{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T01:04:46Z","timestamp":1759971886966,"version":"build-2065373602"},"reference-count":41,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"crossref","award":["338679"],"award-info":[{"award-number":["338679"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002341","name":"Academy of Finland","doi-asserted-by":"crossref","award":["339666"],"award-info":[{"award-number":["339666"]}],"id":[{"id":"10.13039\/501100002341","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100008487","name":"Sosiaali- ja Terveysministeri\u00c3\u00b6","doi-asserted-by":"publisher","award":["VN\/9508\/2021"],"award-info":[{"award-number":["VN\/9508\/2021"]}],"id":[{"id":"10.13039\/501100008487","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>New asthma is considered the most important possible long-term consequence of indoor dampness and mold. However, there are no prospective studies available from schools, there is insufficient evidence on dose-response, and no consensus on how exposure should be assessed. In Finland, visible mold is rare in schools and invasive methods are used to detect mold hidden in building structures.<\/jats:p>\n<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To test if extent and severity of mold damage in school buildings increases the risk of new use of drugs for airway obstruction among students with a dose-response.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Extent of mold damage in 110 Finnish primary and secondary school buildings in 2004 was estimated based on all technical inspections done by 2021. New asthma (n\u2009=\u20091,035) and use of drugs for obstructive airway diseases (n\u2009=\u20093,162) among 30,418 students by 2019 was defined based on drug purchases. Multilevel Cox models were adjusted for confounders obtained from Medical Birth Register.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Extensive mold damage was common. Nine buildings had no or small mold damage, 19 buildings limited, 44 wide and 38 very wide damage in 2004. No association with onset of asthma was observed neither in all students nor in students with previous obstructive airway problems. Among primary school students, there was some suggestion for an association with new use of drugs for obstructive airway diseases, but with highest risk in buildings with limited damage.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The results from this unique and large follow-up study suggest that assessment of the extent and severity of mold damage inside building structures in Finnish schools do not identify buildings, in which students are at increased risk of developing asthma.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333486","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:48:30Z","timestamp":1759945710000},"page":"e0333486","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Inspection confirmed mold damage in schools and new use of drugs for airway obstruction: A cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1083-8777","authenticated-orcid":true,"given":"Juha","family":"Pekkanen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8082-1041","authenticated-orcid":true,"given":"Martin","family":"T\u00e4ubel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauri","family":"Lehtim\u00e4ki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tero","family":"Marttila","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2257-2934","authenticated-orcid":true,"given":"Anne M.","family":"Karvonen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"pone.0333486.ref001","volume-title":"WHO guidelines for indoor air quality: dampness and mould","author":"World Health Organization","year":"2009"},{"key":"pone.0333486.ref002","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5414\/ALX02444E","article-title":"AWMF mold guideline \u201cMedical clinical diagnostics for indoor mold exposure\u201d - Update 2023 AWMF Register No. 161\/001","volume":"8","author":"J Hurra\u00df","year":"2024","journal-title":"Allergol Select"},{"issue":"7","key":"pone.0333486.ref003","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1111\/all.16051","article-title":"The impact of indoor pollution on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma","author":"I Agache","year":"2024","journal-title":"Allergy"},{"issue":"6","key":"pone.0333486.ref004","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1111\/ina.12588","article-title":"Does dampness and mold in schools affect health? Results of a meta-analysis","volume":"29","author":"WJ Fisk","year":"2019","journal-title":"Indoor Air"},{"issue":"7012","key":"pone.0333486.ref005","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1136\/bmj.311.7012.1053","article-title":"Home environment and severe asthma in adolescence: a population based case-control study","volume":"311","author":"DP Strachan","year":"1995","journal-title":"BMJ"},{"issue":"6","key":"pone.0333486.ref006","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1289\/ehp.1002410","article-title":"Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence","volume":"119","author":"MJ Mendell","year":"2011","journal-title":"Environ Health Perspect"},{"issue":"3","key":"pone.0333486.ref007","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1111\/ina.12342","article-title":"Observation-based metrics for residential dampness and mold with dose-response relationships to health: A review","volume":"27","author":"MJ Mendell","year":"2017","journal-title":"Indoor Air"},{"issue":"4","key":"pone.0333486.ref008","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1111\/ina.12464","article-title":"Measured moisture in buildings and adverse health effects: A review","volume":"28","author":"MJ Mendell","year":"2018","journal-title":"Indoor Air"},{"issue":"4","key":"pone.0333486.ref009","article-title":"Quantitative and semiquantitative estimates of mold exposure in infancy and childhood respiratory health","volume":"4","author":"J Cox","year":"2020","journal-title":"Environ Epidemiol"},{"issue":"4","key":"pone.0333486.ref010","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/ina.12550","article-title":"The challenge for microbial measurements in buildings","volume":"29","author":"MJ Mendell","year":"2019","journal-title":"Indoor Air"},{"key":"pone.0333486.ref011","volume-title":"Damp Buildings, Human Health, and HVAC Design Report of the ASHRAE Multidisciplinary Task Group: Damp Buildings Representing ASHRAE TC 1.12, Moisture Management in Buildings","author":"R Peters","year":"2020"},{"issue":"5","key":"pone.0333486.ref012","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1111\/ina.12574","article-title":"Parental worry about indoor air quality and student symptom reporting in primary schools with or without indoor air quality problems","volume":"29","author":"J-J Nissil\u00e4","year":"2019","journal-title":"Indoor Air"},{"issue":"9","key":"pone.0333486.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-036873","article-title":"Psychosocial factors and indoor environmental quality in respiratory symptom reports of pupils: a cross-sectional study in Finnish schools","volume":"10","author":"K Savelieva","year":"2020","journal-title":"BMJ Open"},{"key":"pone.0333486.ref014","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jobe.2017.12.010","article-title":"Need to repair moisture- and mould damage in different structures in Finnish public buildings","volume":"16","author":"PJ Annila","year":"2018","journal-title":"J Build Eng"},{"key":"pone.0333486.ref015","author":"P Annila","year":"2022"},{"issue":"2","key":"pone.0333486.ref016","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/j.1742-7843.2009.00494.x","article-title":"The Nordic countries as a cohort for pharmacoepidemiological research","volume":"106","author":"K Furu","year":"2010","journal-title":"Basic Clin Pharmacol Toxicol"},{"key":"pone.0333486.ref017","unstructured":"Finnish Medical Birth Register. Available from: https:\/\/thl.fi\/en\/statistics-and-data\/data-and-services\/register-descriptions\/newborns"},{"issue":"8","key":"pone.0333486.ref018","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"E von Elm","year":"2007","journal-title":"Ann Intern Med"},{"issue":"12","key":"pone.0333486.ref019","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1164\/rccm.201810-1868CI","article-title":"Inhaled Corticosteroid Therapy in Adult Asthma. Time for a New Therapeutic Dose Terminology","volume":"199","author":"R Beasley","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"pone.0333486.ref020","doi-asserted-by":"crossref","first-page":"1902476","DOI":"10.1183\/13993003.02476-2019","article-title":"NORDSTAR: paving the way for a new era in asthma research","volume":"55","author":"K Geale","year":"2020","journal-title":"Eur Respir J"},{"issue":"11","key":"pone.0333486.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0047526","article-title":"Residential dampness and molds and the risk of developing asthma: a systematic review and meta-analysis","volume":"7","author":"R Quansah","year":"2012","journal-title":"PLoS One"},{"issue":"3","key":"pone.0333486.ref022","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1289\/ehp.7242","article-title":"Home dampness and molds, parental atopy, and asthma in childhood: a six-year population-based cohort study","volume":"113","author":"JJK Jaakkola","year":"2005","journal-title":"Environ Health Perspect"},{"issue":"3","key":"pone.0333486.ref023","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1183\/09031936.00040806","article-title":"Moisture damage and childhood asthma: a population-based incident case-control study","volume":"29","author":"J Pekkanen","year":"2007","journal-title":"Eur Respir J"},{"issue":"3","key":"pone.0333486.ref024","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2014-1239","article-title":"Moisture damage and asthma: a birth cohort study","volume":"135","author":"AM Karvonen","year":"2015","journal-title":"Pediatrics"},{"key":"pone.0333486.ref025","doi-asserted-by":"crossref","first-page":"23002","DOI":"10.1051\/e3sconf\/202017223002","article-title":"Comprehensive assessment brings out shortcomings in almost every school building","volume":"172","author":"T Marttila","year":"2020","journal-title":"E3S Web Conf"},{"key":"pone.0333486.ref026","volume-title":"Building moisture and indoor air quality assessment]. Helsinki: Ministry of the Environment","author":"M Pitk\u00e4ranta","year":"2016"},{"key":"pone.0333486.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-981-10-0466-7_1","article-title":"Practical experiences from several moisture performance assessments.","volume-title":"Recent developments in building diagnosis techniques","author":"PJ Annila","year":"2016"},{"key":"pone.0333486.ref028","volume-title":"Condition investigation of moisture and mould damaged buildings]","author":"M Viljanen","year":"1997"},{"key":"pone.0333486.ref029","unstructured":"Finlex. Decree of the Ministry of Social Affairs and Health on health-related conditions of housing and other residential buildings and qualification requirements for third-party experts. Available from: 2015. https:\/\/www.finlex.fi\/en\/"},{"key":"pone.0333486.ref030","volume-title":"ir tightness, indoor climate and energy economy of detached houses and apartments]","author":"J Vinha","year":"2009"},{"issue":"1","key":"pone.0333486.ref031","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1080\/15428110308984800","article-title":"Effect of building frame and moisture damage on microbiological indoor air quality in school buildings","volume":"64","author":"T Meklin","year":"2003","journal-title":"AIHA J (Fairfax, Va)"},{"issue":"1","key":"pone.0333486.ref032","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/ACI.0b013e328342309d","article-title":"The early origins of asthma: who is really at risk?","volume":"11","author":"PD Sly","year":"2011","journal-title":"Curr Opin Allergy Clin Immunol"},{"issue":"5","key":"pone.0333486.ref033","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1136\/oemed-2012-100963","article-title":"Mould and dampness in dwelling places, and onset of asthma: the population-based cohort ECRHS","volume":"70","author":"D Norb\u00e4ck","year":"2013","journal-title":"Occup Environ Med"},{"issue":"3","key":"pone.0333486.ref034","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1111\/ina.12072","article-title":"Next-generation DNA sequencing reveals that low fungal diversity in house dust is associated with childhood asthma development","volume":"24","author":"KC Dannemiller","year":"2014","journal-title":"Indoor Air"},{"issue":"1","key":"pone.0333486.ref035","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/ina.12413","article-title":"Indoor visible mold and mold odor are associated with new-onset childhood wheeze in a dose-dependent manner","volume":"28","author":"C Shorter","year":"2018","journal-title":"Indoor Air"},{"issue":"1","key":"pone.0333486.ref036","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jaip.2023.09.034","article-title":"Comorbidity Burden in Severe and Nonsevere Asthma: A Nationwide Observational Study (FINASTHMA)","volume":"12","author":"H Kankaanranta","year":"2024","journal-title":"J Allergy Clin Immunol Pract"},{"key":"pone.0333486.ref037","author":"Asthma. Current Care Guidelines","year":"2022"},{"issue":"8","key":"pone.0333486.ref038","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1002\/pds.3465","article-title":"Validation of asthma and eczema in population-based Swedish drug and patient registers","volume":"22","author":"AK \u00d6rtqvist","year":"2013","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"pone.0333486.ref039","volume-title":"The impact of demographic structure and regional differentiation on Helsinki\u2019s tax base]","author":"M Vaattovaara","year":"2002"},{"key":"pone.0333486.ref040","doi-asserted-by":"crossref","first-page":"708","DOI":"10.5334\/bc.366","article-title":"Risk factors for moisture damage presence and severity in Finnish homes","volume":"4","author":"J Taylor","year":"2023","journal-title":"Buildings Cities"},{"issue":"5","key":"pone.0333486.ref041","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1111\/j.1600-0668.2012.00775.x","article-title":"Rhinosinusitis and mold as risk factors for asthma symptoms in occupants of a water-damaged building","volume":"22","author":"J-H Park","year":"2012","journal-title":"Indoor Air"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333486","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:48:43Z","timestamp":1759945723000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333486"}},"subtitle":[],"editor":[{"given":"Thomas","family":"Behrens","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":41,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333486","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,8]]}}}