Indoor bioaerosols and asthma: Overview, implications, and mitigation strategies

Aerosolized particles with a biological origin are called bioaerosols. Bioaerosols from plants, animals, fungi, bacteria, and viruses are an important class of environmental exposures that are clinically relevant to asthma. However, there are important differences in the pathways by which various bioaerosols affect asthma. Additionally, differences in individual susceptibility to different bioaerosols affect exposure reduction and mitigation strategies. Strategies to reduce exposures to potential triggers of asthma are routinely considered as part of standard clinical care and asthma management guidelines. Ventilation standards in buildings may reduce bioaerosol exposure for everyone, but they are not necessarily designed specifically to protect patients with asthma. Direct measurement of a bioaerosol is not generally necessary for practical applications where the relevant source of the bioaerosol has been identified. Different types of bioaerosols can be controlled with similar strategies that prioritize source control (eg, reducing resuspension, integrated pest management, controlling moisture), and these can be supplemented by enhancing air filtration. The goal of this review is to summarize the latest information on bioaerosols, including allergens, fungi, bacteria, and viruses, that have been associated with adverse asthma outcomes and to discuss mitigation options.