new on-set asthma, damp mouldy indoor

September 2, 2010

Int Arch Occup Environ Health. 2010 Feb 3. [Epub ahead of print]

New-onset adult asthma in relation to damp and moldy workplaces.

Karvala K, Toskala E, Luukkonen R, Lappalainen S, Uitti J, Nordman H.

Occupational Medicine Team, Finnish Institute of Occupational Health (FIOH),

Topeliuksenkatu 41 a A, 00250, Helsinki, Finland, kirsi.karvala@....

Abstract

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: Exposure to damp and moldy workplaces can induce new-onset adult

asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.

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