The impact of indoor air pollution on asthma

Dong Won Park; Sang-Heon Kim; Ho Joo Yoon

doi:10.4168/aard.2017.5.6.312

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

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Allergy, Asthma & Respiratory Disease 2017; 5(6): 312-319.

Published online: 30 November 2017

DOI: https://doi.org/10.4168/aard.2017.5.6.312

The impact of indoor air pollution on asthma

Dong Won Park, Sang-Heon Kim, Ho Joo Yoon

Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

Correspondence to: Ho Joo Yoon. Department of Internal Medicine, Hanyang University Seoul Hospital, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2290-8349, Fax: +82-2-2298-9183, hjyoon@hanyang.ac.kr

Received 1 September 2017 Revised 13 October 2017 Accepted 16 October 2017

The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

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.

Keywords: Air pollution, Indoor air quality, Asthma

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

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

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).”

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