THE INDOOR ENVIRONMENT AND ITS EFFECTS ON CHILDHOOD ASTHMA

FCAAIA Notes: Irritants to the airway include air pollution (indoor and outdoor), strong odors from paints, cleaning products, etc., particulates (such as dusty areas), and even the odors from indoor molds and mustiness. People with allergy and/or asthma are particularly susceptible, in that their airways are already hyperreactive (“twitchy”). Allergic inflammation of the upper airway (nose) or lower airway (asthma) makes that “twitchiness” worse. In essence, airway irritants have a synergistic (that is, the total effect is greater than the sum of the individual parts) effect with airway inflammation. Controlling and preventing the allergic airway inflammation with daily controller medications reduces the effect of irritants on the airway.

(Source: Medscape, May 10, 2011, http://www.medscape.com/viewarticle/738958?src=mp&spon=38 )

PURPOSE OF REVIEW: Indoor pollutants and allergens cause asthma symptoms and exacerbations and influence the risk of developing asthma. We review recent studies regarding the effects of the indoor environment on childhood asthma.

RECENT FINDINGS: Exposure to some indoor allergens and second hand smoke are causally related to the development of asthma in children. Many recent studies have demonstrated an association between exposure to indoor pollutants and allergens and airways inflammation, asthma symptoms, and increased healthcare utilization among individuals with established asthma. Genetic polymorphisms conferring susceptibility to some indoor exposures have also been identified, and recent findings support the notion that environmental exposures may influence gene expression through epigenetic modification. Recent studies also support the efficacy of multifaceted environmental interventions in childhood asthma.

SUMMARY: Studies have provided significant evidence of the association between many indoor pollutants and allergens and asthma morbidity, and have also demonstrated the efficacy of multifaceted indoor environmental interventions in childhood asthma. There is also a growing body of evidence suggesting that some indoor pollutants and allergens may increase the risk of developing asthma. Future studies should examine mechanisms whereby environmental exposures may influence asthma pathogenesis and expand the current knowledge of susceptibility factors for indoor exposures.

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