Original Articles: Asthma, Lower Airway Diseases
Household airborne Penicillium associated with peak expiratory flow variability in asthmatic children

https://doi.org/10.1016/S1081-1206(10)60139-1Get rights and content

Background

Exposure to airborne fungi has been associated with increased airway hyperreactivity and asthma prevalence.

Objective

To investigate the association between common indoor fungi and airway hyperreactivity measured by peak expiratory flow variability in asthmatic children.

Methods

Children 6 to 12 years of age (n = 225) with a physician diagnosis of asthma were enrolled in the study to have their peak expiratory flow recorded twice daily during a 2-week period. Genus-specific, quantitative, in-home airborne mold concentrations were measured. Logistic regression models were used to examine the relationship between a mean peak expiratory flow variability greater than 18.5% (75th percentile) and any mold in the home (total mold, Cladosporium, Penicillium, Aspergillus, and Alternaria).

Results

Mold was detected in 93% of the homes. The most common molds were Cladosporium in 72% and Penicillium in 42% of the samples. Controlling for sex, ethnicity, age, and winter season of sampling, Penicillium measured in the home was associated with a mean peak expiratory flow variability greater than 18.5% (odds ratio, 2.4; 95% confidence interval, 1.2–4.8). Greater peak expiratory flow variability was not associated with total mold or other mold measured in the home.

Conclusion

Exposure to airborne Penicillium is associated with increased peak expiratory flow variability in asthmatic children.

Section snippets

INTRODUCTION

For epidemiologic studies that evaluate asthma, peak expiratory flow (PEF) monitoring permits multiple measurements each day for a prolonged period and thus can measure day to day variations in lung function. Previous studies1, 2, 3, 4, 5, 6 have demonstrated associations between fungal exposure and respiratory symptoms in asthmatic patients.

It has been suggested that PEF variability (PEFV) better reflects the dynamic nature of asthma and may help avert impending asthma exacerbations.7, 8, 9

METHODS

The study population consisted of 322 children with physician-diagnosed asthma. These children were enrolled in a cross-sectional study that involved a 2-week trial of in-home PEF monitoring as a part of a larger study of 466 children that evaluated environmental determinants of childhood asthma severity.5, 10 Homes were located in Connecticut and Western Massachusetts. Of the 322 individuals in the present study, 307 (95%) met our age criterion of 6 to 12 years and the American Thoracic

RESULTS

Study children participated in the 2-week PEF monitoring period for a mean (SD) of 6 (3) days. More than half (65%) of the individuals participated for 3 to 8 days; 11% contributed fewer than 3 days of data, 23% had 9 to 13 days, and less than 1% (0.9%) had a full 14 days of data. Unadjusted associations between personal characteristics and PEF measurements are given in Table 1. Girls, children with allergies, and children whose only medication was short-acting inhalers had significantly

DISCUSSION

To our knowledge, this study is the largest to evaluate the association between directly measured indoor home fungi and PEFV. Our data suggest that exposure to Penicillium is associated with PEFV in asthmatic children. Exposure to indoor fungal allergens is important because of both the high percentage of time spent indoors14 and data suggesting the importance of fungal antigens across a variety of allergic diseases, including chronic rhinosinusitis,15 atopic conjunctivitis,16 and atopic

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    Disclosures: Authors have nothing to disclose.

    Funding Sources: This work was supported by grants ES07456 and ES05410 from the National Institute of Environmental Health Sciences, National Institutes of Health.

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