High environmental relative moldiness index during infancy as a predictor of asthma at 7 years of age

Abstract

Background: Mold exposures may contribute to the development of asthma, but previous studies have lacked a standardized approach to quantifying exposures.

Objective: To determine whether mold exposures at the ages of 1 and/or 7 years were associated with asthma at the age of 7 years.

Methods: This study followed up a high-risk birth cohort from infancy to 7 years of age. Mold was assessed by a DNA-based analysis for the 36 molds that make up the Environmental Relative Moldiness Index (ERMI) at the ages of 1 and 7 years. At the age of 7 years, children were evaluated for allergic sensitization and asthma based on symptom history, spirometry, exhaled nitric oxide, and airway reversibility. A questionnaire was administered to the parent regarding the child's asthma symptoms and other potential cofactors.

Results: At the age of 7 years, 31 of 176 children (18%) were found to be asthmatic. Children living in a high ERMI value (≥5.2) home at 1 year of age had more than twice the risk of developing asthma than those in low ERMI value homes (<5.2) (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 1.10-6.26). Of the other covariates, only parental asthma (aOR, 4.0; 95% CI, 1.69-9.62) and allergic sensitization to house dust mite (aOR, 4.1; 95% CI, 1.55-11.07) were risk factors for asthma development. In contrast, air-conditioning at home reduced the risk of asthma development (aOR, 0.3; 95% CI, 0.14-0.83). A high ERMI value at 7 years of age was not associated with asthma at 7 years of age.

Conclusions: Early exposure to molds as measured by ERMI at 1 year of age, but not 7 years of age, significantly increased the risk for asthma at 7 years of age.

Figure 1.

The change-point analysis plot. The line at the Environmental Relative Moldiness Index (ERMI) value of 5.2 represents the threshold above which the log_e odds of asthma were relatively constant. The open circles represent the ERMI values in child’s home at age 1 and corresponding probabilities of the child developing asthma at age 7.