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High environmental relative moldiness index during infancy as a predictor of asthma at 7 years of age
Citation:
Reponen, T., S. J. VESPER, L. Levin, E. Johnson, P. Ryan, J. Burkle, S. A. Grinshpun, S. Zheng, D. I. Bernstein, J. Lockey, M. Villareal, G. K. Khurana Hershey, AND G. LeMasters. High environmental relative moldiness index during infancy as a predictor of asthma at 7 years of age. Annals of Allergy, Asthma and Immunology. American College of Allergy, Asthma, & Immunology , Arlington Heights, IL, 107(2):120-126, (2011).
Impact/Purpose:
Introduction Approximately 9% of children have asthma. The medical costs of asthma are approximately $15 billion per year in the US alone and asthma results in about 2,000 deaths per year (Fisk et al. 2007). Lost school and work days run into the millions each year. The IOM’s expert committee (2004) concluded that exposure to moldy, damp indoor environments was associated with asthma. A subsequent review (Sahakian et al. 2008) of more recent publications also linked dampness to mold and asthma/asthma symptoms. The World Health organization has come to the same conclusion and suggest that exposure to molds should be “minimized” (WHO 2009). A meta-analysis of studies associating mold contamination with adverse health effects demonstrated that building dampness and mold were associated with approximately a 30 to 50% increase in a variety of respiratory and asthma-related health outcomes (Fisk et al. 2007). Therefore, it is critical that mold assessments are accurate and meaningful. US EPA researchers developed a DNA-based method of mold analysis called MSQPCR which is sensitive, specific and accurate. The US EPA in conjunction with HUD developed a simple, standard method of sampling homes for mold populations and created a scale called the ERMI to compare the mould burden in homes across the US (Vesper et al. 2007). In four epidemiological studies, higher ERMI values in homes were associated with increased risk of asthma in children. Remediating the water-damage and mould in asthmatics homes resulted in a statistically significant improvement in the child’s health and a reduction in the need for hospitalizations and emergency room visits (Kercsmar et al. 2006). Although these results are from a limited number of studies and have not been corroborated independently by other research groups, they are suggestive of the conclusions that mold problems are not always obvious. Furthermore, discovering hidden mold is possible using the ERMI analysis and subsequently correcting a mold problem may reduce asthma’s costs to the US by reducing hospitalizations and emergency room visits.
Description:
Background Mold exposures may contribute to the development of asthma, but previous studies have lacked a standardized approach to quantifying exposures. Objective To determine whether mold exposures at the ages of 1 and/or 7 years were associated with asthma at the age of 7 years. Methods This study followed up a high-risk birth cohort from infancy to 7 years of age. Mold was assessed by a DNA-based analysis for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI) at the ages of 1 and 7 years. At the age of 7 years, children were evaluated for allergic sensitization and asthma based on symptom history, spirometry, exhaled nitric oxide, and airway reversibility. A questionnaire was administered to the parent regarding the child's asthma symptoms and other potential cofactors. Results At the age of 7 years, 31 of 176 children (18%) were found to be asthmatic. Children living in a high ERMI value (≥5.2) home at 1 year of age had more than twice the risk of developing asthma than those in low ERMI value homes (<5.2) (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 1.10-6.26). Of the other covariates, only parental asthma (aOR, 4.0; 95% CI, 1.69-9.62) and allergic sensitization to house dust mite (aOR, 4.1; 95% CI, 1.55-11.07) were risk factors for asthma development. In contrast, air-conditioning at home reduced the risk of asthma development (aOR, 0.3; 95% CI, 0.14-0.83). A high ERMI value at 7 years of age was not associated with asthma at 7 years of age. Conclusions Early exposure to molds as measured by ERMI at 1 year of age, but not 7 years of age, significantly increased the risk for asthma at 7 years of age.