Timo T. Hugg

Residential Dampness and Molds and the Risk of Developing Asthma: A Systematic Review and Meta-Analysis

Context Studies from different geographical regions have assessed the relations between indoor dampness and mold problems and the risk of asthma, but the evidence has been inconclusive. Objective To assess the relations between indicators of indoor dampness and mold problems and the risk of developing new asthma, and to investigate whether such relations differ according to the type of exposure. Data sources A systematic literature search of PubMed database from 1990 through March 2012 and the reference lists of recent reviews and of relevant articles identified in our search. Study selection Cohort/longitudinal and incident case-control studies assessing the relation between mold/dampness and new asthma were included. Data extraction Three authors independently evaluated eligible articles and extracted relevant information using a structured form. Synthesis Sixteen studies were included: 11 cohort and 5 incident case-control studies. The summary effect estimates (EE) based on the highest and lowest estimates for the relation between any exposure and onset of asthma were 1.50 (95% confidence interval [CI] 1.25–1.80, random-effects model, Q-statistic 38.74 (16), P = 0.001) and 1.31 (95% CI 1.09–1.58, random-effects model, Q-statistic 40.08 (16), P = 0.000), respectively. The summary effect estimates were significantly elevated for dampness (fixed-effects model: EE 1.33, 95% CI 1.12–1.56, Q-statistic 8.22 (9), P = 0.413), visible mold (random-effects model; EE 1.29, 95% CI 1.04–1.60, 30.30 (12), P = 0.001), and mold odor (random-effects model; EE 1.73, 95% CI 1.19–2.50, Q-statistics 14.85 (8), P = 0.038), but not for water damage (fixed-effects model; EE 1.12, 95% CI 0.98–1.27). Heterogeneity was observed in the study-specific effect estimates. Conclusion The evidence indicates that dampness and molds in the home are determinants of developing asthma. The association of the presence of visible mold and especially mold odor to the risk of asthma points towards mold-related causal agents.

Association of indoor dampness and molds with rhinitis risk: a systematic review and meta-analysis.

BACKGROUND A substantial proportion of the worlds population is exposed to indoor dampness-related exposures. Since the 1990s, studies have assessed the relation between indoor dampness and mold and rhinitis, but the evidence has been inconclusive. No previous meta-analysis has been reported on this topic. OBJECTIVE We conducted a systematic review and meta-analysis of studies on the relations between indoor dampness and mold and the risk of different types of rhinitis and investigated whether these relations differ according to the type of exposure. METHODS A systematic search of the Ovid MEDLINE and EMBASE databases was conducted (1950 through August 2012), and reference lists of relevant articles were reviewed. Cross-sectional, case-control, and cohort studies in children or adults were selected according to a priori criteria and evaluated by 3 authors independently. RESULTS Thirty-one studies on rhinitis, allergic rhinitis (AR), or rhinoconjunctivitis were included. In meta-analyses the largest risk was observed in relation to mold odor (rhinitis: 2.18 [95% CI, 1.76-2.71]; AR: 1.87 [95% CI, 0.95-3.68]). The risk related to visible mold was also consistently increased (rhinitis: 1.82 [95% CI, 1.56-2.12]; AR: 1.51 [95% CI, 1.39-1.64]; rhinoconjunctivitis: 1.66 [95% CI, 1.27-2.18]). In addition, exposure to dampness was related to increased risk of all types of rhinitis. CONCLUSION This meta-analysis provides new evidence that dampness and molds at home are determinants of rhinitis and its subcategories. The associations were strongest with mold odor, suggesting the importance of microbial causal agents. Our results provide evidence that justifies prevention and remediation of indoor dampness and mold problems, and such actions are likely to reduce rhinitis.

Exposure to animals and the risk of allergic asthma: a population-based cross-sectional study in Finnish and Russian children

BackgroundThere is little information on potential differences in animal exposure between Finland and Russia and particularly on the effects of animal exposure on asthma among Russian children. The aim of the study was to compare the pet and farm animal exposures and to assess the relations of pre- and postnatal animal exposures to the occurrence of allergic asthma in Finnish and Russian school children.MethodsWe conducted a population-based cross-sectional study in neighbour towns on either side of the Finnish-Russian border; Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7–16 years (response rate 79%). Multivariate logistic regression analysis was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) related to each exposure.ResultsCurrent indoor exposure to pets was more frequent among school children in Svetogorsk than in Imatra (67.5% vs. 56.0%, P < 0.001). Finnish children were exposed more frequently to dogs, whereas Russian children to cats during childhood and to farm animals during pregnancy and infancy. The risk of self-reported allergic asthma was inversely related to indoor dog keeping ever in Finland (adjusted OR 0.35, 95% CI 0.13, 0.95), whereas in Russia the risk of allergic asthma was increased in relation to combined indoor cat exposure during infancy and currently (4.56, 1.10, 18.91). The risk of asthma was elevated in relation to contact to farm animals during pregnancy (Finland: 1.95, 0.69, 5.50; Russia: 1.90, 0.70, 5.17) and early life (Finland: 2.05, 0.78, 5.40; Russia: 1.21, 0.39, 3.73).ConclusionExposure to pets and farm animals during childhood differed significantly between Finland and Russia. Our study provides evidence that early-life exposure to cats increases the risk of asthma whereas exposure to dogs is protective. Our findings suggest that intermittent fetal and early-life exposure to farm animals increases the risk of allergic asthma in urban children visiting farms.

Asthma and allergic rhinitis increase respiratory symptoms in cold weather among young adults.

BACKGROUND The occurrence of cold temperature-related symptoms has not been investigated previously in young adults, although cold weather may provoke severe symptoms leading to activity limitations, and those with pre-existing respiratory conditions may form a susceptible group. We tested the hypothesis that young adults with asthma and allergic rhinitis experience cold-related respiratory symptoms more commonly than young adults in general. METHODS A population-based study of 1623 subjects 20-27 years old was conducted with a questionnaire inquiring about cold weather-related respiratory symptoms, doctor-diagnosed asthma and rhinitis, and lifestyle and environmental exposures. RESULTS Current asthma increased the risk of all cold weather-related symptoms (shortness of breath adjusted PR 4.53, 95% confidence interval 2.93-6.99, wheezing 10.70, 5.38-21.29, phlegm production 2.51, 1.37-4.62, cough 3.41, 1.97-5.87 and chest pain 2.53, 0.82-7.79). Allergic rhinitis had additional effect especially on shortness of breath (7.16, 5.30-9.67) and wheezing (13.05, 7.75-22.00), some on phlegm production (3.69, 2.49-5.47), but marginal effect on cough and chest pain. INTERPRETATION Our study shows that already in young adulthood those with asthma, and especially those with coexisting allergic rhinitis, experience substantially more cold temperature-related respiratory symptoms than healthy young adults. Hence, young adults with a respiratory disease form a susceptible group that needs special care and guidance for coping with cold weather.

Early Respiratory Infections and the Development of Asthma in the First 27 Years of Life

Previous studies have provided contradictory evidence on the role of early childhood respiratory infections in the development of asthma and other allergic diseases during childhood. We investigated early-life respiratory infections as predictors of the development of asthma in a 20-year prospective cohort study (the Espoo Cohort Study, 1991-2011). Information on upper respiratory tract infections (URTIs) and lower respiratory tract infections (LRTIs) was collected with a parent-administered baseline questionnaire covering the preceding 12 months (part 1; n = 2,228), and information on LRTIs leading to hospitalization was obtained from the National Hospital Discharge Registry (part 2; n = 2,568). The incidence of asthma was assessed on the basis of 6-year and 20-year follow-up questionnaires. Adjusted hazard ratios were estimated using Cox proportional hazards models. Both URTIs (adjusted hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.22, 2.19) and LRTIs (adjusted HR = 2.11, 95% CI: 1.48, 3.00) in early childhood were strong predictors of asthma incidence up to young adulthood (ages 20-27 years). A declining age trend was present for both URTIs (P-trend < 0.01) and LRTIs (P-trend < 0.001). In part 2 of our analysis, a significant risk of asthma was found in relation to LRTIs requiring hospitalization (adjusted HR = 1.93, 95% CI: 1.10, 3.38). The results provide new evidence that respiratory tract infections in early life predict the development of asthma through childhood to young adulthood.

Erratum: Allergic diseases and asthma in the family predict the persistence and onset-age of asthma: a prospective cohort study

Author details Center for Environmental and Respiratory Health Research, University of Oulu, Oulu, Finland. Respiratory Medicine Unit, Department of Medicine, Oulu University Hospital, Oulu, Finland. Respiratory Medicine Unit, Institute of Clinical Medicine, University of Oulu, Oulu, Finland. Public Health, Institute of Health Sciences, University of Oulu, Oulu, Finland. Medical Research Center Oulu, University of Oulu, Oulu, Finland.

Fine-Scale Exposure to Allergenic Pollen in the Urban Environment: Evaluation of Land Use Regression Approach

Background: Despite the recent developments in physically and chemically based analysis of atmospheric particles, no models exist for resolving the spatial variability of pollen concentration at urban scale. Objectives: We developed a land use regression (LUR) approach for predicting spatial fine-scale allergenic pollen concentrations in the Helsinki metropolitan area, Finland, and evaluated the performance of the models against available empirical data. Methods: We used grass pollen data monitored at 16 sites in an urban area during the peak pollen season and geospatial environmental data. The main statistical method was generalized linear model (GLM). Results: GLM-based LURs explained 79% of the spatial variation in the grass pollen data based on all samples, and 47% of the variation when samples from two sites with very high concentrations were excluded. In model evaluation, prediction errors ranged from 6% to 26% of the observed range of grass pollen concentrations. Our findings support the use of geospatial data–based statistical models to predict the spatial variation of allergenic grass pollen concentrations at intra-urban scales. A remote sensing–based vegetation index was the strongest predictor of pollen concentrations for exposure assessments at local scales. Conclusions: The LUR approach provides new opportunities to estimate the relations between environmental determinants and allergenic pollen concentration in human-modified environments at fine spatial scales. This approach could potentially be applied to estimate retrospectively pollen concentrations to be used for long-term exposure assessments. Citation: Hjort J, Hugg TT, Antikainen H, Rusanen J, Sofiev M, Kukkonen J, Jaakkola MS, Jaakkola JJ. 2016. Fine-scale exposure to allergenic pollen in the urban environment: evaluation of land use regression approach. Environ Health Perspect 124:619–626; http://dx.doi.org/10.1289/ehp.1509761

The Importance of Family History in Asthma during the First 27 Years of Life

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Awareness of Climate Change and the Dietary Choices of Young Adults in Finland: A Population-Based Cross-Sectional Study

Climate change is a major public health threat that is exacerbated by food production. Food items differ substantially in the amount of greenhouse gases their production generates and therefore individuals, if willing, can mitigate climate change through dietary choices. We conducted a population-based cross-sectional study to assess if the understanding of climate change, concern over climate change or socio-economic characteristics are reflected in the frequencies of climate-friendly food choices. The study population comprised 1623 young adults in Finland who returned a self-administered questionnaire (response rate 64.0%). We constructed a Climate-Friendly Diet Score (CFDS) ranging theoretically from −14 to 14 based on the consumption of 14 food items. A higher CFDS indicated a climate-friendlier diet. Multivariate linear regression analyses on the determinants of CFDS revealed that medium concern raised CFDS on average by 0.51 points (95% confidence interval (CI) 0.03, 0.98) and high concern by 1.30 points (95% CI 0.80, 1.80) compared to low concern. Understanding had no effect on CFDS on its own. Female gender raised CFDS by 1.92 (95% CI 1.59, 2.25). Unemployment decreased CFDS by 0.92 (95% CI −1.68, −0.15). Separate analyses of genders revealed that high concern over climate change brought about a greater increase in CFDS in females than in males. Good understanding of climate change was weakly connected to climate-friendly diet among females only. Our results indicate that increasing awareness of climate change could lead to increased consumption of climate-friendly food, reduction in GHG emissions, and thus climate change mitigation.

Pollen concentrations inside private cars during the Poaceae and Artemisia spp. pollen season – a case study

A growing number of studies are researching indoor air concentrations of pollen in buildings, but to our knowledge no studies have dealt with the precise concentration of pollen inside private cars. The aim of this study was to assess the risk of exposure to pollen in private cars throughout the Poaceae and Artemisia spp. pollen season. The study was conducted in the town of Lappeenranta and along Highway 6 in south‐east Finland between July 14 and August 17, 2003. The pollen concentrations were measured inside two moving and parked cars using rotorod‐type samplers. Surface and ambient Burkard samples were also collected. Both Poaceae and Artemisia spp. pollen were recorded only on one day and in low concentrations (<10 pollen grains per cubic meter, pg/m3) inside moving and parked cars, whereas the concentrations of Betula spp. (0–15 vs. 0–12 pg/m3) and Pinus (0–41 vs. 0–80 pg/m3) ranged from low to moderate, respectively. The number of pollen grains on the inside surfaces of cars ranged from zero to 72 pg/cm2 during the measurement periods. The concentrations of Poaceae and Artemisia spp. pollen in the indoor air of the car during the flowering period were low, therefore, likely to cause reactions only in the most sensitive people. By contrast, even after the main flowering period the concentrations of Betula spp. pollen were on a level high enough to cause reactions in individuals with allergies.