The burden of asthma as reflected by the prevalence defined by doctor's diagnosis and the use of healthcare services by preschool children in a Swedish region

Dampness in buildings and health (DBH): Report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden

With the aim of identifying health-relevant exposures in buildings, an epidemiological study "Dampness in Buildings and Health" (DBH) started in the year 2000 in Sweden. The health focus of the study is on asthma and allergic symptoms among small children and their parents. The first step in the study was an epidemiological cross-sectional questionnaire on housing and health involving 14,077 preschool children in the county of Värmland in Sweden (March-April 2000). Self-reported moisture-related problems in the building were strongly associated with asthma, allergic symptoms, and airway infections among children and adults. Other factors associated with symptoms among the children were allergic heredity, smoking in the family, male sex, urban living, short breast feeding, pet keeping, daycare attendance, non-farming life and some food habits. The second step in the study was a nested case-control study including 198 children with symptoms and 202 healthy controls. A detailed clinical examination by physicians in parallel with extensive inspections and measurements in the subjects' homes were conducted from October 2001 to April 2002. The influence of selection bias in case-control studies has been studied, and questionnaires on self-reported symptoms and building characteristics have been validated. Identified risk factors for allergic symptoms are, e.g., inspector-observed dampness, a low ventilation rate, endotoxin, Penicillium and phthalates in dust. In the third phase, a 5-year follow-up study will be carried out during 2005. The same questionnaire as used in DBH-phase 1 will be distributed to the 10,852 children/parents who responded to the first questionnaire in 2000. Finally, in a fourth phase, controlled experimental studies in climate chambers and in vitro tests regarding findings from DBH-Phase 2 are planned to be conducted during 2004-08.

PRACTICAL IMPLICATIONS

Asthma and allergies among small children are associated with a number of risk factors in the indoor environment. In investigations of building-related health problems many factors have to be considered, including "dampness" emissions from building materials, and ventilation rates.