Fungal Contamination in Public Buildings: Health Effects and Investigation Methods

Table 3. Cross-sectional studies on respiratory and allergic effects of exposure to indoor molds, 1995 to 2001

Country	Study population (n)	Data collection method	Exposure	Disease	OR	95% CI	Covariats adjusted for	Ref.
Canada	School children, mean age = 10 (n = 403)	E + D: questionnaire to parents	Mold/mildew in present home in the past year	Non-respiratory symptoms	2.25	1.26 - 4.00	Age, gender, parental allergies, parental education, pets, ETS, dust mites, bacterial endotoxins	Dales and Miller 1999
				Irritation	1.81	1.02 - 3.24
				Cough/wheezing	1.28	0.74 - 2.23
				Asthma	0.91	0.42 - 1.95
				Chest illness	1.51	0.76 - 3.02
Canada	As above	E: dust sampling D: questionnaire to parents	Altrnaria detected in dust	Non-respiratory symptoms	0.79	0.38 - 1.67	Age, parental illness, parental smoking, dust mites	Dales et al., 1999
				Irritation	1.05	0.51 - 2.18
				Cough/wheezing	2.00	0.84 - 4.74
				Asthma	1.90	0.55 - 6.59
				Chest illness	2.77	0.85 - 9.01
Australia	Children between 7 and 14 years of age from 80 households (n = 148)	E: air sampling D: questionnaire (asthma) and skin prick test to common aeroallergens (atopy)	100-CFU/m3 increase in Penicillium spores	Asthma	1.43	1.03 - 2.00	Parental asthma, allergy	Garrett et al., 1998
			100-CFU/m3 increase in Aspergillus spores	Atopy (response to at least one skin prick test)	1.48	1.10 - 1.99	Gender, parental asthma
Finland	Adults aged 25 to 64 years (n = 1,460)	E + D: mail questionnaire	Visible mold OR musty odour OR moisture stains OR water/moisture damage	Asthma	1.02	NS	Age, gender, smoking, education, type of dwelling	Pirhonen et al., 1996
				Atopy	1.62	p < 0.001
				Allergic rhinitis	1.66	p < 0.001
				Cough	1.37	NS
				Phlegm	1.36	p < 0.05
				Rhinitis	1.69	p < 0.001
				Eye irritation	1.52	p < 0.01
				Lumbar backache	1.49	p < 0.01
				Recurrent stomachache	1.65	p < 0.001
Finland	As above, but excluding those reporting lumbar backache or recurrent stomachache	E + D: mail questionnaire	Visible mold OR musty odour OR moisture stains OR water/moisture damage	Atopy	1.34	NS		Pirhonen et al., 1996
				Allergic rhinitis	1.37	NS
				Cough	1.48	NS
				Phlegm	0.94	NS
				Rhinitis	1.21	NS
				Eye irritation	1.69	p < 0.05
Finland	Adults aged >= 16 years inhabiting 310 dwellings (n = 699)	E + D: self-administered questionnaire	Mold present	Sinusitis	1.92	1.11 - 3.30	Smoking, age, gender, allergy, pets, atopic predisposition	Koskinen et al. 1999
				Bronchitis	1.98	1.13 - 3.48
				Cough without phlegm	1.42	0.92 - 2.19
				Cough with phlegm	1.15	0.78 - 1.69
				Nocturnal cough	2.11	1.21 - 4.98
				Nocturnal dyspnoea	2.33	1.09 - 4.98
				Sore throat	1.46	1.03 - 2.08
				Rhinitis	1.06	0.71 - 1.59
				Impaired smell	1.23	0.80 - 1.91
				Eye irritation	1.08	0.76 - 1.53
Findland	Adults aged >= 16 years inhabiting 310 dwellings (n = 699)	E: homes visually inspected for signs of moisture by a civil engineer D: self-administered questionnaire	Moisure present	Bronchitis	1.68	0.95 - 2.95	As above	Koskinen et al. 1999
				Cough without phlegm	1.60	1.01 - 2.53
				Cough with phlegm	1.44	1.44 - 2.19
				Nocturnal cough	2.30	1.32 - 4.01
				Nocturnal dyspnoea	1.58	0.74 - 3.39
				Sore throat	2.40	1.56 - 3.69
				Rhinitis	1.89	1.15 - 3.11
				Impaired smell	1.28	0.80 - 2.06
				Eye irritation	1.43	0.84 - 1.83
Findland	First-year university students aged 18 to 25 (n = 10,677)	E + D: postal questionnaire (D validated against clinical assessment in a sub-sample of 290 people)	Visible mold growth in dwellings in the past year	Asthma	2.21	1.48 - 3.28	Parental education, smoking, ETS exposure, pets, wall-to-wall carpets, place of residence (form, rural non-farm, urban), type of residence	Kilpeläinen et al. 2001
				Allergic rhinitis	1.29	1.01 - 1.66
				Allergic conjunctivitis	0.95	0.68 - 1.34
				Atopic dermatitis	1.31	0.96 - 1.79
			Visible mold OR damp stains OR water damage in the past year	Asthma	1.66	1.25 - 2.19
				Allergic rhinitis	1.30	1.12 - 1.51
				Allergic conjunctivitis	1.12	0.92 - 1.36
				Atopic dermatitis	1.29	1.06 - 1.56
Netherlands	Boys aged 6 to 12 (n = 222)	E + D: questionnaire to parents (mold growth: never, sometimes, often, always)	Mold growth in past 2 years (always vs. never)	Chronic cough	3.56	0.80 - 14.10	Age, gender, parental smoking, unvented kitchen geysers, parental education	Cuijpers et al. 1995
				Shortness of breath	2.26	0.54 - 9.49
				Wheezing	0.95	0.16 - 5.46
Netherlands (continued)	Girls aged 6 to 12 (n = 248)	E + D: questionnaire to parents (mold growth: never, sometimes, often, always)	Mold growth in past 2 years (always vs. never)	Chronic cough	0.79	0.07 - 8.34
				Wheezing	2.69	0.48 - 15.21
Taiwan	Children aged 8 to 12 (n = 1,340)	E:+ D: questionnaire to parents	Dampness	Cough	2.52	1.34 - 4.75	Age, gender, parental education, number of smokers in household, gas stove	Li and Hsu 1996
				Phlegm	1.86	1.18 - 2.93
				Wheeze	1.36	0.83 - 2.21
				MD-diagnosed asthma	1.25	0.81 - 1.95
				Bronchitis	1.29	0.96 - 1.73
				Pneumonia	1.33	0.75 - 2.36
				Allergic rhinitis	1.39	1.05 - 1.84
Taiwan	Children aged 8 to 12 (n = 1,340)	E:+ D: questionnaire to parents	Mold growth in home	Cough	1.87	1.00 - 3.25	As above	Li and Hsu 1996
				Phlegm	1.50	0.95 - 2.36
				Wheeze	1.20	0.73 - 1.99
				MD-diagnosed asthma	1.12	0.72 - 1.74
				Bronchitis	1.68	1.26 - 2.25
				Pneumonia	1.77	1.03 - 3.05
				Allergic rhinitis	1.27	0.96 - 1.68
United States	Young adults aged 20 to 22 years (n = 2,041)	E + D: self-administered postal questionnaire	Visible mold	MD-diagnosed asthma	1.5	1.0 - 2.4	Gender, race, education, smoking status	Hu et al. 1997
				Current asthma	2.0	1.2 - 3.2
			Water leaking	MD-diagnosed asthma	1.6	0.7 - 3.5
				Current asthma	1.6	0.7 - 3.8
			Indoor dampness	MD-diagnosed asthma	1.2	0.8 - 1.9
				Current asthma	1.3	0.7 - 2.2

E: exposure assessment; D: disease assessment

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