New-onset adult asthma in relation to damp and moldy workplaces.
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.
Karvala
Kirsi
K
Occupational Medicine Team, Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 a A, 00250, Helsinki, Finland. kirsi.karvala@ttl.fi
Toskala
Elina
E
Luukkonen
Ritva
R
Lappalainen
Sanna
S
Uitti
Jukka
J
Nordman
Henrik
H
D000328:Adult; D000391:Air Microbiology; D000395:Air Pollutants, Occupational / Q000009:adverse effects*; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005658:Fungi / Q000276:immunology; D006801:Humans; D006813:Humidity / Q000009:adverse effects*; D007073:Immunoglobulin E / Q000276:immunology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D012129:Respiratory Function Tests; D055815:Young Adult
D000395:Air Pollutants, Occupational; D007073:Immunoglobulin E