Effects on patients with asthma of eradicating visible indoor mould: a randomised controlled trial

Abstract

Background: It is not clear whether associations between respiratory symptoms and indoor mould are causal. A randomised controlled trial was conducted to see whether asthma improves when indoor mould is removed. Methods: Houses of patients with asthma were randomly allocated into two groups. In one group, indoor mould was removed, fungicide was applied and a fan was installed in the loft. In the control group, intervention was delayed for 12 months. Questionnaires were administered and peak expiratory flow rate was measured at baseline, 6 months and 12 months. Results: Eighty-one houses were allocated to the intervention group and 83 to the control group; 95 participants in 68 intervention houses and 87 in 63 control houses supplied follow-up information. Peak expiratory flow rate variability declined in both groups, with no significant differences between them. At 6 months, significantly more of the intervention group showed a net improvement in wheeze affecting activities (difference between groups 25%, 95% CI 3% to 47%; p = 0.028), perceived improvement of breathing (52%, 95% CI 30% to 74%; p,0.0001) and perceived reduction in medication (59%, 95% CI 35% to 81%; p,0.0001). By 12 months the intervention group showed significantly greater reductions than the controls in preventer and reliever use, and more improvement in rhinitis (24%, 95% CI 9% to 39%; p = 0.001) and rhinoconjunctivitis (20%, 95% CI 5% to 36%; p = 0.009). Conclusions: Although there was no objective evidence of benefit, symptoms of asthma and rhinitis improved and medication use declined following removal of indoor mould. It is unlikely that this was entirely a placebo effect.

Enhancing ventilation in homes of children with asthma: pragmatic randomised controlled trial

“…The results of CHARISMA strengthen the generally positive findings of six recent randomised trials of interventions to enhance the indoor environment -one in the US, 12 three in the UK, 11,14,15 and two in New Zealand. 16,17 Although the six interventions were heterogeneous, all sought to enhance ventilation, or housing, or both.…”

“…[23][24][25] In particular, it was decided not to measure peak flow because of diurnal variation in readings, with the result that even a large sample size might not detect a difference. 15,17 To count mould spores in children's bedrooms, or to measure their sensitisation to such spores, was also beyond the scope of this pragmatic study.…”

“…11 In short, empirical evidence that investment in housing benefits health is promising but limited. [12][13][14][15][16][17] This randomised controlled trial aimed to strengthen this evidence by evaluating the effectiveness and cost-effectiveness of installing ventilation systems, and improving central heating if necessary, in the homes of children with moderate or severe asthma. The primary objective was to test whether these improvements change asthmaspecific quality of life.…”

Correlation between ERMI Values and Other Moisture and Mold Assessments of Homes in the American Healthy Homes Survey

“…2 Other studies have shown that remediating the water damage and mold in asthmatics' homes resulted in improvements in their health. 3,4 Therefore, accurate assessment of the molds in homes may be critical in evaluating asthma trigger concentrations.…”

Indoor Environmental Control Practices and Asthma Management

“…52 Remediation of mold has been shown to reduce symptoms and medication use in several populations, and its effects may not depend on whether the population is sensitized to mold. 55,56 The evaluation of a patient with persistent asthma includes an assessment of sensitization to the major indoor molds, which can be accomplished with specific IgE testing performed on a blood sample or through referral to a board-certified allergist for skin testing. Air sampling, thermography, moisture meters, environmental history, and direct observation are all useful techniques to identify moisture problems.…”