Journal List > Allergy Asthma Respir Dis > v.5(6) > 1059282

Park, Kim, and Yoon: The impact of indoor air pollution on asthma

Abstract

Asthma is a common, chronic respiratory disease which is a serious issue for healthcare worldwide. When treating asthma, the main therapeutic goals are to achieve good control of symptoms and to prevent exacerbation. The interaction between genetic predisposition and environmental triggers contributes to the pathophysiology of asthma. In this regard, there is growing public awareness of the risk associated with poor indoor air quality. Because people spend considerable amounts of time every day indoors, it is important to identify and control risk factors in the indoor environment impacting individuals susceptible to asthma for successful treatment and prevention. Along with particulate matter, ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, volatile organic compounds, and second-hand smoke are the most common types of air pollutants encountered indoors. This review highlights epidemiological and experimental data on the role of indoor air pollution in the development and aggravation of asthma. Despite some studies showing significant associations between exposure to indoor air pollution and asthma morbidity, conflicting conclusions are drawn in the literature because of limitations in study design, variation in the methods for assessing exposure, possible confounding factors, and other issues. This review will improve our understanding and facilitate the establishment of a better strategy for asthma management and prevention.

Figures and Tables

Table 1

Sources of indoor air pollutants and the strength of evidence linking specific indoor air pollutant exposure to exacerbation of asthma in asthmatic individuals

aard-5-312-i001
Pollutant Sources Strength of evidence related to exacerbation of asthma (IOM 2015 updated*)
Particulate matter (PM) Numerous sources including combustion (cigarettes, wood stoves, fireplaces, cooking, candles); resuspended materials (crustal, industrial operations, house dust) Not included in IOM reports
Ozone (O3) Infiltration of outdoor air; ozone generating air purifiers (air cleaning device with high voltage); office machines (photocopiers) Not included in IOM reports
Nitrogen dioxide (NO2) Kerosene heaters, unvented gas heaters, gas stove, tobacco smoke, auto exhaust from attached garages Limited or suggestive evidence of an association (despite of confounding effect by other consistently correlated emissions from gas stoves)
Sulfur dioxide (SO2) Primarily associated with oil and coal burning appliances; unvented or malfunctioning kerosene, gas, wood or coal burning appliances Not included in IOM reports
Environmental tobacco smoke (ETS) Cigarettes, cigars, and pipes Sufficient evidence of an association (chronic ETS exposure in preschool-age children); limited or suggestive evidence of an association (chronic ETS exposure in older children and adults); limited or suggestive evidence of an association (acute ETS exposure in asthmatics sensitive to ETS exposure)
Carbon monoxide (CO) Unvented or malfunctioning gas appliances, wood stoves, fireplaces, tobacco smoke Not included in IOM reports
Formaldehyde, other aldehydes Composite wood products such as plywood and particleboard, furnishings, wallpaper, paints, adhesives, insulations, combustion appliances; tobacco smoke Limited or suggestive evidence of an association, particularly in formaldehyde (nonoccupational exposure) through enhanced response to other allergens
Volatile organic chemicals (VOCs; benzene, chloroform, paradichlorobenzene, methylene chloride, phthalates, styrene) Solvents, glues, cleaning agents, pesticides, building materials, paints, treated water, moth repellents, dry-cleaned clothing, air fresheners Inadequate or insufficient evidence, in indoor residential VOC exposures (other than formaldehyde)

IOM, Institute of Medicine of the National Academies (in United States).

*In 2000, the Committee on the Assessment of Asthma and Indoor Air of the IOM reviewed and summarized the scientific evidence for relationship between indoor air pollutant exposures and the exacerbation and development of asthma. Recently, IOM reported update to the 2000 review.47

Table 2

Interventions to reduce indoor air pollution

aard-5-312-i002
Interventions on the source of pollution (source control)
 Alternative fuels
 Improved stoves
Interventions to the living environment (improving ventilation)
 Heating, ventilation, and air conditioning system
Interventions to user behavior (air cleaner)
 Mechanical filters (high efficiency particulate air)
 Electrostatic precipitators
 Sorption filters
 Photocatalytic oxidation cleaners
 Ozone generators

Notes

This study was funded by the Korea Ministry of Environment (MOE) as “the Environmental Health Action Program (2016001360003).”

References

1. Kim CY, Park HW, Ko SK, Chang SI, Moon HB, Kim YY, et al. The financial burden of asthma: a nationwide comprehensive survey conducted in the republic of Korea. Allergy Asthma Immunol Res. 2011; 3:34–38.
2. Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med. 2009; 180:59–99.
3. Dougherty RH, Fahy JV. Acute exacerbations of asthma: epidemiology, biology and the exacerbation-prone phenotype. Clin Exp Allergy. 2009; 39:193–202.
4. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014; 383:1581–1592.
5. Kim SH, Yang HJ, Jang AS, Kim SH, Song WJ, Kim TB, et al. Effects of particulate matter in ambient air on the development and control of asthma. Allergy Asthma Respir Dis. 2015; 3:313–319.
6. Yang HJ, Kim SH, Jang AS, Kim SH, Song WJ, Kim TB, et al. Guideline for the prevention and management of particulate matter/yellow dust-induced adverse health effects on the patients with bronchial asthma. J Korean Med Assoc. 2015; 58:1034–1043.
7. Klepeis NE, Nelson WC, Ott WR, Robinson JP, Tsang AM, Switzer P, et al. The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants. J Expo Anal Environ Epidemiol. 2001; 11:231–252.
8. Ristovski ZD, Miljevic B, Surawski NC, Morawska L, Fong KM, Goh F, et al. Respiratory health effects of diesel particulate matter. Respirology. 2012; 17:201–212.
9. Wallace LA, Mitchell H, O'Connor GT, Neas L, Lippmann M, Kattan M, et al. Particle concentrations in inner-city homes of children with asthma: the effect of smoking, cooking, and outdoor pollution. Environ Health Perspect. 2003; 111:1265–1272.
10. Jaakkola MS, Jaakkola JJ. Effects of environmental tobacco smoke on the respiratory health of adults. Scand J Work Environ Health. 2002; 28:Suppl 2. 52–70.
11. Delva J, Tellez M, Finlayson TL, Gretebeck KA, Siefert K, Williams DR, et al. Cigarette smoking among low-income African Americans: a serious public health problem. Am J Prev Med. 2005; 29:218–220.
12. Cibella F, Cuttitta G, Della Maggiore R, Ruggieri S, Panunzi S, De Gaetano A, et al. Effect of indoor nitrogen dioxide on lung function in urban environment. Environ Res. 2015; 138:8–16.
13. Lin W, Brunekreef B, Gehring U. Meta-analysis of the effects of indoor nitrogen dioxide and gas cooking on asthma and wheeze in children. Int J Epidemiol. 2013; 42:1724–1737.
14. Harrison RM, Thornton CA, Lawrence RG, Mark D, Kinnersley RP, Ayres JG. Personal exposure monitoring of particulate matter, nitrogen dioxide, and carbon monoxide, including susceptible groups. Occup Environ Med. 2002; 59:671–679.
15. Mølhave L, Kjaergaard SK, Sigsgaard T, Lebowitz M. Interaction between ozone and airborne particulate matter in office air. Indoor Air. 2005; 15:383–392.
16. Breysse PN, Buckley TJ, Williams D, Beck CM, Jo SJ, Merriman B, et al. Indoor exposures to air pollutants and allergens in the homes of asthmatic children in inner-city Baltimore. Environ Res. 2005; 98:167–176.
17. Hubbard HF, Coleman BK, Sarwar G, Corsi RL. Effects of an ozone-generating air purifier on indoor secondary particles in three residential dwellings. Indoor Air. 2005; 15:432–444.
18. Wieslander G, Norbäck D, Björnsson E, Janson C, Boman G. Asthma and the indoor environment: the significance of emission of formaldehyde and volatile organic compounds from newly painted indoor surfaces. Int Arch Occup Environ Health. 1997; 69:115–124.
19. Holguin F. Traffic, outdoor air pollution, and asthma. Immunol Allergy Clin North Am. 2008; 28:577–588. viii–ix.
20. Pénard-Morand C, Raherison C, Charpin D, Kopferschmitt C, Lavaud F, Caillaud D, et al. Long-term exposure to close-proximity air pollution and asthma and allergies in urban children. Eur Respir J. 2010; 36:33–40.
21. Morgenstern V, Zutavern A, Cyrys J, Brockow I, Koletzko S, Krämer U, et al. Atopic diseases, allergic sensitization, and exposure to traffic-related air pollution in children. Am J Respir Crit Care Med. 2008; 177:1331–1337.
22. McCormack MC, Breysse PN, Hansel NN, Matsui EC, Tonorezos ES, Curtin-Brosnan J, et al. Common household activities are associated with elevated particulate matter concentrations in bedrooms of inner-city Baltimore pre-school children. Environ Res. 2008; 106:148–155.
23. Arif AA, Shah SM. Association between personal exposure to volatile organic compounds and asthma among US adult population. Int Arch Occup Environ Health. 2007; 80:711–719.
24. Treyster Z, Gitterman B. Second hand smoke exposure in children: environmental factors, physiological effects, and interventions within pediatrics. Rev Environ Health. 2011; 26:187–195.
25. Wu P. Maternal smoking during pregnancy and its effect on childhood asthma: understanding the puzzle. Am J Respir Crit Care Med. 2012; 186:941–942.
26. Gilliland FD, Berhane K, McConnell R, Gauderman WJ, Vora H, Rappaport EB, et al. Maternal smoking during pregnancy, environmental tobacco smoke exposure and childhood lung function. Thorax. 2000; 55:271–276.
27. Gilliland FD, Berhane K, Li YF, Rappaport EB, Peters JM. Effects of early onset asthma and in utero exposure to maternal smoking on childhood lung function. Am J Respir Crit Care Med. 2003; 167:917–924.
28. Mészáros D, Burgess J, Walters EH, Johns D, Markos J, Giles G, et al. Domestic airborne pollutants and asthma and respiratory symptoms in middle age. Respirology. 2014; 19:411–418.
29. Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012; 129:735–744.
30. Zacharasiewicz A. Maternal smoking in pregnancy and its influence on childhood asthma. ERJ Open Res. 2016; 2(3):pii: 00042-2016.
31. Annesi-Maesano I, Hulin M, Lavaud F, Raherison C, Kopferschmitt C, de Blay F, et al. Poor air quality in classrooms related to asthma and rhinitis in primary schoolchildren of the French 6 Cities Study. Thorax. 2012; 67:682–688.
32. Rumchev K, Spickett J, Bulsara M, Phillips M, Stick S. Association of domestic exposure to volatile organic compounds with asthma in young children. Thorax. 2004; 59:746–751.
33. Smedje G, Norbäck D, Edling C. Asthma among secondary schoolchildren in relation to the school environment. Clin Exp Allergy. 1997; 27:1270–1278.
34. Garrett MH, Hooper MA, Hooper BM, Rayment PR, Abramson MJ. Increased risk of allergy in children due to formaldehyde exposure in homes. Allergy. 1999; 54:330–337.
35. Rumchev KB, Spickett JT, Bulsara MK, Phillips MR, Stick SM. Domestic exposure to formaldehyde significantly increases the risk of asthma in young children. Eur Respir J. 2002; 20:403–408.
36. McGwin G, Lienert J, Kennedy JI. Formaldehyde exposure and asthma in children: a systematic review. Environ Health Perspect. 2010; 118:313–317.
37. Lehmann I, Thoelke A, Rehwagen M, Rolle-Kampczyk U, Schlink U, Schulz R, et al. The influence of maternal exposure to volatile organic compounds on the cytokine secretion profile of neonatal T cells. Environ Toxicol. 2002; 17:203–210.
38. Garrett MH, Hooper MA, Hooper BM, Abramson MJ. Respiratory symptoms in children and indoor exposure to nitrogen dioxide and gas stoves. Am J Respir Crit Care Med. 1998; 158:891–895.
39. Diette GB, Hansel NN, Buckley TJ, Curtin-Brosnan J, Eggleston PA, Matsui EC, et al. Home indoor pollutant exposures among inner-city children with and without asthma. Environ Health Perspect. 2007; 115:1665–1669.
40. Henderson AJ. The effects of tobacco smoke exposure on respiratory health in school-aged children. Paediatr Respir Rev. 2008; 9:21–27.
41. Kattan M, Gergen PJ, Eggleston P, Visness CM, Mitchell HE. Health effects of indoor nitrogen dioxide and passive smoking on urban asthmatic children. J Allergy Clin Immunol. 2007; 120:618–624.
42. Stein RT, Holberg CJ, Sherrill D, Wright AL, Morgan WJ, Taussig L, et al. Influence of parental smoking on respiratory symptoms during the first decade of life: the Tucson Children's Respiratory Study. Am J Epidemiol. 1999; 149:1030–1037.
43. Jin Y, Seiber EE, Ferketich AK. Secondhand smoke and asthma: what are the effects on healthcare utilization among children? Prev Med. 2013; 57:125–128.
44. Lin HC, Park JY, Seo DC. Comprehensive US statewide smoke-free indoor air legislation and secondhand smoke exposure, asthma prevalence, and related doctor visits: 2007-2011. Am J Public Health. 2015; 105:1617–1622.
45. Eisner MD, Yelin EH, Katz PP, Earnest G, Blanc PD. Exposure to indoor combustion and adult asthma outcomes: environmental tobacco smoke, gas stoves, and woodsmoke. Thorax. 2002; 57:973–978.
46. Eisner MD, Klein J, Hammond SK, Koren G, Lactao G, Iribarren C. Directly measured second hand smoke exposure and asthma health outcomes. Thorax. 2005; 60:814–821.
47. Kanchongkittiphon W, Mendell MJ, Gaffin JM, Wang G, Phipatanakul W. Indoor environmental exposures and exacerbation of asthma: an update to the 2000 review by the Institute of Medicine. Environ Health Perspect. 2015; 123:6–20.
48. Belanger K, Holford TR, Gent JF, Hill ME, Kezik JM, Leaderer BP. Household levels of nitrogen dioxide and pediatric asthma severity. Epidemiology. 2013; 24:320–330.
49. Gillespie-Bennett J, Pierse N, Wickens K, Crane J, Howden-Chapman P. Housing Heating and Health Study Research Team. The respiratory health effects of nitrogen dioxide in children with asthma. Eur Respir J. 2011; 38:303–309.
50. Hansel NN, Breysse PN, McCormack MC, Matsui EC, Curtin-Brosnan J, Williams DL, et al. A longitudinal study of indoor nitrogen dioxide levels and respiratory symptoms in inner-city children with asthma. Environ Health Perspect. 2008; 116:1428–1432.
51. Delfino RJ, Quintana PJ, Floro J, Gastañaga VM, Samimi BS, Kleinman MT, et al. Association of FEV1 in asthmatic children with personal and microenvironmental exposure to airborne particulate matter. Environ Health Perspect. 2004; 112:932–941.
52. Koenig JQ, Mar TF, Allen RW, Jansen K, Lumley T, Sullivan JH, et al. Pulmonary effects of indoor- and outdoor-generated particles in children with asthma. Environ Health Perspect. 2005; 113:499–503.
53. McCormack MC, Breysse PN, Matsui EC, Hansel NN, Peng RD, Curtin-Brosnan J, et al. Indoor particulate matter increases asthma morbidity in children with non-atopic and atopic asthma. Ann Allergy Asthma Immunol. 2011; 106:308–315.
54. Simoni M, Carrozzi L, Baldacci S, Scognamiglio A, Di Pede F, Sapigni T, et al. The Po River Delta (north Italy) indoor epidemiological study: effects of pollutant exposure on acute respiratory symptoms and respiratory function in adults. Arch Environ Health. 2002; 57:130–136.
55. Peden DB. Air pollution in asthma: effect of pollutants on airway inflammation. Ann Allergy Asthma Immunol. 2001; 87:6 Suppl 3. 12–17.
56. McDonnell WF. Use of submaximal inhalation and spirometry to assess the effects of ozone exposure. Arch Environ Health. 2004; 59:76–83.
57. Alexis NE, Becker S, Bromberg PA, Devlin R, Peden DB. Circulating CD11b expression correlates with the neutrophil response and airway mCD14 expression is enhanced following ozone exposure in humans. Clin Immunol. 2004; 111:126–131.
58. Ross MA, Persky VW, Scheff PA, Chung J, Curtis L, Ramakrishnan V, et al. Effect of ozone and aeroallergens on the respiratory health of asthmatics. Arch Environ Health. 2002; 57:568–578.
59. Lin M, Chen Y, Burnett RT, Villeneuve PJ, Krewski D. Effect of short-term exposure to gaseous pollution on asthma hospitalisation in children: a bi-directional case-crossover analysis. J Epidemiol Community Health. 2003; 57:50–55.
60. Beach JR, Raven J, Ingram C, Bailey M, Johns D, Walters EH, et al. The effects on asthmatics of exposure to a conventional water-based and a volatile organic compound-free paint. Eur Respir J. 1997; 10:563–566.
61. Park DW, Kim SH, Moon JY, Song JS, Choi J, Kwak HJ, et al. The effect of low-volatile organic compounds, water-based paint on aggravation of allergic disease in schoolchildren. Indoor Air. 2017; 27:320–328.
62. Ezratty V, Bonay M, Neukirch C, Orset-Guillossou G, Dehoux M, Koscielny S, et al. Effect of formaldehyde on asthmatic response to inhaled allergen challenge. Environ Health Perspect. 2007; 115:210–214.
63. Casset A, Marchand C, Purohit A, le Calve S, Uring-Lambert B, Donnay C, et al. Inhaled formaldehyde exposure: effect on bronchial response to mite allergen in sensitized asthma patients. Allergy. 2006; 61:1344–1350.
64. Romieu I, Castro-Giner F, Kunzli N, Sunyer J. Air pollution, oxidative stress and dietary supplementation: a review. Eur Respir J. 2008; 31:179–197.
65. Alexis NE, Carlsten C. Interplay of air pollution and asthma immunopathogenesis: a focused review of diesel exhaust and ozone. Int Immunopharmacol. 2014; 23:347–355.
66. Hulin M, Simoni M, Viegi G, Annesi-Maesano I. Respiratory health and indoor air pollutants based on quantitative exposure assessments. Eur Respir J. 2012; 40:1033–1045.
67. Ormstad H. Suspended particulate matter in indoor air: adjuvants and allergen carriers. Toxicology. 2000; 152:53–68.
68. Pilotto LS, Nitschke M, Smith BJ, Pisaniello D, Ruffin RE, McElroy HJ, et al. Randomized controlled trial of unflued gas heater replacement on respiratory health of asthmatic schoolchildren. Int J Epidemiol. 2004; 33:208–214.
69. Butz AM, Matsui EC, Breysse P, Curtin-Brosnan J, Eggleston P, Diette G, et al. A randomized trial of air cleaners and a health coach to improve indoor air quality for inner-city children with asthma and secondhand smoke exposure. Arch Pediatr Adolesc Med. 2011; 165:741–748.
70. Morgan WJ, Crain EF, Gruchalla RS, O'Connor GT, Kattan M, Evans R 3rd, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004; 351:1068–1080.
71. Lanphear BP, Hornung RW, Khoury J, Yolton K, Lierl M, Kalkbrenner A. Effects of HEPA air cleaners on unscheduled asthma visits and asthma symptoms for children exposed to secondhand tobacco smoke. Pediatrics. 2011; 127:93–101.
72. Chan-Yeung M, Ferguson A, Watson W, Dimich-Ward H, Rousseau R, Lilley M, et al. The Canadian Childhood Asthma Primary Prevention Study: outcomes at 7 years of age. J Allergy Clin Immunol. 2005; 116:49–55.
TOOLS
ORCID iDs

Ho Joo Yoon
https://orcid.org/0000-0002-4645-4863

Similar articles