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Association between fungal spore exposure in inner-city schools and asthma morbidity
Sachin N Baxi1, William J Sheehan1, Joanne E Sordillo2
1Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Background:
Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students.
Objective:
To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma.
Methods:
In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period.
Results:
Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels.
Conclusion:
Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed.
Clinical Trial Registration:
Clinicaltrials.govNCT01756391.
Insights
Classroom fungus exposure, particularly Alternaria, is linked to increased asthma symptoms in sensitized children. This highlights the importance of monitoring indoor air quality in schools for students with asthma.
Area of Science:
- Environmental Health
- Pediatric Allergy and Immunology
- Respiratory Medicine
Background:
- Home fungal exposures are known asthma triggers.
- The impact of school/classroom fungal exposures on childhood asthma morbidity is not well understood.
Purpose of the Study:
- To investigate the association between school-based fungal exposures and asthma symptoms in students with asthma, considering their sensitization status.
Main Methods:
- A prospective study followed 280 children with asthma from 37 inner-city schools for one year.
- Classroom air samples were collected twice for fungal spore analysis.
- Asthma symptom frequency (days with symptoms per 2-week period) was tracked and correlated with fungal exposure levels.
Main Results:
- Fungal spores were detected in all classrooms, with significant variability in concentration.
- Exposure to Alternaria spores was significantly associated with increased asthma symptom days in students sensitized to Alternaria.
- Highly exposed, sensitized students experienced 3.2 more symptom days per 2-week period compared to less exposed sensitized students.
Conclusions:
- Children with asthma sensitized to Alternaria may experience more symptom days when exposed to this fungus in their classroom environment.
- Classroom fungal exposure is a relevant factor in asthma symptom exacerbation for sensitized children.
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