Clearing the Air Asthma and Indoor Air Exposures (2000) / Chapter Skim
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11 Summary of Research Recommendations and Overall Conclusions
11 Summary of Research Recommendations and Overall Conclusions
Pages 394-408
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From page 394... ...
It emphasizes that much more research, based on combining data from genetic analyses with those identifying pathophysiological processes involved in asthma, is needed to ultimately determine the genetic basis of asthma, as well as the potential development of new strategies for therapeutic intervention. ANIMAL ALLERGENS The associations between dust mite allergen, asthma exacerbation, and asthma development are much more well defined than the associations between larger animals and asthma.
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From page 395... ...
Although frequent animal washing and HEPA filter use are widely recommended, their efficacy in reducing asthma severity has not been proven. The relationship between cat or dog allergen exposure in early childhood, the development of sensitization, and the development of asthma merits further investigation.
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From page 396... ...
Future research should focus on the efficacy of cockroach allergen reduction in the homes of asthmatic patients, the aerodynamic properties of cockroach allergen, the efficacy of cockroach immunotherapy, and B and T cell reactive epitopes. Further studies are also needed to better elucidate any relationship between cockroach allergen exposure and asthma development; explore the interaction of cockroach allergen with infectious agents, irritants, and other allergens in causing asthma; and examine the influences of genetics, socioeconomic status, and location on exposure and sensitization.
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From page 397... ...
These include studies of gene-environment interactions and the risk of developing atopy or asthma, preferably with prospective assessment of endotoxin exposure from birth, improved endotoxin exposure assessment across populations likely to have significant differences in exposure, and studies of endotoxin exposure and asthma severity. Gene-environment interactions between the CD14 polymorphism and endotoxin exposure should take into account that CD14 is a pattern receptor and thus not specific for LPS-LBP complexes.
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From page 398... ...
INFECTIOUS AGENTS Numerous studies suggest an association between the infections discussed in Chapter 5 and asthma exacerbations, although uncertain ascertainment of asthma and questions about the identity of the specific infections responsible limit the confidence with which some conclusions can be drawn. Advances in analysis techniques that allow more sensitive and confident identification of viruses, such as PCR and ELISA, will facilitate research on this topic.
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From page 399... ...
Studies should be conducted to evaluate the ambiguous relationship between pollen exposure, sensitivity, and asthma. Additional research is also needed to discover the extent of indoor pollen allergen exposure and the interactions between pollen sensitivity and air pollutants.
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From page 400... ...
VOLATILE ORGANIC COMPOUNDS With the advent of small, unobtrusive passive diffusion monitors capable of measuring microgram quantities of VOCs in 48hour samples, it should be possible to incorporate personal VOC exposure assessment into future epidemiologic studies addressing environmental factors and asthma, yielding an expanded data base on which to judge the possible role of VOCs in asthma development and exacerbation. Prospective cohort studies that characterize time-averaged personal VOC exposures of study subjects using passive badges and then follow subjects to assess the development and/or exacerbation of asthma could generate information that would allow a more confident assessment of any potential risk.
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From page 401... ...
Additionally, there is a need to develop more effective interventions to achieve sustained pre- and postnatal smoking cessation in pregnant women and mothers, especially those whose children are at higher risk of developing asthma due to their family history, socioeconomic status, and place of residence. Since ETS exposure of children at greatest risk for adverse asthma outcomes (especially low-income and minority children of African-American ancestry)
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From page 402... ...
Development of methods for representative quantitative assessment of bioaerosols of fungal and bacterial origin is a high priority for health outcome studies and hazard assessment. In addition, knowledge of the epidemiology of building-related asthma in problem buildings where there are excess chest complaints among occupants, in comparison to build
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From page 403... ...
To assess how changes in ventilation rates affect indoor humidities and, in turn, the proliferation of dust mites and molds in buildings will require either long-term experiments lasting a year or more or large cross-sectional studies with control for confounding factors. Airtight building envelopes and low rates of ventilation have been cited as factors that may contribute to asthma incidence or symptoms or may explain recent increases in asthma; however, very few relevant data are available.
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From page 404... ...
AIR CLEANING The results of existing experimental studies are inadequate to draw firm conclusions regarding the benefits of air cleaning for asthmatic and allergic individuals. Many of the existing studies have important limitations, such as small study size, lack of blinding, a small or undefined rate of air cleaning, placebo air cleaners that may significantly remove the larger particles associated with asthma, and no exposure assessment or inadequate assessment.
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From page 405... ...
However, experimental data and theoretical predictions indicate that air cleaners with a lower efficiency rating are likely to be equally effective in reducing the concentrations of most, and perhaps all, of the indoor-generated particles associated with allergies and asthma. These lower-efficiency air cleaners could have a lower product cost, less powerful or noisy fans, higher rates of airflow and particle removal, and reduced energy consumption.
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From page 406... ...
Many of the studies reported are not based on rigorous protocols. Definition of clinical outcome especially in infants, measurement of exposure, rigorous study design, appropriate population selection, and dealing with issues of
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From page 407... ...
Although considerable work has been done and is being done on asthma per se, increased research efforts are needed to address the characteristics of healthy indoor environments. 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.
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