energy dissipators suffers larger performance degradation as compared to the damped building.

The Evolution of the Satratoxin and Atranone Gene Clusters of Stachybotrys chartarum.

Stachybotrys chartarum is frequently isolated from damp building materials or improperly stored animal forage. Human and animal exposure to the secondary metabolites of this mold is linked to severe health effects. The mutually exclusive production of either satratoxins or atranones defines the chemotypes A and S. Based upon the genes (satratoxin cluster, SC1-3, sat or atranone cluster, AC1, atr) that are supposed to be essential for satratoxin and atranone production, S. chartarum can furthermore be divided into three genotypes: the S-type possessing all sat- but no atr-genes, the A-type lacking the sat- but harboring all atr-genes, and the H-type having only certain sat- and all atr-genes. We analyzed the above-mentioned gene clusters and their flanking regions to shed light on the evolutionary relationship. Furthermore, we performed a deep re-sequencing and LC-MS/MS (Liquid chromatography–mass spectrometry) analysis. We propose a first model for the evolution of the S. chartarum genotypes. We assume that genotype H represents the most ancient form. A loss of the AC1 and the concomitant acquisition of the SC2 led to the emergence of the genotype S. According to our model, the genotype H also developed towards genotype A, a process that was accompanied by a loss of SC1 and SC3.

Asthma and rhinitis in wet and dry season among students in upper Northern Thailand: the role of building dampness and household air pollution

ABSTRACT We investigated associations between domestic exposure and respiratory health in students inNorthern Thailand in wet and dry season (1159 participants), calculating odds ratios (OR) with 95% confidence intervals (CI) by multilevel logistic regression. Totally 6.0% had wheeze, 23.0% dyspnoea, 4.0% current asthma, 54.6% rhinitis and 31.5% rhinoconjunctivitis. Girls had less wheeze (OR 0.66; 95% CI 0.43-1.00) and current asthma (OR 0.32; 95% CI 0.19-0.54). Water leakage was associated with wheeze (OR 2.35; 95% CI 1.09-5.06), dyspnea (OR 2.00; 95% CI 1.24-3.23) and rhinoconjunctivitis (OR 1.62; 95% CI 1.11-2.38). Mould was associated with rhinitis (OR 1.89; 95% CI 1.06-3.38). Window pane condensation was associated with wheeze (OR 2.60; 95% CI 1.13-5.98) and rhinoconjunctivitis (OR 1.70; 95% CI 1.08-2.67). Biomass burning was associated with wheeze, dyspnoea, rhinitis and rhinoconjunctivitis. In conclusion, household dampness and pollution from domestic biomass burning can increase asthma symptoms and rhinitis symptoms in students in northern Thailand.

A novel damped braced tube system for tall buildings in high seismic zones

SummaryThe damped outrigger system is known to efficiently provide additional damping in buildings with heights of over 250 m. However, particularly for supertall buildings in the center of Tokyo, Japan, the outrigger truss from the center core to the exterior columns need to span distances of more than 20 m. This increases the flexural stiffness demand on the outrigger that leads to larger truss depths making the damped outrigger system inefficient. For such tall buildings with large plans, a new damping modification system, the “damped braced tube system” is proposed, where the exterior surface of the elastic mega braces are partially removed vertically to create a split and are replaced with dissipaters (energy‐dissipation devices). The damped braced tube system enhances the seismic performance as the exterior surfaces of the elastic mega braces work together with the damped slits like in a coupled wall system and increases the overall damping ratio. In this paper, numerical models were constructed based on a real project in Japan consisting of a 397‐m supertall building employing the damped tubular braced system using oil dampers (referred to as viscous dissipaters). A series of generalized response spectrum based numerical analyses and optimizations were performed to minimize the seismic response. The proposed system exhibited improved damping performance with the first to third mode damping ratios reaching to more than 7% while providing a wide range of options for dissipater distribution for design. Finally, the elevation of the slit's base is recommended to be equal to 0.22 of the total building height considering the trade‐off relationship between the first modal damping ratio and the fundamental period.

Effects of Building Mold and Dampness on Adult Rhinitis and Asthma Mediated by Different Odors

Effects of Building Mold and Dampness on Adult Rhinitis and Asthma Mediated by Different Odors

Assessment of Wall Salinity in the Selection of Renovation Plaster Systems

This article presents issues related to assessing the degree of wall salinity to select plaster systems for renovations of damp building walls. The most commonly used salt concentration tests pose many difficulties. If used uncritically, they risk failing to select the right system or its incorrect make. The accuracy of the colorimetric method for testing chloride, nitrate, and sulphate content was analysed to exemplify the magnitude of the problem. Both multi-salt solutions of known concentrations and unknown composition extracted from drillings in the walls of a historical facility were examined. A comparative methodology using ion chromatography as a standard was employed in the research. The analytical methods and the selected modules of the „Statistica” software were used to analyse data and present the results. The colorimetric method has been shown to distort salt concentration values, posing a risk of unsuccessful repair work on high-salinity walls. A method for determining the correction reducing the measurement error has been proposed. The factors affecting the error were also mentioned. Attention has also been drawn to the resolution and application of a method with a correct concentration range intended to improve work efficiency and optimize the costs incurred in renovating the salty wall.

Preparation and characterization of composite scallop shell powder-based and diatomite-based hygroscopic coating materials with metal-organic framework for indoor humidity regulation

Dampness and dryness in buildings have negative effects on occupant's health, building envelope and energy usage. One promising approach is to apply hygroscopic materials with excellent moisture buffering performance in buildings to control the indoor air humidity passively. This paper proposed an innovative application of combination of metal organic frameworks (MOFs) and traditional hygroscopic materials used as passive moisture control coating materials . The scallop shell powder and diatomite, as two kind of substrates, was mixed with 20 wt% zeolite to obtain scallop shell powder-based (SZ) and diatomite-based (DZ) composite inorganic porous mineral materials, respectively. A series of novel composite hygroscopic coating materials (SZ-5, SZ-10 and DZ-5, DZ-10) were prepared by mixing the two composite porous materials with 5 wt% and 10 wt% MIL-100 (Fe) which has excellent performance of water sorption as one kind of MOFs. The microstructures of the produced samples were characterized by nitrogen adsorption/desorption technique and scanning electron microscopy while their hygrothermal properties including the thermal conductivity , the moisture adsorption/desorption performance and the moisture permeability were measured and tested. The results showed that the moisture adsorption amount and moisture adsorption rate for SZ-10 were 0.0121 g/g and 2.29 g/m 2 ·h, respectively. The diatomite-based sample DZ-10 exhibited greater moisture controlling performance with the moisture adsorption amount of 0.0201 g/g and the moisture adsorption rate of 4.62 g/m 2 ·h, which were 3 and 3.88 times those of the pure diatomite sample. The moisture buffer value (MBV) of DZ-10 were largest, indicating that this sample was the highest efficiency moisture buffering material. • A series of novel moisture buffering materials were prepared for interior coating. • Hygrothermal performance of composite materials with MIL-100 (Fe) were tested. • Composite materials with MIL-100(Fe) show better moisture buffer performance. • The relationship between microstructure and hygrothermal properties was discussed.

Transcriptomic Profiling of Adult-Onset Asthma Related to Damp and Moldy Buildings and Idiopathic Environmental Intolerance.

A subset of adult-onset asthma patients attribute their symptoms to damp and moldy buildings. Symptoms of idiopathic environmental intolerance (IEI) may resemble asthma and these two entities overlap. We aimed to evaluate if a distinct clinical subtype of asthma related to damp and moldy buildings can be identified, to unravel its corresponding pathomechanistic gene signatures, and to investigate potential molecular similarities with IEI. Fifty female adult-onset asthma patients were categorized based on exposure to building dampness and molds during disease initiation. IEI patients (n = 17) and healthy subjects (n = 21) were also included yielding 88 study subjects. IEI was scored with the Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire. Inflammation was evaluated by blood cell type profiling and cytokine measurements. Disease mechanisms were investigated via gene set variation analysis of RNA from nasal biopsies and peripheral blood mononuclear cells. Nasal biopsy gene expression and plasma cytokine profiles suggested airway and systemic inflammation in asthma without exposure to dampness (AND). Similar evidence of inflammation was absent in patients with dampness-and-mold-related asthma (AAD). Gene expression signatures revealed a greater degree of similarity between IEI and dampness-related asthma than between IEI patients and asthma not associated to dampness and mold. Blood cell transcriptome of IEI subjects showed strong suppression of immune cell activation, migration, and movement. QEESI scores correlated to blood cell gene expression of all study subjects. Transcriptomic analysis revealed clear pathomechanisms for AND but not AAD patients. Furthermore, we found a distinct molecular pathological profile in nasal and blood immune cells of IEI subjects, including several differentially expressed genes that were also identified in AAD samples, suggesting IEI-type mechanisms.

The risk of respiratory tract infections and antibiotic use in a general population and among people with asthma.

AimThe aim of this study was to investigate occupational, environmental, early life and other risk factors associated with respiratory infections and antibiotics use in a general population and among asthmatic individuals.MethodThis study included 15 842 participants of the Respiratory Health in Northern Europe (RHINE) study aged 25–54 years from five Nordic countries, who answered a questionnaire covering respiratory outcomes, exposures, demographic characteristics and numbers of infections and courses of antibiotics in the last 12 months. Multiple logistic regression with and without adjustment for age, sex, smoking status, body mass index and centre were used to study the risk of infection and antibiotics in relation to asthma, and also the association between infection and antibiotics and occupations.ResultsIn the whole population, 11.6% reported having three or more respiratory infections, and 14.7% had used antibiotics because of respiratory tract infections within the last year. Asthmatic participants reported tripled odds for such infections (adjusted OR 2.98, 95% CI 2.53–3.52) and antibiotics use (adjusted OR 3.67, 95% CI 3.18–4.24) as compared to non-asthmatic participants. Both in the general and the asthmatic population, female sex, obesity and exposure to building dampness were associated with respiratory infections. Female sex and current smoking and living in Tartu were associated with antibiotic use. The use of antibiotics was doubled in people hospitalised for severe respiratory infection in childhood.ConclusionIn this study we identified several factors associated with increased respiratory infections and use of antibiotics in a general population and among asthmatic individuals. The frequency of respiratory infections and subsequent antibiotic treatment were increased among those with asthma.