摘要：Objectives. We investigated the relation between respiratory symptoms and exposure to water-damaged homes and the effect of respirator use in posthurricane New Orleans, Louisiana. Methods. We randomly selected 600 residential sites and then interviewed 1 adult per site. We created an exposure variable, calculated upper respiratory symptom (URS) and lower respiratory symptom (LRS) scores, and defined exacerbation categories by the effect on symptoms of being inside water-damaged homes. We used multiple linear regression to model symptom scores (for all participants) and polytomous logistic regression to model exacerbation of symptoms when inside (for those participating in clean-up). Results. Of 553 participants (response rate=92%), 372 (68%) had participated in clean-up; 233 (63%) of these used a respirator. Respiratory symptom scores increased linearly with exposure ( P <.05 for trend). Disposable-respirator use was associated with lower odds of exacerbation of moderate or severe symptoms inside water-damaged homes for URS (odds ratio (OR)=.51; 95% confidence interval (CI)=0.24, 1.09) and LRS (OR=0.33; 95% CI=0.13, 0.83). Conclusions. Respiratory symptoms were positively associated with exposure to water-damaged homes, including exposure limited to being inside without participating in clean-up. Respirator use had a protective effect and should be considered when inside water-damaged homes regardless of activities undertaken. In August and September 2005, Hurricanes Katrina and Rita caused unprecedented flooding in New Orleans, Louisiana. In the aftermath, visible mold growth occurred in approximately 44% of area homes. 1 Air sampling for mold spores conducted in October and November 2005 showed high levels both indoors and outdoors. 2 Similar sampling in October 2005 showed elevated levels of endotoxin, a bacterial cell wall component, in water-damaged homes. 3 A 2004 Institute of Medicine report concluded that sufficient evidence exists for associating the presence of mold or other dampness-related agents in damp buildings with nasal and throat symptoms, cough, wheeze, asthma exacerbations in sensitized asthmatics, and hypersensitivity pneumonitis. 4 Since that report, there has been additional evidence to suggest that asthma can develop during childhood 5 and in the occupational setting 6 as a result of exposure to dampness or mold. The conditions in New Orleans after the hurricanes thus posed a potential health risk to thousands of returning residents. In light of these circumstances, public health officials made recommendations on the use of personal protective equipment. Among these was the recommendation for the general public to use particulate respirators when around mold-contaminated dust, such as might be encountered during clean-up activities. 7 , 8 The risk of health effects for residents involved in activities less likely to disturb mold-contaminated materials, such as visually inspecting the interior of an affected home or collecting belongings, was thought to be lower. Thus, for such activities, the public was advised that respirators were not usually needed. 8 Although respiratory illness and asthma exacerbations have been noted following flooding, 9 the contributory role to respiratory disease of postflood exposure to water-damaged homes has not been well documented. We sought to better understand the relation between respiratory symptoms and exposure to water-damaged homes in posthurricane New Orleans. Given the recommendation about respirator use and the observation that respirator use was common among the public following the hurricanes, 10 a second objective was to determine the effect of respirator use on symptoms. We conducted a population-based investigation to address these issues.
