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INDEX Access to health care, see Utilization of health care Adolescents chlamydia, 180 dampness and asthma, 173,180 fungi, 168, 173 gender factors, 71 prevalence, 30 smoking, 269, 283-284, 290, 401 symptoms, 24, 26-27 Adoptee studies, 79 Adults, 24 allergic vs nonallergic asthma, 33 cat allergens, 108 chlamydia, 179-180 clinical presentation, 24, 26 cockroach allergens, 132 cow and horse allergens, 121 dampness, 308 endotoxins, 152 fungi, 11,166, 170 molds, 11, 308 mortality, 81 nitrogen dioxide, 229, 231, 254 prevalence, 30, 33 respiratory syncytial virus, 177 rhinovirus, 11, 101 sulfur dioxide, 254 tobacco smoking, 7, 9, 268, 269, 270, 279, 280-281 cessation efforts, 282, 284-285 gender factors, 274-275, 276-277, 278-279 pregnant women, 10, 269, 272- 273, 275, 278, 280, 282, 285-286, 290, 401 twin studies, 78-79 volatile organic compounds, 241, 242 see also Occupational asthma; Pregnant women African Americans, 1, 30-31, 68, 70, 71- 73,77 children, 71, 73, 77 cockroach allergens, 126,129 tobacco smoke, 283, 286, 290, 401 Age factors, general, 27 CDC study, 29, 30 gender and, 27, 71 "growing out of asthma," 26 mortality, 81 prevalence, 73 see also Adolescents; Adults; Children; Infants; Preschool children Agriculture cow and horse allergens, 120-121 endotoxins, 151, 155 425

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426 fungi, 163 pesticides, 235, 236 respiratory syncytial virus, 176 Air cleaning, 3, 14-16,124, 253, 327, 328, 360-386, 417 cat allergens, 111-112,113,114,124, 370-371 climate and weather, 381, 382 cost factors, 363, 382-383 electrostatic precipitators, 362, 370-377 heating, ventilation, and air conditioning systems, 362-363, 364-365, 367, 372-373, 377, 380, 382-383 mites, 380 noise, 363-364, 366, 384 ozone, 252 portable, 363-364, 365, 366, 367, 369, 377-378, 379, 380 research recommendations, 385-386, 404405 standards, 360, 361, 366-367, 369 theoretical considerations, 327-331, 409414 tobacco smoke, 281-282, 289, 369, 370-371, 381 see also High-efficiency particulate air (HEPA) filters; Ventilation Air conditioning, see Heating, ventilation, and air- conditioning (HVAC) systems Airway inflammation, 6, 27-28, 31, 34, 87, 89-90, 92-93, 96, 253 endotoxins, 150, 152 tobacco smoke, 271-272, 278 Airway smooth muscle, 89, 96-98 American Home Appliance Manufacturers, 360 American Lung Association, 378-379 American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), 332, 338, 341-342, 356, 361, 366-367, 369 American Thoracic Society, 310 Animal allergens, 3, 4, 6, 7, 11, 105-124, 417 attitudes toward pets, 117,124 birds, domestic, 7, 9,11,121-123 exposure assessment, general, 57, 58- 59 INDEX prevention and mitigation, general, 13-14, 15, 16 research recommendations, 22,123 124, 136, 150, 394-397 see also Cats; Cows; Dogs; Horses; Insects; Rodents Animal models, 41, 416 cockroach allergens, 129 formaldehyde, 245 ozone, 252 pesticides, 237, 400 plasticizers, 250 tobacco smoke, 273 volatile organic compounds, 241 Annual Housing Survey, 303 Antibiotics, 29, 63 Assays, see Bioassays Attitudes and beliefs air conditioning, 382-383 dampness, 306 fear of attack, 34 "growing out of asthma," 26 office workers, 319 tobacco smoking, 278-279, 280, 284 286 (passim) toward pets, 117,124 Australia, 1,116, 228, 323 Bacteria, see Chlamydia; Endotoxins; Mycoplasma pneumonias Beliefs, see Attitudes and beliefs Bioassays, 106, 128 cockroach allergens, 125,126 dust mites, 137,139, 142 ELISA, 125, 142,184, 398 endotoxins, 151-152, 157-158, 397-398 fungi, 160,162,168, 169 pollen, 190 polymerase chain reaction, 106,184, 398 RAST, 80,107,108,126,160,168, 169, 190 volatile organic compounds, 241 Biological markers, other, 53, 57, 60-61 tobacco smoke, 267-268, 269, 272-273 Birds, domestic, 7, 9,11,121-123 Black persons, see African Americans Breast-feeding, 78 Building Assessment Evaluation Study, 319

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INDEX Building materials, 4-5, 18, 21, 62 formaldehyde, 243, 245 moisture, 299-301, 303 volatile organic compounds, 239 Buildings, nonresidential, 7, 21,183, 316- 326 cat allergens, 112-113,123-124, 321 dog allergens, 113,114-115,123-124, 321 infectious agents, 183 symptoms, 342, 358, 402403 tobacco smoke, 123-124, 266, 270, 283, 321 see also Heating, ventilation, and air- conditioning (HVAC) systems; Occupational asthma; Schools and daycare centers Canada, 228 Carbon dioxide, 241, 347, 357 Carbon monoxide, 225, 265 Cats, 3, 6, 9,11, 12, 13-14, 55,106-114, 116, 123, 141, 395 air cleaning, 111-112,113,114,124, 370-371 children, 109,112, 168 dampness and, 309 exposure assessment, 11, 57, 58-59, 106-108, 123-124 immunoglobin, 107, 110 public buildings, 112-113, 123-124, 321 schools, 112,123-124, 321 ventilation, 356 Cell adhesion molecules, 92-95, 394 Census Bureau, 78 Centers for Disease Control and Prevention, 1, 29-30, 68 Chemical agents, 3, 4, 6, 7-8, 9, 11, 15, 16, 20, 223-262, 323 carbon dioxide, 241, 347, 357 carbon monoxide, 225, 265 fragrances, 3, 9, 11, 247-250 herbicides, 49 see also Formaldehyde; Nitrogen dioxide and nitrogen oxides; Pesticides; Plasticizers; Tobacco smoke, Volatile organic compounds 427 Children, 24-25, 26, 69-70 adoptee studies, 79 African Americans, 71, 73, 77 air cleaning, 385 allergic vs nonallergic asthma, 33 bird allergens, 122 cat allergens, 109,112,168 chlamydia, 179 cockroach allergens, 130-132 cow and horse allergens, 120 dampness and mold, 308, 309 dog allergens, 116-117 dust mite allergens, 9,136,143-144, 168 endotoxins, 152, 155 fungi, 166-172 (passim) Hispanics, 73 incidence and prevalence, 20, 27, 30, 33,67-68,69-70,71,73,78,80 nitrogen dioxide, 227-228, 229-230 pesticides, 234-235 pollen, 190-191 respiratory syncytial virus, 176, 177, 178 rhinovirus, 175-176,181, 183 rodent allergens, 119 spirometry, 34 tobacco smoke, 6, 7,11, 20, 263, 267, 268, 269-281, 283, 286-290, 401 volatile organic compounds, 241, 322, 349 see also Infants; Preschool children; Schools and daycare centers Chlamydia, 3, 7, 9,11,178-180,181,182 Chronic obstructive pulmonary disease, 27-28, 81-82 Cleaning techniques, see Air cleaning Climate and weather, 13 air cleaning, 381, 382 cockroaches, 4, 131-132 dust mites, 62,147-148 fungi, 168 tobacco smoke, 281, 286 ventilation, 334, 335, 339, 340-341, 344, 346, 353, 354-355 see also Dampness and moisture; Heating, ventilation, and air- conditioning systems; Temperature factors Clinical presentation, see Symptoms

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428 Cockroaches, 3, 4, 6, 9, 11, 13, 109, 124- 136, 417 African Americans, 126, 129 bioassays, 125, 126 children, 130-132 infants, 127, 130-131 preschool, 10,11,130-131, 132 climate, 4, 131-132 dampness, 127 dose-response relationships, 130-131, 132 eosinophils, 128-129 exposure assessment, 57, 58,125-126, 132, 329 genetic factors, 132 hospitalization, 130-131 immunoglobin, 125,126,129, 130-131 immunotherapy, 396 occupational asthma, 126 particulate matter, 126,135 pesticides, 133-134, 237 prevention and mitigation measures, 132-136 race/ethnicity, 129 research recommendations, 13-16, 136, 396 respiratory syncytial virus, 131-132 schools and daycare centers, 126-127 socioeconomic status, 126,128,129 standards, 126 symptoms, 128-129,131-132,149, 150 urban areas, 127,128,129,130,134,140 Commercial and institutional buildings, see Buildings, nonresidential Consumer Products Safety Commission, 246 Cosmetics, see Fragrances Cost and cost-effectiveness factors, 22 air cleaning, 363, 382-383 burden of asthma, 68 heating, ventilation, and air- conditioning systems, 346-347, 349, 356, 357, 382-383 methodological considerations, 40 moisture remediation, 305 Cows, 9, 11, 120-121, Dampness and moisture, 4, 7, 14, 18, 298-316, 417 adolescents, 173, 180 INDEX building materials, 299-301, 303 cockroach allergens, 127 dog allergens, 309 dust mites, 142, 145,147-148, 307, 309, 310, 354-355 endotoxins, 151,155, 156 flooding, 303, 306, 311, 321, 402 fungi, 154,168, 171-173, 302, 303, 306-307, 309, 310 geographic factors, 62; see also Climate and weather heating, ventilation, and air- conditioning systems, 300, 307, 310, 319-320, 340-341, 343, 357- 358, 365 measurement of, 302-304, 307, 308 mold, 302, 303, 308, 309, 322 nonresidential buildings, 316; see also "moisture" under Heating, ventilation, and air- conditioning (HVAC) systems public education on, 311, 402 research recommendations, 294, 311, 402 schools, 322 standards, 21, 298, 311, 402 types of, 299-300 ventilation, 300, 307, 310, 319-320, 331, 340-341, 343, 352-353, 354- 355, 357-358, 359 volatile organic compounds, 239 Definitional issues, general, viii, 2, 4, 19, 22-24, 406407 causality, 4547 dose, 55-56 exposure assessment, 12(n.3), 51-54 methodological bias, 4244 prevalence and, 70-71 ventilation, 331 Definition of specific agents bird allergens, 121 cat allergens, 106-107 cockroach allergens, 125-126 cow and horse allergens, 120 chlamydia, 178 dog allergens, 114 dust mites, 137-138, 149 endotoxins, 150-151 formaldehyde, 243-244 fragrances, 247

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INDEX fungi, 158-159, 161 mycoplasma, 180-181 nitrogen dioxide, 224 ozone, 251 particulate matter, 253 pesticides, 234 plants, 184 plasticizers, 250 pollen, 184, 186 respiratory syncytial virus, 176 rhinovirus, 175 rodent allergens, 118 sulfur dioxide, 253-354 tobacco smoke, 264-265 volatile organic compounds, 237 Demographic factors, see Educational attainment; Gender factors; Genetic factors; Geographic factors; Migrant population studies; Race/ethnicity; Socioeconomic status Department of Health and Human Services, 19 see also National Institute for Occupational Safety and Health Diagnosis, see Symptoms DNA, 98,106, 161 Dogs, 3, 6, 9,11,109,114-117,123-124, 141, 321, 395 children, 112 dampness and, 309 exposure assessment, 57, 59,123-124 immunoglobin, 115, 117 public buildings, 113, 114-115, 123- 124, 321 symptoms, 115, 395 Dose-response relationships, 10, 22, 47, 50 cockroach allergens, 130-131,132 dust mites, 146 tobacco smoke, 278-280 Drugs, see Medication Dust mites, see Mites Economic factors, see also Cost and cost- effectiveness factors; Socioeconomic status Education, see Public education Educational attainment, 21, 285, 286 429 Electrostatic precipitators, 362, 370-377 ELISA, 125, 142,184, 398 Emergency department visits, 30, 33, 70, 80 cat allergens, 109 Employment-related asthma, see Occupational asthma Endotoxins, 3, 4, 7, 9, 11, 14, 150-158, 297, 415 agriculture and, 151,155 airway inflammation, 150,152 bioassays, 151-152,157-158, 397-398 children, 152, 155 dampness, 151,155, 156 exposure assessment, 151-152,156 immune system, 153, 154, 157, 158, 397 occupational asthma, 151,155,156 pregnant women, 152 prevention and mitigation, 156-157 research recommendations, 157-158, 397-398 symptoms, 152-156 T lymphocytes, 153, 154, 157,158, 397 urban areas, 155,157 England, 113, 227-228 Environmental Protection Agency Indoor Air Division, 19, 20 Indoor Environments Division, 20 nitrogen dioxide regulation, 224 Office of Research and Development, 20 outreach strategy, 2 ozone, 252 study at hand, vii, 19, 3940 tobacco smoke, 263, 265 Environmental tobacco smoke, see Tobacco smoke Enzyme-linked-immunosorbent assays, see ELISA Enzymes, 90,138-139, 159 Eosinophils, 25-26, 89-90, 92, 93, 95 cockroach allergens, 128-129 Ethnicity, see Race/ethnicity ETS, see Tobacco smoke European Community Respiratory Health Survey, 116 Exercise, 28, 32 Exposure assessment, 12,17, 56-62, 63, 77-78, 223, 224, 402, 406407 bird allergens, 121-122

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430 cat allergens, 11, 57, 58-59,106-108, 123-124 cockroach allergens, 57, 58,125-128, 132, 329 cow and horse allergens, 120 definitional issues, 12(n.3), 51-54 dog allergens, 57, 59,114-115,123-124 dust mites, 56-58, 78,139,142-143, 329 endotoxins, 151-152, 156 formaldehyde, 57, 225, 244 fragrances, 247, 249 fungi, 57, 59,158,162-164,169-173, 174-175, 329 microenvironmental model, 54-55 nitrogen dioxide, 57, 61, 77, 224-226 time factors, 226, 231, 234-235, 399 ozone, 251-252 pesticides, 57, 133, 234-235 plants, 57, 399 pollen allergens, 59,187-188, 329 rhinovirus, 175 rodents, 118, 396 time factors, see "exposure" under Time factors tobacco smoke, 57, 60-61, 77-78, 263, 265-271, 278-280, 286-287, 288 volatile organic compounds, 57, 61 62, 238-242 time factors, 239, 242, 244, 400 see also Bioassays; Dose-response relationships; specific allergens under Prevention and mitigation Gender factors measures Exposure mitigation and prevention, see Prevention and mitigation measures Farm animals, see Cows; Horses Fetuses, see Pregnant women Filters, 360-363, 364-365, 368, 370-375, 377, 417 see also High-efficiency particulate air (HEPA) filters Finland, 116-117, 121 Flooding, 303, 306, 311, 321, 402 Food and Drug Administration, 126 Foreign countries, see International perspectives; specific countries INDEX Formaldehyde, 3, 7, 9,11, 225, 241, 243 247 building materials, 243, 245 exposure assessment, 57, 225, 244 Fragrances, 3, 9, 11, 247-250, 400401 Fungi, 3, 6, 7, 9,14,17,158-175,185 adolescents, 168, 173 adults, 11,166, 170 agricultural, 163 bioassays, 160,162,168, 169 children, 166-172 (passim) dampness and, 154,168,171-173, 302, 303, 306-307, 309, 310 exposure assessment, 57, 59,158, 162-164, 169-173, 174-175, 329 glucans, 159,161, 162 immunotherapy, 168-169 inflammatory response, 160-161 mycotoxins, 159, 161-162 occupational asthma, 163 plant, 185, 186 prevention and mitigation, 173-174 research recommendations, 22,174 175, 186, 307, 398 schools, 170, 322 standards of exposure, 174 symptoms, 164-173, 174-175 temperature factors, 154,156, 306, 322 T lymphocytes, 161 ventilation, 352, 359 adolescents, 71 age and, 27, 71 CDC study, 29, 30 hospitalizations, 70 mortality, 68 nitrogen dioxide, 399 prevalence, 27, 29, 72, 78 tobacco smoke, 274-275, 276-277, 278 279 twin studies, 78 see also Pregnant women Genetic factors, 16,17, 23, 28, 32, 63, 67, 80, 98-99, 110 cat allergens, 106,107 cockroach allergens, 132 DNA, 98,106, 161 endotoxins, 157

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INDEX research recommendations, 99, 394, 396 twin studies, viii, 78-79, 80 Geographic factors, 29-31, 62, 68, 70, 73 dust mites, 147-148 fungal sensitization, 166-167 prevalence, 70, 71, 73, 74-75 rural areas, 120-121, 151, 155, 163, 176, 235, 236 ventilation rates, 335 see also Climate and weather; Dampness and moisture; International perspectives; Urban areas; specific countries Germany, 80, 143, 239 Glucans, 159, 161, 162 Guidelines for the Diagnosis and Management of Asthma, 33, 87 Heating, ventilation, and air- conditioning (HVAC) systems, 3, 14-15, 18, 319-321, 333, 336- 337, 338-347, 353-358, 360 air cleaning, 362-363, 364-365, 367, 372-373, 377, 380, 382-383 beliefs about, 382-383 cost factors, 346-347, 349, 356, 357, 382-383 dust mites, 147, 148 formaldehyde, 244 infectious agents, 183, 299, 343-344, 357-359, 365, 404 moisture, 300, 307, 310, 319-320, 340- 341, 343, 357-358, 365 mold, 321-322 nitrogen dioxide, 225, 231, 233 ozone, 251 preventive measures, 21, 310 schools, 321-322 sulfur dioxide, 254 tobacco smoke, 281, 289 volatile organic compounds, 239, 243 see also Ventilation High-efficiency particulate air (HEPA) filters, 124, 362, 365-366, 367, 369, 384, 395, 405 cat allergens, 112, 113, 114, 124, 395 particulate matter (nonbiologic), 253 research recommendations, 385-386 symptoms, effects on, 370-375, 380 431 Hispanics, 71, 73, 129, 283 Historical perspectives dampness, 303, 305 morbidity and mortality, vii, 3, 29-31, 67-68, 105 nonresidential buildings, 318-319 prevalence, 29-31, 72, 73, 81-82, 105 previous IOM studies, 19-22, 40 risk factor studies, 28-29, 77-78 Horses, 9, 11, 120-121 Hospitalization, 33, 69-70, 81 air cleaning, 374-377 CDC prevalence study, 29-30 cockroach allergens, 130-131 emergency departments, 30, 33, 70, 80, 109 ozone, 252 pollen, 191-192 regional factors, 29-30 socioeconomic status, 79-80 House dust mites, see Mites Houseplants, see Plants Humidity and humidifiers, see Dampness and moisture HVAC, see Heating, ventilation, and air- conditioning (HVAC) systems Immune system, viii, 253, 396 definition of asthma, 22-23 endotoxins, 153, 154, 157, 158, 397 formaldehyde, 245 macrophages, 22, 93, 104, 152-153, 161 see also Inflammatory response; T lymphocytes Immunoassays, see Bioassays Immunoglobin, 31, 34, 57, 88 cat allergens, 107, 110 chlamydia, 180 cockroach allergens, 125, 126, 129, 130-131 dog allergens, 115, 117 dust mites, 137-139, 149 endotoxins, 157 monoclonal antibodies, 125, 142 respiratory syncytial virus, 177, 178 rodent allergens, 119 Immunotherapy, 28, 115, 184 cockroaches, 396 dog allergens, 115 fungi, 168-169

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432 Incidence and prevalence, vii, 1, 21, 22, 29, 67-68, 70-82, 231 adolescents, 30 adults, 30, 33 allergic vs nonallergic asthma, 33 children, 20, 27, 30, 33, 67-68, 69-70, 71,73,78,80 dampness and, 7, 310 definitional issues, 70-71 gender factors, 27, 29, 72, 78 historical perspectives, 29-31, 72, 73, 81-82, 105 international perspectives, 1, 73-74, 76, 77 tobacco smoke, 269, 274-278, 283 Income, see Socioeconomic status Indoor Allergens: Assessing and Controlling Adverse Health Effects, 19-21 Infants, 8, 26, 399, 406407 breast-feeding, 78 chlamydia, 179 cockroach allergens, 127,130-131 dampness and mold, 308 dust mites, 397 nitrogen dioxide, 399 respiratory syncytial virus, 177, 178 rhinovirus, 181 tobacco smoke, 266, 267, 268, 272, 275-278, 286-287, 290 see also Pregnant women Infectious agents, general, 3, 20, 28, 32, 175-184 heating, ventilation, and air- conditioning systems, 183, 299, 343-344, 357-359, 365, 404 nitrogen dioxide exposure and, 231- 232 research recommendations, 183-184, 398-399 ventilation systems, 183, 332-333, 356 see also Chlamydia; Dampness and moisture; Endotoxins; Fungi; Molds; Mycoplasma pneumonias; Respiratory syncytial virus; Rhinovirus Inflammatory response, viii, 31, 32-33, 253 cat allergens, 107 definition of asthma, 22-23 eosinophilic, 25-26, 89-90, 92, 93, 95, 125-129 INDEX fungi, 160-161 nitrogen dioxide, 230-231 research recommendations, 23, 34, 394 see also Airway inflammation; Chronic obstructive pulmonary disease Insects, 9,17,124-125, 185 see also Cockroaches; Mites Institutional and commercial buildings, see Buildings, nonresidential Interleukin, 93, 95, 97, 99 endotoxins, 152,153, 154 International Agency for Research on Cancer, 49 International Classification of Diseases, 30 International perspectives dampness, 304 dust mites, 136-137, 140,146 fungal sensitization, 166-167 prevalence, 1, 73-74, 76, 77 severity, 77 twin studies, 78-79 see also specific countries International Study of Asthma and Allergy in Childhood, 73, 76 Macrophages, 22, 93,104, 152-153,161 Mast cells, 22, 88-89, 90,177 Medication, 23, 33, 96, 371 antibiotics, 29 children, 25 Mexican Americans, 73 Microenvironmental model, 54-55 Migrant population studies, 79 Minority groups, see Race/ethnicity Mites,3,4,6,7,9,10,11,13,17,29,115- 116, 122, 127, 135, 136-150, 165, 178,254,416 air cleaning, 380 bioassays, 137,139, 142 children, 9,136,143-144, 168 climate conditions, 62,147-148 dampness and, 142,145,147-148, 307, 309, 310, 354-355 dose-response relationships, 146 exposure assessment, 56-58, 78,139, 142-143, 329 geographic factors, 147-148; see also "climate conditions" supra and "international perspectives" infra

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INDEX heating, ventilation, and air- conditioning (HVAC) systems, 147, 148 immunoglobin, 137-139, 149 infants, 397 international perspectives, 136-137, 140, 146 plants, 185 prevention and mitigation measures, 145-150, 396-397 research recommendations, 22,123, 150, 394-395, 396-397 schools, 322, 323 symptoms, 139-145 temperature factors, 62, 145; see also "climate conditions" supra T lymphocytes, 137-138 urban areas, 145,146 ventilation, 147,148, 351-352, 353, 354-355, 359 Mitigation measures, see Prevention and mitigation measures Moisture, see Dampness and moisture Molds, 4, 9, 122, 171-173, 302, 303, 308, 309 schools, 321-322, 323 ventilation, 359 Molecular biology, 3, 87, 96-97, 401 cell adhesion molecules, 92-95, 394 see also Genetic factors Monoclonal antibodies, 125,142 Morbidity and mortality, 67-70, 75-77, 79-82, 129 EPA outreach strategy, 2, 20 race/ethnicity, 69, 70, 71-73, 77, 79 socioeconomic status, viii, 69, 79-80, 81 trends, vii, 3, 29-31, 67-68,105 see also Symptoms Mycoplasma pneumonias, 3, 7, 9,11, 180- 181, 182 Mycotoxins, 159, 161-162 National Ambient Air Quality Standards, 224 National Center for Health Statistics, 29 National Cooperative Inner City Asthma Study, 119,130,134 National Health and Nutrition Examination Survey, 70-71 433 National Health Care Survey, 69 National Health Interview Survey, 29, 73,77,79 National Hospital Discharge Survey, 29, 69 National Institute for Occupational Safety and Health, 317, 318, 319 Netherlands, 118,137, 144 New Zealand, 1, 79,109,116,122,140 Nitrogen dioxide and nitrogen oxides, 3, 6, 9, 11, 224-234, 254, 330 adults, 229, 231, 254 children, 227-228, 229-230 exposure assessment, 57, 61, 77, 224- 226 time factors, 226, 231, 234-235, 399 gender factors, 399 heating, ventilation, and air- conditioning systems, 225, 231, 233 infants, 399 infectious diseases, 231-232 inflammatory response, 230-231 pollen and, 190,191 prevention and mitigation measures, 233 regulatory interventions, 224 research recommendations, 234, 399 respiratory syncytial virus, 231 schools, 227-228, 322 socioeconomic status, 226, 399 symptoms, 226-233 tobacco smoke, 228 urban areas, 224, 225, 229-230 ventilation, 225, 231, 233, 351, 357 Noise, air cleaning equipment, 363-364, 366, 384 Nonresidential indoor environments, see Buildings, nonresidential Norway, 78-79,112-113, 322-323 Occupational and Environmental Disease Surveillance Database, 322 Occupational asthma, 27, 41, 118-119, 142, 316-326 agriculture, 120-121,151,155, 163, 235, 236

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434 cockroach allergens, 126 cows and horses, 120-121 endotoxins, 151,155, 156 fungi, 163 pesticides, 235, 236 plant allergens, 185 plasticizers, 250-251 tobacco smoke, 265-266, 270 see also Schools and daycare centers Ozone, 3, 77, 241, 251-252, 330, 352 Ozone Generators That Are Sold as Air Cleaners, 252 Particulate matter, general, 3, 4, 15-16, 32, 77, 95, 225, 252-253, 323 cockroach allergens, 126,135 dog allergens, 117 dose concepts, 55-56 nonresidential buildings, general, 344-345 ventilation, 327-331, 347, 351-352, 356-357, 409-414 see also Air cleaning; Mites; Pollen; Tobacco smoke Passive smoking, see Tobacco smoke Perfumes, see Fragrances Pesticides, 3, 7,11, 234-237 animal models, 237, 400 children, 234-235 cockroach control, 133-134, 237 exposure assessment, 57,133, 234-235 occupational exposures, 235, 236 research recommendations, 237, 399- 400 socioeconomic status, 235 symptoms, 235-238 urban areas, 235 volatile organic compounds, 239 Pets, see Birds, domestic; Cats; Dogs; Pharmacological agents, see Medication Plants, 3, 7, 9,11, 184-186 exposure assessment, 57, 399 fungi, 185, 186 mites, 185 research recommendations, 22,186, 399 see also Pollen Plasticizers, 3, 11, 250-251, 400 Pollen, 3, 8, 9,11,14,122,184-185,186-193 bioassays, 190 INDEX children, 190-191 dose concepts, 55-56 exposure assessment, 59,187-188, 329 nitrogen dioxide and, 190,191 sulfur oxides and, 191-192 symptoms, 187,189-192, 193 Polymerase chain reaction, 106,184, 398 Portable air cleaners, 363-364, 365, 366, 367, 369, 377-378, 379, 380 Poverty, see Socioeconomic status Pregnant women, 27 endotoxins, 152 research recommendations, 17, 21, 22, 290, 399, 401 tobacco smoke, 10, 269, 272-273, 275, 278, 280, 282, 285-286, 290, 401 Preschool children, 6, 9,10, 24-25, 26, 30, 70, 71, 416 cockroach allergens, 10,11,130-131, 132 tobacco smoke, 7, 9,10,11, 25, 266, 270, 276-278, 280, 289 see also Infants Prevalence, see Incidence and prevalence Prevention and mitigation measures, vii, 2, 12-18,20,21,22,33,39,40, 49, 87, 224, 253, 406 cat allergens, 111-114, 395 cockroach allergens, 132-136 dampness and moisture, 298, 305, 310-311, 402 dog allergens, 116-117, 395 dust mites, 145-150, 396-397 endotoxins, 156-157 formaldehyde, 246-247 fragrances, 249-250 fungi, 173-174 heating, ventilation, and air- conditioning systems, 21, 310 infectious agents, 182-183 nitrogen dioxide, 233 pesticides, 237 pollen, 192 rodent allergens, 119-120 schools, 323 socioeconomic status, viii, 285, 290 tobacco smoke, 282-290, 401402 volatile organic compounds, 242-243 see also Air cleaning; Public education; Regulatory interventions; Ventilation

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INDEX Professional associations American Home Appliance Manufacturers, 360 American Lung Association, 378-379 American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), 332, 338, 341-342, 356, 361, 366-367, 369 American Thoracic Society, 310 Public buildings, see Buildings, nonresidential Public education, 20, 21, 39 dampness, 311, 402 tobacco smoking, 282, 284-285, 286- 288, 289 see also Schools and daycare centers Puerto Ricans, 129 RAST, 80,107,108,126,160,168, 169, 190 Race/ethnicity, 1, 10 CDC study, 29, 30 cockroach allergens, 129 Hispanics, 71, 73,129, 283 morbidity and mortality, 69, 70, 71- 73,77,79 prevalence, 71 respiratory syncytial virus, 176 smoking, 283, 285, 286, 290, 401 utilization of health care, 79-80 see also African Americans Radioallergenic absorbent test, see RAST Regional factors, see Geographic factors Regulatory interventions, 283 dampness, 21, 311 formaldehyde, 246 nitrogen dioxide, 224 tobacco smoke, 270, 283 ventilation, 318, 332, 338, 341-342, 356 Research recommendations, 2,16-18, 21, 22, 39, 394407 air cleaning, 385-386, 404405 animal allergens, 22,123-124,136, 150, 394-397 cockroach allergens, 13,136, 396 dampness and moisture, 294, 311, 402 dose-response relationships, 22 dust mites, 22,123,150, 394-395, 396- 397 435 endotoxins, 157-158, 397-398 fragrances, 250, 400401 fungi, 22,174-175,186, 307, 398 genetics, 99, 394, 396 infectious agents, 183-184, 398-399 inflammatory response, 23, 34, 394 nitrogen dioxide and nitrogen oxides, 234, 399 nonresidential buildings, 324-325, 359, 402403 pesticides, 237, 399400 plant allergens, 22,186, 399 plasticizers, 251, 400 pollen, 193 pregnant women, 17, 21, 22, 290, 399, 401 previous IOM study, 21-22 rodent allergens, 395-396 synergistic effects, 62-63 tobacco smoke, 290, 401402 ventilation, 359-360, 403404 volatile organic compounds, 243, 400 Respiratory syncytial virus, 3, 7, 9, 10, 11, 176-178, 181, 182 cockroach allergens, 131-132 infants, 177, 178 nitrogen dioxide, 231 socioeconomic status, 176 Rhinovirus, 3, 6, 9,11,175-176,181,183 Risk factors, general, 28-29, 3940, 67 adoptee studies, 79 historical perspectives, 28-29, 77-78 see also Chemical agents; Dampness and moisture; Demographic factors; Exposure assessment; Genetic factors; Infectious agents, general; Occupational asthma; Tobacco smoke; other specific allergens Rodents, 3, 9,11, 118-120, 396 Rural areas, see Agriculture Schools and daycare centers, 28, 78, 318, 321-323, 324, 417 cat allergens, 112,123-124, 321 cockroach allergens, 126-127 dampness, 322 days of school missed, 77 dog allergens, 123-124, 321 dust mites, 322, 323

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436 fungi, 170, 322 heating, ventilation, and air- conditioning (HVAC) systems, 321-322 infectious agents, 183 molds, 321-322, 323 nitrogen dioxide, 227-228, 322 prevention and mitigation measures, 323 rodent allergens, 118 tobacco smoke, 269-270, 283 ventilation, 321-322, 344-345, 349, 358 Sex-based differences, see Gender factors Smoking, see Tobacco smoke Socioeconomic status, 1,17, 21 cockroach allergens, 126,128,129 hospitalization, 79-80 infectious agents, 183 methodological issues, 43, 63 morbidity and mortality, general, viii, 69, 79-80, 81 nitrogen dioxide, 226, 399 pesticides, 235 prevention and mitigation measures, viii, 285, 290 respiratory syncytial virus, 176 rodent allergens, 395-396 smoking cessation, 285, 290 utilization of health care services, 79- 80 Spirometry, 33-34 Standards air cleaning, 360, 361, 366-367, 369 American Home Appliance Manufacturers, 360 American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE), 332, 338, 341-342, 356, 361, 366-367, 369 cockroach allergens, 126 dampness, 21, 298, 311, 402 fungal exposure assessment, 174 International Classification of Diseases, 30 nitrogen dioxide regulation, 224 ventilation, 318, 332, 338, 341-342, 356 see also Regulatory interventions INDEX Sulfur oxides, 3, 77, 225, 253-254 pollen and, 191-192 Sweden, 114-115,116,121, 241, 245-246, 308, 322, 353 Symptoms, viii, 24-28, 34, 81, 253, 406- 407 adolescents, 24, 26-27 air cleaners, effects on symptoms, 370-377, 378-382 birds, 122, 123 cat allergens, 108-110,111, 395 chlamydia, 179-180 cockroach allergens, 128-129,131- 132, 149, 150 definition of asthma, general, 22, 23, 70-71 dampness-related asthma, 310 dog allergens, 115, 395 dust mites, 139-145 endotoxins, 152-156 formaldehyde, 245-246 fragrances, 247-249, 400401 fungi, 164-173, 174-175 infants, 8 mycoplasma, 181-182, 183-184 nitrogen dioxide, 226-233 nonresidential buildings, 342, 358, 402403 ozone, 252 patients' perception of symptoms, 33 pesticides, 235-238 plants, 185-186 plasticizers, 250-251 pollen allergens, 187,189-192,193 pulmonary function tests, 33-34 respiratory syncytial virus, 177-178 rhinovirus, 175-176 rodent allergens, 118-119 sulfur dioxide, 254 tobacco smoke, 271-278, 279-280, 290 volatile organic compounds, 240-242 Synergistic effects, definition, 62-63; see also specific exposures (e.g., Pollen and" under "Sulfur oxides") Temperature factors, 333, 334, 337, 344, 352 fungi, 154,156, 306, 322

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INDEX mites, 62, 145 moisture, 300, 301-302, 306 mold, 302, 322 schools, 322 volatilized organic compounds, 239, 241, 247, 322 see also Climate and weather; Dampness and moisture; Heating, ventilation, and air- conditioning (HVAC) systems Time factors, 23-24, 48, 52-53, 54 air cleaning, 367-368 days of school missed, 77 exposure, 1, 52-53, 54, 55, 56, 58, 60, 61, 107, 113, 410411, 413 dampness, 302 endotoxins, 156 formaldehyde, 244, 246 fungi, 170, 173-174 nitrogen dioxide, 226, 231, 234- 235, 399 occupational exposures, 317 pesticides, 133 tobacco smoke, 264-271 (passim), 275 volatile organic compounds, 239, 242, 244, 400 ventilation rates, 334, 338, 340, 341, 348, 352 T lymphocytes, 22, 89, 90-95, 99, 396 cow and horse allergens, 121 dust mites, 137-138 endotoxins, 153,154, 157,158, 397 fungi, 161 Tobacco smoke (ETS), 3, 4, 14-15, 55, 95, 263-297, 328, 415 adolescents, 269, 283-284, 290, 401 adults, 7, 9, 268, 269, 270, 279, 280- 281 cessation efforts, 282, 284-285 gender factors, 274-275, 276-277, 278-279 pregnant women, 10, 269, 272- 273, 275, 278, 280, 282, 285-286, 290, 401 African Americans, 283, 286, 290, 401 air cleaning, 281-282, 289, 369, 370- 371, 381 airway inflammation, 271-272, 278 437 attitudes and beliefs, 278-279, 280, 284-286 (passim) biological markers, 267-268, 269, 272 273 children, 6, 7,11, 20, 263, 267, 268, 269-281, 283, 286-290, 401 adolescents, 269, 283-284, 290, 401 infants, 266, 267, 268, 272, 275 278, 286-287, 290 preschool, 7, 9,10,11, 25, 266, 270, 276-278, 280, 289 climate and weather, 281, 286 dampness and, 309 dose-response relationships, 278-280 EPA efforts, 263, 265 exposure assessment, 57, 60-61, 77 78, 263, 265-271, 278-280, 286 287, 288 gender factors, 274-275, 276-277, 278 279 heating, ventilation, and air conditioning systems, 281, 289 infants, 266, 267, 268, 272, 275-278, 286-287, 290 nitrogen dioxide and, 228 nonresidential buildings, 123-124, 266,270,283,321 occupational exposures, 265-266, 270 pregnant women, 10, 269, 272-273, 275, 278, 280, 282, 285-286, 290, 401 prevalence, 269, 274-278, 283 prevention and mitigation measures, 282-290, 401-402 race/ethnicity, 283, 285, 286, 290, 401 regulatory interventions, 270, 283 research recommendations, 290, 401 402 schools, 269-270, 283 socioeconomic status, 285, 290 symptoms, 271-278, 279-280, 290 urban areas, 265-266 ventilation, 281, 289, 347, 356, 369 Treatment, 22, 23-24, 33-34, 87 medication, 23, 25, 29, 33, 96, 371 see also Hospitalization; Prevention and mitigation measures Twin studies, viii, 78-79, 90

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438 United Kingdom, 1, 113, 118-119, 227 228, 263, 271 Urban areas, 1, 17, 69 cockroach allergens, 127, 128, 129, 130, 134, 140 dust mites, 145, 146 endotoxins, 155, 157 infectious agents, 183 nitrogen dioxide, 224, 225, 229-230 pesticides, 235 prevalence, 70, 71, 79 rodent allergens, 119 tobacco smoke, 265-266 volatile organic compounds, 239 Utilization of health care, 69-70, 81 socioeconomic status, 79-80 see also Hospitalization Ventilation, 3, 14-15,18, 327-328, 331 360, 379 air conditioning vs. 382-383 cat allergens, 356 climate conditions, 334, 335, 339, 340 341, 344, 346, 353, 354-355 defined, 331 dust mites, 147, 148, 351-352, 353, 354-355, 359 formaldehyde, 244 fungi, 352, 359 infectious agents, 183, 332-333, 356 moisture, 300, 307, 310, 319-320, 331, 340-341, 343, 352-353, 354-355, 357-358, 359 multifamily apartment buildings, 336-338 nitrogen dioxide, 225, 231, 233, 351, 357 particulate matter, general, 327-331, 347, 351-352, 356-357, 409414 regulatory interventions and standards, 318, 332, 338, 341 342, 356 research recommendations, 359-360, 403404 schools, 321-322, 344-345, 349, 358 single-family residences, 333-335, 348, 354-355, 359 INDEX sulfur dioxide, 254 theoretical considerations, 327-331, 409414 time factors, 334, 338, 340, 341, 348, 352 tobacco smoke, 281, 289, 347, 356, 369 volatile organic compounds, 239, 243, 348-349, 351, 357 see also Air cleaning; Heating, ventilation, and air- conditioning (HVAC) systems Viral agents, 328, 330, 415 see also Respiratory syncytial virus; Rhinovirus Volatile organic compounds, 3, 7, 11, 225, 237-243 adults, 241, 242 bioassays, 241 building materials, 239 children, 241, 322, 349 dampness, 239 exposure assessment, 57, 61-62, 238 242 time factors, 239, 242, 244, 400 heating, ventilation, and air conditioning (HVAC) systems, 239, 243 nonresidential buildings, general, 344-345 pesticides, 239 prevention and mitigation measures, 242-243 research recommendations, 243, 400 schools, 322, 349 symptoms, 240-242 temperature factors, 239, 241, 247, 322 tobacco smoke, 264-265, 272 urban areas, 239 ventilation, 239, 243, 348-349, 351, 357 see also Formaldehyde Water vapor, see Dampness and moisture Weather, see Climate and weather World Health Organization, 263