title: Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma (Review).
abstract: BACKGROUND
  Dampness and mould in buildings have been associated with adverse respiratory symptoms, asthma and respiratory infections of inhabitants. Moisture damage is a very common problem in private houses, workplaces and public buildings such as schools.
  
  
  OBJECTIVE
  To determine the effectiveness of remediating buildings damaged by dampness and mould in order to reduce or prevent respiratory tract symptoms, infections and symptoms of asthma.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1951 to June week 1, 2011), EMBASE (1974 to June 2011), CINAHL (1982 to June 2011), Science Citation Index (1973 to June 2011), Biosis Previews (1989 to June 2011), NIOSHTIC (1930 to November 2010) and CISDOC (1974 to November 2010).
  
  
  METHODS
  Randomised controlled trials (RCTs), cluster-RCTs (cRCTs), interrupted time series studies and controlled before-after (CBA) studies of the effects of remediating dampness and mould in a building on respiratory symptoms, infections and asthma.
  
  
  METHODS
  Two authors independently extracted data and assessed the risk of bias in the included studies.
  
  
  RESULTS
  We included eight studies (6538 participants); two RCTs (294 participants), one cRCT (4407 participants) and five CBA studies (1837 participants). The interventions varied from thorough renovation to cleaning only. We found moderate-quality evidence in adults that repairing houses decreased asthma-related symptoms (among others, wheezing (odds ratio (OR) 0.64; 95% confidence interval (CI) 0.55 to 0.75) and respiratory infections (among others, rhinitis (OR 0.57; 95% CI 0.49 to 0.66)). For children, we found moderate-quality evidence that the number of acute care visits (among others mean difference (MD) -0.45; 95% CI -0.76 to -0.14)) decreased in the group receiving thorough remediation. One CBA study showed very low-quality evidence that after repairing a mould-damaged office building, asthma-related and other respiratory symptoms decreased. For children and staff in schools, there was very low-quality evidence that asthma-related and other respiratory symptoms in mould-damaged schools were similar to those of children and staff in non-damaged schools, both before and after intervention. For children, respiratory infections might have decreased after the intervention.
  
  
  CONCLUSIONS
  We found moderate to very low-quality evidence that repairing mould-damaged houses and offices decreases asthma-related symptoms and respiratory infections compared to no intervention in adults. There is very low-quality evidence that although repairing schools did not significantly change respiratory symptoms in staff or children, pupils' visits to physicians due to a common cold were less frequent after remediation of the school. Better research, preferably with a cRCT design and with more validated outcome measures, is needed.
authors.affiliation: Finnish Institute of Occupational Health, Tampere, Finland. Riitta.Sauni@ttl.fi
authors.forename: Riitta
authors.initials: R
authors.lastname: Sauni
authors.forename: Jukka
authors.initials: J
authors.lastname: Uitti
authors.forename: Merja
authors.initials: M
authors.lastname: Jauhiainen
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kreiss
authors.forename: Torben
authors.initials: T
authors.lastname: Sigsgaard
authors.forename: Jos H
authors.initials: JH
authors.lastname: Verbeek
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000517:prevention & control*; D001249:Asthma / Q000517:prevention & control*; D002648:Child; D002656:Child Day Care Centers; D052918:Environmental Restoration and Remediation / Q000379:methods*; D019317:Evidence-Based Medicine; D005658:Fungi; D006798:Housing; D006801:Humans; D006813:Humidity / Q000009:adverse effects; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D012574:Schools; D017132:Workplace
keywords: Adult; Asthma [* prevention & control]; Child; Environmental Remediation [* methods]; Fungi; Housing [* standards]; Humans; Humidity [* adverse effects]; Respiratory Sounds; Respiratory Tract Infections [*prevention & control]; Schools [standards]; Sick Building Syndrome [complications; prevention & control]