Starting from the Institute of Medicine (IOM) and World Health Organization (WHO) reports, this review provides an overview of the literature published from 2006 to 2017 on the associations between indoor mould exposure and asthma and rhinitis separately in children and adults with a focus on longitudinal epidemiological studies.A systematic search of peer-reviewed literature was performed, including systematic reviews and meta-analyses, longitudinal, incident case–control and panel studies. 61 publications were identified reporting visible mould or mould odour or quantitative assessment of culturable fungi or mould species.In children, visible mould and mould odour were associated with the development and exacerbations of asthma, providing sufficient evidence of a causal relationship. Results from population-based studies in adults were too few and divergent to conclude at more than a limited level of evidence. Exposure to mould in a work building was associated with the incidence and exacerbations of occupational asthma, and we concluded at a sufficient evidence for an association. Systematic reviews, meta-analyses and longitudinal studies on the relationships between mould exposure and allergic rhinitis provide sufficient evidence of an association.This review extended the conclusions of the IOM and WHO reports, and highlighted the need for further longitudinal studies on asthma in adults, and on rhinitis.

Summary: Background Exhaled nitric oxide (eNO) has attracted increasing interest as a non‐invasive marker of airway inflammation in asthma. However, little evidence exists on the influences exerted on eNO by the interrelations among atopic status, asthma and rhinitis.Methods Among the 1156 children who participated in a large‐scale epidemiological survey on asthma and allergies (ISAAC II: International Study of Asthma and Allergies in Childhood Phase II) in the city of Clermont‐Ferrand, 53 asthmatics without corticosteroid treatment and 96 non‐asthmatics were invited to perform eNO and skin prick tests (SPTs) to 12 common allergens.Results Atopic asthmatic children had higher eNO than non‐atopic asthmatic children (28.9±9.1 vs. 17.1±13.1 p.p.b.; P=0.0004) with a significant increase when one SPT or more are positive (26.5±7.8 vs. 17.1±13.1 p.p.b.; P=0.03). Similarly, non‐asthmatic, atopic subjects had higher eNO than non‐atopic subjects with a significant increase when two SPTs or more are positive (19.4±9.8 vs. 11.7 ±6.7 p.p.b.; P=0.003). In the case of equal levels of positive SPTs (0, 1, 2), asthmatic children always had higher eNO than non‐asthmatic ones. Furthermore, among non‐asthmatic children, the eNO level increased only in atopics who had rhinitis (20.7±13 vs. 12.5±6.4 p.p.b. in atopic controls (subjects without rhinitis and asthma) and 12.3±6.6 p.p.b. in non‐atopic controls; P=0.001), whereas among asthmatic children, eNO level increased in atopics independently of rhinitis (28.2±9.5 p.p.b. in those with rhinitis and 30.9±8.1 p.p.b. in those without) as well as in non‐atopics with rhinitis (22.5±17.2 p.p.b.).Conclusions Our data suggest that besides atopy and asthma, allergic rhinitis should also be taken into account in the assessment of eNO.

Background: Assessment of dyspnea in COPD patients relies in clinical practice on the modified Medical Research Council (mMRC) scale, whereas the Baseline Dyspnea Index (BDI) is mainly used in clinical trials. Little is known on the correspondence between the two methods. Methods: Cross-sectional analysis was carried out on data from the French COPD cohort Initiatives BPCO. Dyspnea was assessed by the mMRC scale and the BDI. Spirometry, plethysmography, Hospital Anxiety-Depression Scale, St George’s Respiratory Questionnaire, exacerbation rates, and physician-diagnosed comorbidities were obtained. Correlations between mMRC and BDI scores were assessed using Spearman’s correlation coefficient. An ordinal response model was used to examine the contribution of clinical data and lung function parameters to mMRC and BDI scores. Results: Data are given as median (interquartile ranges, [IQR]). Two-hundred thirty-nine COPD subjects were analyzed (men 78%, age 65.0 years [57.0; 73.0], forced expiratory volume in 1 second [FEV₁] 48% predicted [34; 67]). The mMRC grade and BDI score were, respectively, 1 [1–3] and 6 [4–8]. Both BDI and mMRC scores were significantly correlated at the group level (rho =-0.67; P<0.0001), but analysis of individual data revealed a large scatter of BDI scores for any given mMRC grade. In multivariate analysis, both mMRC grade and BDI score were independently associated with lower FEV₁% pred, higher exacerbation rate, obesity, depression, heart failure, and hyperinflation, as assessed by the inspiratory capacity/total lung capacity ratio. The mMRC dyspnea grade was also associated with the thromboembolic history and low body mass index. Conclusion: Dyspnea is a complex symptom with multiple determinants in COPD patients. Although related to similar factors (including hyperinflation, depression, and heart failure), BDI and mMRC scores likely explore differently the dyspnea intensity in COPD patients and are clearly not interchangeable.

Background: Most panel studies focusing on rhinitis and conjunctivitis symptoms and birch pollen have been performed on a linear basis and have not included air pollution and meteorological variables as potential confounders. The objective of this panel study was to assess the relationship between symptoms of seasonal allergic rhinoconjunctivitis and daily airborne birch pollen concentrations, checking with adequate statistical tools the shapes of concentration-response curves and controlling for confounders. Methods: The severity of rhinitis, conjunctivitis, and bronchial symptoms was recorded daily in March and April 2010 (3,311 person-days) in 61 seasonal allergic rhinoconjunctivitis patients sensitized to birch. Data were analyzed with generalized additive and generalized estimating equation models to quantify the effects of birch pollens. Results: The relationship between birch pollen and the percentage of patients with nasal, ocular and bronchial symptoms was linear until birch daily average concentrations of, respectively, 110, 70, and 70 grains/m3; it reached a plateau thereafter. For an increase of 10 grains/m3, the OR (95% CI) for nasal, ocular, and bronchial symptoms were, respectively, 1.07 (1.03-1.12), 1.17 (1.08-1.27), and 1.12 (1.03-1.21). At the beginning of the season, no nasal or ocular symptoms were observed below a threshold of 30 grains/m3. Conclusions: Adequate modeling regression shows that the clinical response to natural exposure to birch pollen in sensitized patients varies during Betula pollen season, with a threshold at the beginning of the season, while over the whole season the relationship is linear for nasal, ocular, and bronchial symptoms up to a saturation point, followed by a plateau.