How is the indoor environment related to asthma?: literature review.
OBJECTIVE
This paper reports a review conducted to identify the factors in the indoor environment that have an evidence-based link with the exacerbation or development of asthma and to identify measures that healthcare professionals can promote to reduce exposure to these risk factors in the home.


BACKGROUND
The indoor environment, particularly at home, has been recognized as a major source of exposure to allergens and toxic chemicals. Exposure to allergens and toxins is thought to exacerbate respiratory conditions, in particular, asthma.


METHODS
Searches were made of health and indoor environment databases, including Cochrane Library, National Health Services Centre for Reviews and Assessment Reports, British Medical Journal, CINAHL and Ovid library, MEDSCAPE/MEDLINE, EMBASE, INGENTA, Science Citation Index, Web of Science. Searches were also made of other Internet-based resources, including those of international and government bodies. The following keywords were used: allergens, allergen avoidance, asthma, asthma prevention, cat, damp, Der p 1, dog, environmental control, house dust mites, indoor air quality, indoor environment, meta analysis, mould, pets, remedial actions, respiratory illnesses and systematic reviews.


RESULTS
There is evidence of a link between asthma and a small number of indoor environmental factors. There is currently only reasonable evidence for one causative factor for asthma in the indoor environment and that is house dust mite allergen. Although there are many studies of different remedial actions that can be taken in the home, often these give evidence of reduced risk of exposure but not clinical improvement in asthma. Although there is a lack of medical evidence for the reduction of known sensitizers such as mould, this is because of a dearth of research rather than evidence of no association.


CONCLUSIONS
There is some evidence of a link between the indoor environment and asthma. There are measures, which could be promoted by healthcare professionals to alleviate asthmatic symptoms.
Richardson
George
G
Faculty of Health and Social Work, University of Plymouth, Plymouth, UK. ionian@tiscali.co.uk
Eick
Susan
S
Jones
Raymond
R
D016902:Air Pollution, Indoor / Q000009:adverse effects*; D000485:Allergens / Q000276:immunology; D000818:Animals; D000829:Animals, Domestic / Q000276:immunology; D039741:Antigens, Dermatophagoides / Q000276:immunology; D001249:Asthma / Q000209:etiology* / Q000276:immunology; D001512:Bedding and Linens; D002415:Cats; D004285:Dogs; D017753:Ecosystem; D004780:Environment, Controlled; D004781:Environmental Exposure / Q000517:prevention & control; D005658:Fungi / Q000276:immunology; D006798:Housing; D006801:Humans; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
D000485:Allergens; D039741:Antigens, Dermatophagoides; D014028:Tobacco Smoke Pollution