ObjectivesMany studies have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health effects, but causal links remain unclear. Findings on measured microbiologic factors have received little review. We conducted an updated, comprehensive review on these topics.Data sourcesWe reviewed eligible peer-reviewed epidemiologic studies or quantitative meta-analyses, up to late 2009, on dampness, mold, or other microbiologic agents and respiratory or allergic effects.Data extractionWe evaluated evidence for causation or association between qualitative/subjective assessments of dampness or mold (considered together) and specific health outcomes. We separately considered evidence for associations between specific quantitative measurements of microbiologic factors and each health outcome.Data synthesisEvidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and nonallergic individuals. Evidence strongly suggested causation of asthma exacerbation in children. Suggestive evidence was available for only a few specific measured microbiologic factors and was in part equivocal, suggesting both adverse and protective associations with health.ConclusionsEvident dampness or mold had consistent positive associations with multiple allergic and respiratory effects. Measured microbiologic agents in dust had limited suggestive associations, including both positive and negative associations for some agents. Thus, prevention and remediation of indoor dampness and mold are likely to reduce health risks, but current evidence does not support measuring specific indoor microbiologic factors to guide health-protective actions.

Background: Associations of higher indoor carbon dioxide (CO2) concentrations with impaired work performance, increased health symptoms, and poorer perceived air quality have been attributed to correlation of indoor CO2 with concentrations of other indoor air pollutants that are also influenced by rates of outdoor-air ventilation.Objectives: We assessed direct effects of increased CO2, within the range of indoor concentrations, on decision making.Methods: Twenty-two participants were exposed to CO2 at 600, 1,000, and 2,500 ppm in an office-like chamber, in six groups. Each group was exposed to these conditions in three 2.5-hr sessions, all on 1 day, with exposure order balanced across groups. At 600 ppm, CO2 came from outdoor air and participants’ respiration. Higher concentrations were achieved by injecting ultrapure CO2. Ventilation rate and temperature were constant. Under each condition, participants completed a computer-based test of decision-making performance as well as questionnaires on health symptoms and perceived air quality. Participants and the person administering the decision-making test were blinded to CO2 level. Data were analyzed with analysis of variance models.Results: Relative to 600 ppm, at 1,000 ppm CO2, moderate and statistically significant decrements occurred in six of nine scales of decision-making performance. At 2,500 ppm, large and statistically significant reductions occurred in seven scales of decision-making performance (raw score ratios, 0.06–0.56), but performance on the focused activity scale increased.Conclusions: Direct adverse effects of CO2 on human performance may be economically important and may limit energy-saving reductions in outdoor air ventilation per person in buildings. Confirmation of these findings is needed.

This paper reviews current literature on the associations of ventilation rates and carbon dioxide concentrations in non-residential and non-industrial buildings (primarily offices) with health and other human outcomes. Twenty studies, with close to 30,000 subjects, investigated the association of ventilation rates with human responses, and 21 studies, with over 30,000 subjects, investigated the association of carbon dioxide concentration with these responses. Almost all studies found that ventilation rates below 10 Ls-1 per person in all building types were associated with statistically significant worsening in one or more health or perceived air quality outcomes. Some studies determined that increases in ventilation rates above 10 Ls-1 per person, up to approximately 20 Ls-1 per person, were associated with further significant decreases in the prevalence of sick building syndrome (SBS) symptoms or with further significant improvements in perceived air quality. The carbon dioxide studies support these findings. About half of the carbon dioxide studies suggest that the risk of sick building syndrome symptoms continued to decrease significantly with decreasing carbon dioxide concentrations below 800 ppm. The ventilation studies reported relative risks of 1.5-2 for respiratory illnesses and 1.1-6 for sick building syndrome symptoms for low compared to high low ventilation rates.

There is more justification now for improving IEQ in schools to reduce health risks to students than to reduce performance or attendance risks. However, as IEQ-performance links are likely to operate largely through effects of IEQ on health, IEQ improvements that benefit the health of students are likely to have performance and attendance benefits as well. Immediate actions are warranted in schools to prevent dampness problems, inadequate ventilation, and excess indoor exposures to substances such as NO(2) and formaldehyde. Also, siting of new schools in areas with lower outdoor pollutant levels is preferable.

IntroductionThe association of adverse health effects with dampness and mold in buildings has been the subject of much research. Most studies on this topic have found an increased risk of one or more adverse health effects in buildings with signs of dampness or visible mold. The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review (IOM, 2004) of this scientific literature. The IOM concluded that excessive indoor dampness is a public health problem, noted that dampness problems are common, and recommended corrective measures. While the IOM report summarized the main features and results of the reviewed studies, which included a broad range of health outcomes, it provided no quantitative summaries of the findings of these studies.In this paper, we report the results of quantitative meta-analyses of the studies reviewed in the IOM report and other similar studies that met specified study inclusion criteria. A meta-analysis uses statistical methods to combine data from different but comparable research studies, in order to provide a quantitative summary estimate on the size and variability of an association. Studies are generally selected for relevance, quality, and similarity. The contribution of larger, more precise studies to the summary estimate is generally more heavily weighted. Results of metaanalyses presented here are central point estimates and confidence intervals (CIs) of odds ratios (ORs) that summarize the magnitude of increased risk of several health outcomes in buildings with dampness and mold. The central estimates and CIs of ORs, if assumed to reflect causal relationships, can be used to communicate Abstract The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review of the scientific literature pertaining to the association of indoor dampness and mold contamination with adverse health effects. In this paper, we report the results of quantitative meta-analyses of the studies reviewed in the IOM report plus other related studies. We developed point estimates and confidence intervals (CIs) of odds ratios (ORs) that summarize the association of several respiratory and asthma-related health outcomes with the presence of dampness and mold in homes. The ORs and CIs from the original studies were transformed to the log scale and random effect models were applied to the log ORs and their variance. Models accounted for the correlation between multiple results within the studies analyzed. Central estimates of ORs for the health outcomes ranged from 1.34 to 1.75. CIs (95%) excluded unity in nine of 10 instances, and in most cases the lower bound of the CI exceeded 1.2. Based on the results of the meta-analyses, building dampness and mold are associated with approximately 30-50% increases in a variety of respiratory and asthma-related health outcomes. Practical ImplicationsThe results of these meta-analyses reinforce the IOM's recommendation that actions be taken to prevent and reduce building dampness problems, and a...

Background: Previous research has found relationships between specific indoor environmental exposures and exacerbation of asthma.Objectives: In this review we provide an updated summary of knowledge from the scientific literature on indoor exposures and exacerbation of asthma.Methods: Peer-reviewed articles published from 2000 to 2013 on indoor exposures and exacerbation of asthma were identified through PubMed, from reference lists, and from authors’ files. Articles that focused on modifiable indoor exposures in relation to frequency or severity of exacerbation of asthma were selected for review. Research findings were reviewed and summarized with consideration of the strength of the evidence.Results: Sixty-nine eligible articles were included. Major changed conclusions include a causal relationship with exacerbation for indoor dampness or dampness-related agents (in children); associations with exacerbation for dampness or dampness-related agents (in adults), endotoxin, and environmental tobacco smoke (in preschool children); and limited or suggestive evidence for association with exacerbation for indoor culturable Penicillium or total fungi, nitrogen dioxide, rodents (nonoccupational), feather/down pillows (protective relative to synthetic bedding), and (regardless of specific sensitization) dust mite, cockroach, dog, and dampness-related agents.Discussion: This review, incorporating evidence reported since 2000, increases the strength of evidence linking many indoor factors to the exacerbation of asthma. Conclusions should be considered provisional until all available evidence is examined more thoroughly.Conclusion: Multiple indoor exposures, especially dampness-related agents, merit increased attention to prevent exacerbation of asthma, possibly even in nonsensitized individuals. Additional research to establish causality and evaluate interventions is needed for these and other indoor exposures.Citation: Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. 2015. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect 123:6–20; http://dx.doi.org/10.1289/ehp.1307922

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Epidemiologic research into the causes of non‐specific symptoms among office workers has produced a variety of conflicting findings which are difficult to synthesize. This paper first discusses methodologic issues important in the interpretation of epidemiologic studies, and then reviews the findings of 32 studies of 37 factors potentially related to office worker symptoms. Among environmental factors assessed, there were generally consistent findings associating increased symptoms with air‐conditioning, carpets, more workers in a space, VDT use, and ventilation rates at or below 10 liters/second/person. Studies with particularly strong designs found decreased symptoms associated with low ventilation rate, short‐term humidification, negative ionization, and improved office cleaning, although studies reviewed showed little consistency of findings for humidification and ionization. Relatively strong studies associated high temperature and low relative humidity with increased symptoms, whereas less strong studies were not consistent. Among personal factors assessed, there were generally consistent findings associating increased symptoms with female gender, job stress/dissatisfaction, and allergies/asthma. For other environmental or personal factors assessed, findings were too inconsistent or sparse for current interpretation, and there were no findings from strong studies. Overall evidence suggested that work related symptoms among office workers were relatively common, and that some of these symptoms represented preventable physiologic effects of environmental exposures or conditions. Future research on this problem should include blind experimental and case‐control studies, using improved measurements of both environmental exposures and health outcomes