Occupational and environmental health professionals are confronted with issues concerning the health effects of indoor fungal bioaerosol exposure. This article reviews current data on the health effects of indoor mold exposure and provides practical suggestions for occupational and environmental health practitioners regarding how best to manage these exposures based on published human studies. We conducted MEDLINE searches and reviewed all English language studies on indoor mold exposure (visible survey or objective sampling) and human health effects published from 1966 to November 2002. The main findings of the studies are analyzed in conjunction with plausible association of health effects and fungal exposure. Five case control studies, 17 cross-sectional surveys, and 7 case reports met the selection criteria. Current evidence suggests that excessive moisture promotes mold growth and is associated with an increased prevalence of symptoms due to irritation, allergy, and infection. However, specific human toxicity due to inhaled fungal toxins has not been scientifically established. Methods for measuring indoor bioaerosol exposure and health assessment are not well standardized, making interpretation of existing data difficult. Additional studies are needed to document human exposure-disease and dose-response relationships.

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and conclusions Two groups of patients were followed up for four to eight years after first referral or admission to hospital for intermittent claudication (IC) in a study of the natural history of the disease and of factors determining its outcome. In one series of 60 patients, those who stopped or reduced smoking after referral had a much improved prognosis. Thus even after the diagnosis of IC it is extremely important that patients should be encouraged to stop smoking, since this correctable factor appears to be of greater importance in determining outcome than other medical risk factors for the disease that are less amenable to treatment. In the second study, 160 patients were followed up for eight years after first hospital admission. They had a total of 480 hospital admissions and had spent 11 190 days in hospital; their life expectancy after the age of 60 was about half that of the general population. Age, coronary artery disease, cerebrovascular disease, and diabetes were associated with an adverse outcome.

Disorders related to indoor air quality have become a major concern for primary care physicians, who often are asked to evaluate patients whose symptoms may be caused or aggravated by indoor exposure to mold. In this article, we review the common types of indoor mold and discuss the management of mold exposure and related illnesses.