TABLE 3.

Longitudinal studies on occupational asthma related to working in mouldy buildings

First author, location [ref.]	Study design	Mould exposure	Main outcomes	Results
Park, USA [46]	Nested study Cases n=49 Controls n=152 Employees working in a water-damaged building	Floor and chair dust TCF HF Endotoxins Pet allergens	POA	POA (for increasing IQR) and chair dust Single environmental variable  aOR (95% CI) TCF 1.67 (1.07–2.60) HF 1.85 (1.19–2.89) Multiple environmental variables: HF 1.79 (1.12–2.85)
Karvala, FIOH: Finland [42]	Patients assessed between 1995 and 2004 for suspicion of mould-induced OA n=258	Retrospective work exposure: building damage report and microbial analyses	SIC with mould extracts, especially A. fumigatus, C. cladosporioides and A. kiliense Three OA groups: probable, possible, unlikely	Mould duration exposure usually >5 years Sensitisation to moulds: probable: 20.4% possible: 10.7% unlikely: 4.4% Among 133 probable OA (SIC+): A. fumigatus: 85 C. cladosporioides: 26 A. kiliense: 19
Karvala, FIOH: Finland [43]	Longitudinal study over 3–12 years n=483	Exposure: building damage report and microbial analyses	Doctor-diagnosed incident asthma among patients with ALS related to damp workplaces, but without asthma at baseline	Doctor-diagnosed incident asthma No more exposition (ref.) Same remediated OR 2 (95% CI 0.7–5.4) Persistent exposure: OR 4.6 (95% CI 1.8–11.6)
Park, USA [47]	Employees working in a damp building. Baseline n=131 BR-RS without asthma n=361 without BR-RS and asthma at baseline	Floor dust: TCF Ergosterol Endotoxins	BR-AS development	BR-AS development: aOR (95% CI) BR-RS 1.00 (ref.) BR-RS+ 2.24 (1.34–3.72) Baseline TCF 1st tertile 1 (ref.) 2nd tertile 3.59 (1.46–8.83) 3rd tertile: 4.92 (1.90–12.72)
Karvala, FIOH: Finland [44]	Longitudinal study over 3–12 years n=1267	Exposure: building damage report and microbial analyses	Quality of life SF12 physical and mental component scores Four baseline groups n=127 OA n=453 WEA n=483 ALS n=204 URS	SF12, physical component score Mean±sd URS 69.7±28.9 ALS 62.9±29.7 WEA 54.7±30.6 OA 45.4±29.1 p <0.001
Karvala, FIOH: Finland [45]	Longitudinal study over 7–8 years n=1098	Exposure: building damage report and microbial analyses	Self-rated work ability 0: low <scale<10: best Early withdrawal from work owing to disability Four baseline groups n=127 OA n=453 WEA n=483 ALS n=204 URS	Low self-rated work ability (scale <8) %, aOR (95% CI) URS 34%, 1.0 ALS 40%, 1.2 (0.8–1.7) WEA 50%, 1.8 (1.2–2.8) OA 57%, 2.6 (1.4–4.7) Early withdrawal from work %, aOR (95% CI) URS 7%, 1.0 ALS 13%, 1.6 (0.8–3.1) WEA 13%, 1.6 (0.8–3.1) OA 33%, 5.7 (2.8–11.9)

FIOH: Finnish Institute of Occupational Health; TCF: total culturable fungi; HF: hydrophilic fungi; POA: post-occupancy asthma; IQR: interquartile range; aOR: adjusted odds ratio; OA: occupational asthma; SIC: specific inhalation challenge; A. fumigatus: Aspergillus fumigatus; C. cladosporioides: Cladosporium cladosporioides; A. kiliense: Acremonium kiliense; ALS: asthma-like symptoms; BR: building-related; RS: rhinosinusitis; AS: asthma symptoms, WEA: work-exacerbated asthma; URS: upper respiratory symptoms; SF12: 12-item short form survey.