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Executive Summary
Pages 1-18

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From page 1...
... There is ample justification for this speculation. We know, for example, that individuals spend nearly all of their time indoors most of it in their own homes and that many of the exposures thought to be associated with asthma occur predominately indoors.
From page 2...
... Other publications, cited throughout the report, go into greater detail on specific issues. The major topics addressed in the report are the following: · the definition of asthma and the characteristics of its clini cal presentation (Chapter 1~; · methodologic issues in evaluating the evidence regarding indoor air exposures and asthma, including the categorizations used to summarize the evidence and the framework for considering exposure to indoor sources (Chapter 2~;
From page 3...
... ; · the pathophysiology of asthma that is, the molecular mechanisms that underlie the structural and functional changes in the lungs and airways of asthmatics (Chapter 4~; · the committee's review of the state of the scientific literature regarding indoor air exposures and the exacerbation and development of asthma Table 1 lists the biologic and chemical ex posures addressed in this report. (Chapters 5-7~; · the scientific literature on general exposures in indoor environments (Chapters 8-9~; and · how indoor exposures to pollutants associated with the incidence or symptoms of asthma are affected by building ventilation and particle air cleaning (Chapter 10~.
From page 4...
... i] CONCLUSIONS ABOUT THE RELATIONSHIP BETWEEN INDOOR EXPOSURES AND ASTHMA The committee used a uniform set of categories to summarize its conclusions regarding the association between exposure to an indoor agent and asthma development and exacerbation, and the effectiveness of exposure mitigation and prevention measures.
From page 6...
... Epidemiologic investigations, challenge studies, and clinical experience have yielded solid information on the potential for many indoor exposures to exacerbate asthma. The committee found sufficient evidence to conclude that there is a causal relationship between · exposure to the allergens produced by cats, cockroaches, and house dust mites, and exacerbations of asthma in sensitized individuals; and · ETS exposure and exacerbations of asthma in preschoolaged children.
From page 7...
... , Chiamydia pneumonias, and Mycoplasma pneumonias, and exacerbation of asthma; · chronic ETS exposure and exacerbation of asthma in older children and adults; · acute ETS exposure and exacerbation of asthma in individuals responsive to this exposure; · nonacute, nonoccupational formaldehyde exposure and wheezing and other respiratory symptoms; and · exposure to certain fragrances and the manifestation of respiratory symptoms in asthmatics sensitive to such exposures. Inadequate or insufficient information was identified to determine whether or not exacerbations of asthma result from nonacute, nonoccupational exposures to cow, horse, and rodent allergens; endotoxins; houseplants2 or cut flowers; the bacterial agent Chiamydia trachomatis; pesticides; plasticizers; and volatile organic compounds (VOCs)
From page 8...
... It is thus difficult to study the determinants of and influences on asthma development. An additional complication stems from the fact that some of the most provocative evidence regarding development comes from studies of infants.
From page 9...
... At concentrations that may occur only when gas appliances are used in poorly ventilated mittee concluded there is sufficient evidence of a causal relationship between exposure to house dust mite allergen and the development of asthma in susceptible children. This conclusion was based on the preponderance of several lines of evidence, including the results of clinical studies and population-based, casecontrol, and prospective epidemiologic investigations; the consis
From page 10...
... Published case reports, public health surveillance of physician reporting, and cross-sectional studies of building occupants with indoor air quality complaints also provide limited or suggestive evidence of an association between aspects of the nonindustrial indoor environment and the development of asthma, with a building occupancy-related pattern of symptoms and in some instances objective abnormalities. What is lacking for the most part, however, is knowledge of specific etiologic agents in these nonindustrial indoor environments that might be responsible for new work-related asthma cases.
From page 11...
... TABLE 3 Summary of Finclings Regarcling the Association Between Indoor Biologic and Chemical Exposures and the Development of Asthma Biologic Agents Chemical Agents Sufficient Evidence of a Causal Relationship House dust mite Sufficient Evidence of an Association (no agents met this definition) Limited or Suggestive Evidence of an Association Cockroach (in preschool-aged children)
From page 12...
... The science regarding indoor environmental interventions, exposure limitation, and effects on asthma outcomes is not nearly as well developed as that regarding the health effects of exposures. Exposure assessments is often the weakest link in environmental health studies because it is difficult to do and is given inadequate attention by many researchers.
From page 13...
... Extermination alone appears ineffective because significant allergen levels remain in settled dust; cleaning alone in the absence of complete extermination does not eliminate the sources of the allergen. There was inadequate or insufficient evidence to determine whether or not an association exists between any cockroach mitigation or prevention strategy and transient or long-term improvement of symptoms or Jung function in cockroach-allergic asthmatics.
From page 14...
... It is possible to physically remove accessible growing fungi from indoor environments. The entry of fungal spores from outdoors can be substantially reduced in mechanically ventilated buildings by pressurizing them and filtering incoming air; closing windows should also reduce indoor concentrations from outdoor sources.
From page 15...
... Theoretical and limited empirical data indicate that particle air cleaners are most likely to be effective in reducing the exacerbation of asthma symptoms associated with particles smaller than approximately 2 ,um, such as ETS particles5 and some airborne cat allergen. There is insufficient evidence to determine whether or not the use of particle air cleaners is associ 4The indoor concentrations of some pollutants from outdoors particulate matter and ozone, for example may increase with the ventilation rate.
From page 16...
... Subsequent chapters of this report contain specific recommendations for further research on the biologic and chemical agents addressed and on the characteristics of indoor environments that may influence asthma outcomes. A digest of these recommendations is contained in Chapter 11.
From page 17...
... , measurement of exposure, rigorous study design, appropriate population selection, and generalizability of the findings are among the issues that are often not adequately addressed. Indoor environments typically include exposures to multiple potentially problematic agents dust mites and fungi, for example, are ubiquitous.
From page 18...
... Asthma research clearly needs interdisciplinary involvement not only of clinicians, immunologists, and researchers in related biologic areas but also of engineers, architects, materials manufacturers and others who are responsible for the design and function of indoor environments. Collaborations should be fostered, and consideration should be given to formulating mode!


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