Background: Previous research has found relationships between specific indoor environmental exposures and exacerbation of asthma.
Objectives: The current review provides an updated summary of knowledge from the scientific literature on indoor exposures and exacerbation of asthma.
Methods: Peer-reviewed articles on indoor exposures and exacerbation of asthma were identified through PubMed from 2000 to 2013, from reference lists, and from authors’ files. Articles focused on modifiable indoor exposures in relation to frequency or severity of exacerbation of asthma were selected for review. Research findings were reviewed and summarized with consideration of the strength of the evidence.
Results: Sixty-nine eligible articles were included. Major changed conclusions include: a causal relationship with exacerbation for indoor dampness-related agents (in children); associations with exacerbation for dampness-related agents (in adults), endotoxin, and ETS (in pre-school children); and limited or suggestive evidence for association with exacerbation for indoor culturable Penicillium or total fungi, NO2, rodents (nonoccupational), feather/down pillows (protective relative to synthetic bedding), and (regardless of specific sensitization) dust mite, cockroach, dog, and dampness-related agents.
Discussion: This review, incorporating evidence reported since 2000, increases the strength of evidence linking many indoor factors to the exacerbation of asthma. Conclusions should be considered provisional until more thorough examination of all available evidence.
Conclusion: Multiple indoor exposures, especially dampness-related agents, merit increased attention to prevent exacerbation of asthma, possibly even in non-sensitized individuals. Additional research to establish causality and evaluate interventions is needed for these and other indoor exposures.
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