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Original Research: Asthma |

Current Asthma in Schoolchildren Is Related to Fungal Spores in ClassroomsFungal Spores in Classrooms and Children’s Asthma

Chi-Hsien Chen, MD; H. Jasmine Chao, PhD; Chang-Chuan Chan, PhD; Bing-Yu Chen, PhD; Yue Leon Guo, MD, PhD
Author and Funding Information

From the Department of Environmental and Occupational Medicine (Drs C.-H. Chen, Chan, and Guo), National Taiwan University College of Medicine and National Taiwan University Hospital; the School of Public Health (Dr Chao), Taipei Medical University; and the Institute of Occupational Medicine and Industrial Hygiene (Drs Chan, B.-Y. Chen, and Guo), National Taiwan University, Taipei, Taiwan.

CORRESPONDENCE TO: Yue Leon Guo, MD, PhD, Department of Environmental and Occupational Medicine, National Taiwan University (NTU), College of Medicine and NTU Hospital, Room 339, 17 Syujhou Rd, Taipei 100, Taiwan; e-mail: leonguo@ntu.edu.tw


FUNDING/SUPPORT: This study was supported by the Taiwan National Science Council [Grants NSC98-2621-M-002-019 and NSC101-2621-M-002-002]; the Global Research Laboratory [Grant K21004000001-10AO500-00710] through the National Research Foundation funded by the South Korean Ministry of Education, Science, and Technology; and the National Taiwan University Hospital [Grant UN102-071].

Part of this article was presented in abstract form at the 2013 Joint Conference of ISEE, ISES, and ISIAQ on “Environment and Health—Bridging South, North, East and West,” August 19-23, 2013, Basel, Switzerland.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(1):123-134. doi:10.1378/chest.13-2129
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BACKGROUND:  The presence of visible mold in households is associated with asthma. However, the role of “classroom fungus” in the development of childhood asthma, as well as the fungal species that may lead to asthma, remains controversial. This nationwide school survey was conducted to investigate the correlation between fungal spores in classrooms and asthma in schoolchildren.

METHODS:  From April to May 2011, a cross-sectional survey was conducted to assess allergic/asthmatic conditions in schoolchildren aged 6 to 15 years old in 44 schools across Taiwan. Personal histories and current asthmatic conditions were collected using a modified International Study of Asthma and Allergies in Childhood questionnaire. Fungal spores in classroom were collected using a Burkard Personal Air Sampler and counted under light microscopy. Three-level hierarchical modeling was used to determine the complex correlation between fungal spores in classrooms and childhood asthma.

RESULTS:  The survey was completed by 6,346 out of 7,154 parents (88.7%). The prevalences of physician-diagnosed asthma, current asthma, and asthma with symptoms reduced on holidays or weekends (ASROH) were 11.7%, 7.5%, and 3.1%, respectively. The geometric mean spore concentrations of total fungi, Aspergillus/Penicillium, and basidiospores were 2,181, 49, and 318 spores/m3. Aspergillus/Penicillium and basidiospores were significantly correlated with current asthma and ASROH after adjusting for personal and school factors. Of those with current asthma, 41% reported relief of symptoms during weekends.

CONCLUSIONS:  Classroom Aspergillus/Penicillium and basidiospores are significantly associated with childhood asthma and ASROH. Government health policy should explore environmental interventions for the elimination of fungal spores in classrooms to reduce the prevalence of childhood asthma.

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