Hagmolen of Ten Have, the Netherlands [104] | 526 children with asthma (mean age 11 years) Follow-up: 2 weeks (2 visits) | At baseline: positive response to a question on visible mould in the past 2 years | Daily variability of peak flow Daily symptoms: wheezing, cough, BHR at follow-up | No association between mould exposure and symptoms In exposed children: increased peak flow variability: +2.70% (95% CI 0.92–4.47, p=0.003), and higher BHR: aOR: 3.95 (1.82–8.57) |
Inal, Turkey [105] | 19 children with asthma or rhinitis, and monosensitised to mould (aged 4–13 years) Follow-up: 1 year | Every month: indoor air: MAS-100 Eco 100 L·min−1 Culture CFU·m−3: Cladosporium, Penicillium, Aspergillus, Alternaria and others (undefined or >1%) | Daily variability of peak flow: morning and evening Daily symptoms (rhinitis and asthma scores) | No association between mean exposure to mould (37.5 CFU·m−3) and daily variability of peak flow or symptoms |
Bundy, Western Massachusetts and Connecticut, USA [106] | 225 children with asthma (6–12 years old) Follow-up: 2 weeks | At baseline: indoor air: Burkard 1 min 20 L·min−1 Culture and classification: 0 CFU·m−3, 1–499 CFU·m−3, 500–999 CFU·m−3, >1000 CFU·m−3, Cladosporium, Alternaria, Penicillium or Aspergillus | Daily variability of peak flow: three series of measurements morning and evening performed by children Daily symptoms (wheezing, cough and nocturnal symptoms), drugs reported by the mother | No association between mould exposure and symptoms Associations between Penicillium (0 versus detectable) and peak flow variability of >18.5% (75th percentile) aOR 2.39 (95% CI 1.19–4.81) |
Pongracic, the Inner-City Asthma Study: USA [107] | 469 children with mild to severe asthma and at least one positive SPT to mould (aged 5–11 years) Follow-up: 2 years | At baseline and every 6 months: indoor air 2 measurements Burkard 1 min 30.5 L·min−1, 1 m from floor, children's room Outdoor air Culture CFU·m−3: Cladosporium, Alternaria, Penicillium and Aspergillus Dust measurements on floor and bed | Call report every 2 months: max number of days (in 2 weeks) with symptoms (wheezing, cough, chest tightness, awakening due to asthma or play activities stopped because of asthma) Number of unplanned visits to hospital or EV in the past 2 months | Association between 10-fold increase in Penicillium level and increased number of days with symptoms: 1.19 days per 2 weeks, p<0.03 Association between indoor mould and exacerbations and EV: aOR 1.22 (95% CI 1.05–1.43) and 1.13 (1.01–1.26) Association between Penicillium and EV: OR 1.15 (1.05–1.27) (all children), and 1.11 (1.03–1.20) in those SPT− for Penicillium |
Wu, USA [32] | 395 children with mild-to-moderate persistent asthma CAMP study (aged 5–12 years) Follow-up: 6 months and 3 years or before in case of moving | At baseline and at the first follow-up (6 months): dust measurements on floor (main living room, bedrooms and kitchen) and on child's bed Vacuum cleaner equipped with a filter (Douglas ReadiVac model): 2 min for each zone of different surfaces Culture and classification: high mould dust exposure: >25 000 CFU·g−1 of house dust | Severe asthma exacerbations Hospitalisations or urgent care visits during the 4 years of follow-up (report every 4 months) Polymorphisms (SNPs) in chitinase genes | 24% (n=95) had high mould dust exposure Number of urgent care visits increased with high mould dust exposure in children with genetic polymorphisms (rs2486953, rs4950936 and rs1417149) in the CHIT1 gene |
Gent, Western Massachusetts and Connecticut, USA [108] | 1233 school-aged children with asthma (aged 5–10 years) Follow-up: 1 month | At baseline: indoor air: Burkard 1 min 20 L·min−1, culture: CFU·m−3 Dust measurements on floor and furniture in the main living room Blood allergens: mould, mites, cat, dog (µg·g−1) and cockroaches (U·g−1) | Daily symptoms (wheezing, cough), drugs and severity (five levels) Allergic sensitisation: allergens and IgE | In sensitised children: associations between Penicillium and risk of wheezing: aOR 2.12 (95% CI 1.12–4.04), cough: 2.01 (1.05–3.85) and asthma severity score: 1.99 (1.06–3.72) |
Vicendese, Melbourne, Australia [33] | Nested incident case–control study within the MAPCAH study: 44 children (aged 2–17 years) Follow-up: September 2009 to December 2011 | Air fungi in the child's bedroom: two-stage Andersen Sampler for 1 min, flow rate: 28 L·min−1 Total fungi, Cladosporium, Penicillium/Aspergillus and Alternaria, CFU per 28 L of air | Standardised questionnaires from the ISAAC and NZ Otago studies Incident asthma readmissions | Association between every doubling concentration of CFU of airborne Cladosporium (per 28 L of air) in the bedroom and asthma readmission: aOR 1.68 (95% CI 1.04–2.72) |
Dannemiller, Western Massachusetts and Connecticut, USA [34] | n=196, subgroup of the 1233 school-aged children with asthma (aged 5–10 years) Follow-up: 1 month | At baseline: indoor air: Burkard 1 min 20 L·min−1, culture: CFU·m−3 Dust measurements on floor and furniture in the main living room Total fungi concentration dichotomised at the median (high and low exposure) | Daily symptoms (wheezing, cough), and medication use Asthma severity (five levels) expressed as mild (reference, 0 or 1) or severe (3 or 4), level 2 not included in the analyses Total and specific IgE | Association between high fungal concentration and asthma severity in all children: aOR 2.02 (95% CI 1.14–3.56) and in nonatopic children: aOR 2.40 (95% CI 1.06–5.44), but not in atopic children: 1.69 (0.77–3.75) |
Casas, HITEA project: Spain, the Netherlands, Finland [35] | 419 children (aged 6–12 years) from 25 schools: 106 children from 8 schools in Spain, 150 children from 11 schools in the Netherlands, 163 children from 6 schools in Finland Follow-up: 1 year | School with or without (reference) moisture damage: number, extent, severity and location of dampness, and moisture damage observations recorded during inspections | Three symptom diaries: a 2-week diary starting before the summer school holiday (May–July 2009), a 3-week diary starting at the end of the summer holiday (August–October 2009) and a 2-week diary during winter and spring (January–May 2010) 16 symptoms in the past 24 h: wheeze, shortness of breath, dry cough during day or at night, phlegm, woken up… and severity (no symptom, slight, moderate or severe) | Holiday and weekends were associated with lower scores Results were heterogeneous across the three countries In Spain, all adjusted IRRs <1 for summer holiday (ref. school day) in schools with moisture damage: lower respiratory symptoms IRR 0.61 (95% CI 0.46–0.81), upper respiratory or allergy symptoms 0.78 (95% CI 0.63–0.93), other symptoms 0.64 (95% CI 0.49–0.83) Similar results in Finland for summer holiday and weekend All random-effect combined IRRs <1 |