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 for the highest estimates 1.48 (95% confidence interval [CI] 1.23-1.78, random-effects model, Q-statistic 38.75 (16), P = 0.001) ; and for the lowest estimates: 1.27 (95% CI 1.06-1.53, random-effects model, Q-statistic 38.12 (16), P = 0.000) [corrected].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.