Asthma and asthma-like symptoms occur more often among people living in humid indoor climates. It has been postulated that the higher concentration of allergens in these environments is the cause for the increase in the number of affected people. However, poor correlations between allergen concentration and symptoms indicate a missing link between allergen exposure and onset of asthma. Respiratory viruses have been identified in up to 85% cases of asthma or exacerbations of asthma. The missing link between respiratory diseases and humid indoor climates could therefore be attributed to viruses. The infectious effectiveness of respiratory viruses depends strongly on the environment where the viruses are spread. For respiratory viruses, survival and infectivity are dependent on temperature and relative humidity. A direct link between virus-induced inflammation and the asthmatogenic process has been proposed. Therefore, a more effective spreading of viral infections in damp indoor climates is likely to represent the main cause for the increased prevalence of asthma in these environments. Moreover, the incidence of viral infections is higher in patients with asthma compared with that in control subjects. Therefore, a humid indoor climate could also represent a higher risk for persons already sensitized to one or more allergens.
Practical implications: In epidemiological studies where the relationship between moisture in the indoor climate, respiratory symptoms and exposure to allergens is investigated it will be necessary to analyze the role of respiratory viruses in relation to respiratory symptoms. Today, the necessary techniques to address the presence of viruses [e.g. polymerase chain reaction (PCR), antibodies] are highly sensitive. In order to further our understanding of why the frequency of asthma and atopic diseases is still increasing, it is mandatory to implement these methods.