Visually observed mold and moldy odor versus quantitatively measured microbial exposure in homes

The main study objective was to compare different methods for assessing mold exposure in conjunction with an epidemiologic study on the development of children's asthma. Homes of 184 children were assessed for mold by visual observations and dust sampling at child's age 1 (Year 1). Similar assessment supplemented with air sampling was conducted in Year 7. Samples were analyzed for endotoxin, (1-3)-β-D-glucan, and fungal spores. The Mold Specific Quantitative Polymerase Chain Reaction assay was used to analyze 36 mold species in dust samples, and the Environmental Relative Moldiness Index (ERMI) was calculated. Homes were categorized based on three criteria: 1) visible mold damage, 2) moldy odor, and 3) ERMI. Even for homes where families had not moved, Year 7 endotoxin and (1-3)-β-d-glucan exposures were significantly higher than those in Year 1 (p < 0.001), whereas no difference was seen for ERMI (p = 0.78). Microbial concentrations were not consistently associated with visible mold damage categories, but were consistently higher in homes with moldy odor and in homes that had high ERMI. Low correlations between results in air and dust samples indicate different types or durations of potential microbial exposures from dust vs. air. Future analysis will indicate which, if any, of the assessment methods is associated with the development of asthma.     

Assessment of endotoxin levels in the home and current asthma and wheeze in school-age children

The relationship between household endotoxin and asthma in children is not clear. To further investigate the relationship between sources of endotoxin and childhood asthma, we conducted a case-control study of children with and without asthma and examined their more frequent household exposures in the home. Children ages 6-13 years with current asthma (n = 70) or wheeze only (n = 19) were sex and age matched (+/-1 year) to 107 controls. Play area and mattress dust were collected for endotoxin analysis. Atopic status was determined by skin prick testing for allergies. A family size of >4 per household was associated with higher endotoxin levels (EU/mg) in the bed dust (P < 0.05). Passive smoking (P < 0.05) and the presence of a cat were associated with higher levels of endotoxin in mattress dust. Endotoxin levels in either the play dust or the bed dust did not differ between cases and controls. Within atopic cases, those with higher endotoxin loads (EU/m2) in bed or play areas were more likely to miss school for chest illness (P < 0.05). In this study, household endotoxin is not a risk factor for current asthma overall but may be associated with increased severity in children with atopic asthma. PRACTICAL IMPLICATIONS: This study did not find that household sources of endotoxin were associated with asthma. However, within atopic asthmatics, asthma severity (as measured by a history of being kept home from school because of a chest illness in the past year) was associated with higher levels of endotoxin in dust from the child's bed. There is a need to further investigate the nature of the relationship between household endotoxin and asthma severity in children which could lead to better management of childhood asthma.     

House dust‐mite allergen exposure is associated with serum specific IgE but not with respiratory outcomes

Exposure to house dust has been associated with asthma in adults, and this is commonly interpreted as a direct immunologic response to dust‐mite allergens in those who are IgE sensitized to house dust‐mite. Mattress house dust‐mite concentrations were measured in a population‐based sample of 2890 adults aged between 27 and 56 years living in 22 centers in 10 countries. Generalized linear mixed models were employed to explore the association of respiratory symptoms with house dust‐mite concentrations, adjusting for individual and household confounders. There was no overall association of respiratory outcomes with measured house dust‐mite concentrations, even in those who reported they had symptoms on exposure to dust and those who had physician‐diagnosed asthma. However, there was a positive association of high serum specific IgE levels to HDM (>3.5 kU_A/l) with mattress house dust‐mite concentrations and a negative association of sensitization to cat with increasing house dust‐mite concentrations. In conclusion, there was no evidence that respiratory symptoms in adults were associated with exposure to house dust‐mite allergen in the mattress, but an association of house mite with strong sensitization was observed.     

Determinants of house dust,endotoxin, and β‐(1→3)‐D‐glucan in homes of Danish children

Little is known about the geographic variation and determinants of bacterial endotoxin and β ‐(1,3)‐d ‐glucan in Danish house dust. In a population of 317 children, we: (i) described loads and concentrations of floor dust, endotoxin, and β‐(1→3)‐d ‐glucan and (ii) their correlations and (iii) assessed their determinants; (iv) Finally, we compared our findings with previous European studies. Bedroom floor dust was analyzed for endotoxin content by the kinetic limulus amoebocyte lysate assay and for β‐(1→3)‐d ‐glucan by the inhibition enzyme immunoassay. The parents answered questions regarding potential determinants. We found: geometric means (geometric standard deviations) 186 mg/m² (4.3) for dust; 5.46 × 10³EU/m² (8.0) and 31.1 × 10³EU/g (2.6) for endotoxin; and 142 μg/m² (14.3) and 0.71 × 10³ μg/g (7.3) for β‐(1→3)‐d ‐glucan. High correlations (r > 0.75) were found between floor dust and endotoxin and β‐(1→3)‐d ‐glucan loads, while endotoxin and β‐(1→3)‐d ‐glucan concentrations were moderately correlated (r = 0.36–0.41) with the dust load. Having a carpet was positively associated with dust load and with endotoxin and β‐(1→3)‐d ‐glucan concentrations. Pet keeping, dwelling type, and dwelling location were determinants of endotoxin concentrations. No other determinants were associated with β‐(1→3)‐d ‐glucan concentrations. Compared with other European studies, we found lower β‐(1→3)‐d ‐glucan loads and concentrations but higher endotoxin loads and concentrations suggesting a geographically determined different composition of Danish floor dust compared with other European regions.     

Effectiveness of portable HEPA air cleaners on reducing indoor endotoxin,PM10, and coarse particulate matter in an agricultural cohort of children with asthma: A randomized intervention trial

We conducted a randomized trial of portable HEPA air cleaners in the homes of children age 6–12 years with asthma in the Yakima Valley, Washington. All families received asthma education while intervention families also received two HEPA cleaners (child's bedroom, living room). We collected 14-day integrated samples of endotoxin in settled dust and PM₁₀ and PM_10-2.5 in the air of the children's bedrooms at baseline and one-year follow-up, and used linear regression to compare follow-up levels, adjusting for baseline. Seventy-one families (36 HEPA, 35 control) completed the study. Baseline geometric mean (GSD) endotoxin loadings were 1565 (6.3) EU/m² and 2110 (4.9) EU/m², respectively, in HEPA vs. control homes while PM₁₀ and PM_10-2.5 were 22.5 (1.9) μg/m³ and 9.5 (2.9) μg/m³, respectively, in HEPA homes, and 19.8 (1.8) μg/m³ and 7.7 (2.0) μg/m³, respectively, in control homes. At follow-up, HEPA families had 46% lower (95% CI, 31%–57%) PM₁₀ on average than control families, consistent with prior studies. In the best-fit heterogeneous slopes model, HEPA families had 49% (95% CI, 6%–110%) and 89% lower (95% CI, 28%–177%) PM_10-2.5 at follow-up, respectively, at 50th and 75th percentile baseline concentrations. Endotoxin loadings did not differ significantly at follow-up (4% lower, HEPA homes; 95% CI, −87% to 50%).     

Levels and predictors of endotoxin in mattress dust samples from East and West German homes

East-West differences in prevalence of asthma and allergies were suggested to be associated with lifestyle factors. To describe endotoxin levels in mattress dust samples from East and West German homes collected approximately 10 years after reunification. To identify factors that may account for an East-West difference. Dust was collected from mattresses of 2157 infants and 2108 mothers living in Leipzig (former East Germany) and Munich (West Germany). Endotoxin was measured using a chromogenic kinetic Limulus amoebocyte lysate test. Data on bedding, dwelling, and housing characteristics, and occupants' behavior were collected using a self-administered questionnaire. Endotoxin levels were significantly higher in Leipzig compared with Munich for the infants' mattresses but not for the mothers' mattresses. Apart from this, predictors for the mothers' and the infants' mattresses were very similar. Pet-ownership and contact with animals outside the home were most influential. Endotoxin levels in mattress dust were highest in summer and increased with the number of persons living in the household. The overall percentage of variability in endotoxin levels explained by these factors was low. Endotoxin levels were associated with lifestyle factors discussed within the framework of the hygiene hypothesis. None of these factors explains the difference in infant's mattress dust endotoxin between Leipzig and Munich or could be used as a surrogate for endotoxin. PRACTICAL IMPLICATIONS: Endotoxin levels in mattress dust are associated with a number of factors discussed in the framework of the hygiene hypothesis; among other things they are associated with pet-ownership, contact with pets and number of persons living in the home. However, none of these factors and not even a combination of factors explains the variability of endotoxin levels between homes.     

Use of a robotic sampling platform to assess young children's exposure to indoor bioaerosols

Indoor exposures to allergens, mold spores, and endotoxin have been suggested as etiological agents of asthma; therefore, accurate determination of those exposures, especially in young children (6-36 months), is important for understanding the development of asthma. Because use of personal sampling equipment in this population is difficult, and in children <1 year of age impossible, we developed a personal sampling surrogate: the Pretoddler Inhalable Particulate Environmental Robotic (PIPER) sampler to better estimate their exposures. During sampling, PIPER simulates the activity patterns, speed of motion, and the height of the breathing zones of young children, and mechanically resuspends the deposited dust just as a young child does during running and crawling. The concentrations of allergens, mold spores, and endotoxin measured by PIPER were compared to those measured using traditional stationary air sampling method in 75 homes in central New Jersey, United States. Endotoxin was detected in all homes with median concentrations of 1.0 and 0.55 EU/m(3) for PIPER and stationary sampler, respectively. The difference in median concentrations obtained using the two methods was statistically significant for homes with carpeted floors (P = 0.0001) in the heating season. For such homes, the average ratio of endotoxin concentration measured by PIPER to the stationary sampler was 2.96 (95% CI 2.29-3.63). Fungal spores were detected in all homes, with median fungal concentrations of 316 and 380 spores/m(3) for PIPER and stationary sampler, respectively. For fungi, the difference between the two sampling methods was not statistically significant. For both sampling methods, the total airborne mold levels were statistically significantly higher in the non-heating season than in the heating season. Allergens were detected in ~15% of investigated homes. The data indicate that the traditional stationary air-sampling methods may substantially underestimate personal exposures to endotoxin, especially due to resuspension of dust from carpeted floor surfaces. A personal sampling surrogate, such as PIPER, is a feasible approach to estimate personal exposures in young children. PIPER should be seriously considered as the sampling platform for future exposure studies in young children. PRACTICAL IMPLICATIONS: This study investigated potential indoor bioaerosol exposure of young children using a Pretoddler Inhalable Particulate Environmental Robotic (PIPER) sampler platform. The results show that the traditional stationary air-sampling methods can substantially underestimate personal exposures to resuspended material, and that a personal sampling surrogate, such as PIPER, offers a feasible surrogate for measuring personal inhalation exposures of young children.     

Investigation of different approaches to reduce allergens in asthmatic children's homes--the Breath of Fresh Air Project, Cornwall, United Kingdom

During 2001 to 2004, a study was conducted to assess the indoor environmental and health impact of installing allergen-reducing interventions in the homes of asthmatic children. Based on the results of a pilot study, to determine an intervention that would provide improved symptom scores and a reduction in house dust mite allergen (Der p 1), mechanical ventilation and heat recovery (MVHR) systems were installed in 16 homes. Environmental and respiratory health assessments were conducted before and after the installation of the MVHR systems. The results indicated that the installation of MVHR systems reduced Der p 1 concentrations in living room carpets and mattresses. There were significant reductions in symptom scores for breathlessness during exercise, wheezing, and coughing during the day and night. Although, there was not a parallel control group for the main study, the lack of change in the pilot study control group (who did not receive an intervention), indicated that the changes in symptom scores were in part to do with the intervention. Larger scale trials are needed to determine the efficacy of MVHR systems in homes to improve indoor air quality and reduce asthma symptoms.     

Dust sampling methods for endotoxin - an essential, but underestimated issue

Exposure to farming environment in early life has been associated with lower risk for allergic diseases possibly caused by increased exposure to endotoxin. The aims of this study were to compare the reproducibility of different sampling methods for endotoxin, and to determine whether environmental characteristics have different effect on endotoxin levels of different sample types. The reproducibility of sampling methods (bed dust, floor dust, vacuum cleaner dust bag dust, settled dust and air samples) was studied with repeated sampling (five visits during 1 year) in five farming and five urban homes. To examine determinants of endotoxin for different types of dust sample, sampling was conducted once in 12 farming and 17 urban homes. Endotoxin was analyzed using Limulus Amebocyte Lysate assay. Bed dust samples had the best reproducibility (intraclass correlation, ICC=66%), but the difference between farming and non-farming homes was not clear with this sample type. The reproducibility of floor (ICC=52%) and settled dust (ICC=51%) was moderate. With these sample types the difference between farming and non-farming homes was clear. Settled dust had some seasonal variation. Based on this study, the best compromise for sampling for endotoxin appears to be floor dust sample followed by bed and settled dust samples. Practical Implications Endotoxins have been widely measured, even though the validity of different sample types to reflect the endotoxin exposure level of an indoor environment is poorly known. This study shows that bed dust samples have the best reproducibility, but they do not reflect the differences in exposure due to environmental factors such as farming. Floor dust samples with moderate reproducibility may be the best choice for sampling of endotoxin in large field studies.     

Are cats and dogs the major source of endotoxin in homes?

Previous studies have suggested that exposure to cats and dogs during early childhood reduces the risk of allergic disease, possibly by increasing home endotoxin exposure. This study asked the question of whether cats and dogs are the dominant influence on dust endotoxin concentrations in homes after considering other variables reportedly associated with endotoxin. The presence of cats or dogs in homes, household and home characteristics, and dust endotoxin concentrations from 5 locations were assessed in 966 urban and suburban homes. Whether considered together as pets or as cats and dogs separately, the presence of cats and dogs significantly contributed to living room and bedroom floor endotoxin concentrations, but not to bed endotoxin concentrations. However, the two variables consistently related to endotoxin in all home sites were the home occupant density (occupants/room) and cleanliness of the home. Our data suggest that reducing occupant density and improving home cleanliness would reduce home endotoxin concentrations more than removing pet cats or dogs from the home.     

Microbial secondary metabolites in homes in association with moisture damage and asthma

We aimed to characterize the presence of microbial secondary metabolites in homes and their association with moisture damage, mold, and asthma development. Living room floor dust was analyzed by LC‐MS/MS for 333 secondary metabolites from 93 homes of 1‐year‐old children. Moisture damage was present in 15 living rooms. At 6 years, 8 children had active and 15 lifetime doctor‐diagnosed asthma. The median number of different metabolites per house was 17 (range 8–29) and median sum load 65 (4–865) ng/m². Overall 42 different metabolites were detected. The number of metabolites present tended to be higher in homes with mold odor or moisture damage. The higher sum loads and number of metabolites with loads over 10 ng/m² were associated with lower prevalence of active asthma at 6 years (aOR 0.06 (95% CI <0.001–0.96) and 0.05 (<0.001–0.56), respectively). None of the individual metabolites, which presence tended (P < 0.2) to be increased by moisture damage or mold, were associated with increased risk of asthma. Microbial secondary metabolites are ubiquitously present in home floor dust. Moisture damage and mold tend to increase their numbers and amount. There was no evidence indicating that the secondary metabolites determined would explain the association between moisture damage, mold, and the development of asthma.     

Electrostatic dust collectors compared to inhalable samplers for measuring endotoxin concentrations in farm homes

Paired electrostatic dust collectors (EDCs) and daily, inhalable button samplers (BS) were used concurrently to sample endotoxin in 10 farm homes during 7‐day periods in summer and winter. Winter sampling included an optical particle counter (OPC) to measure PM_2.5 and PM_2.5–10. Electrostatic dust collectors and BS filters were analyzed for endotoxin using the kinetic chromogenic Limulus amebocyte lysate assay. Optical particle counter particulate matter (PM) data were divided into two PM categories. In summer, geometric mean (geometric standard deviation) endotoxin concentrations were 0.82 EU/m³ (2.7) measured with the BS and 737 EU/m² (1.9) measured with the EDC. Winter values were 0.52 EU/m³ (3.1) for BS and 538 EU/m² (3.0) for EDCs. Seven‐day endotoxin values of EDCs were highly correlated with the 7‐day BS sampling averages (r = 0.70; P < 0.001). Analysis of variance indicated a 2.4‐fold increase in EDC endotoxin concentrations for each unit increase of the ratio of PM_2.5 to PM_2.5–10. There was also a significant correlation between BS and EDCs endotoxin concentrations for winter (r = 0.67; P < 0.05) and summer (r = 0.75; P < 0.05). Thus, EDCs sample comparable endotoxin concentrations to BS, making EDCs a feasible, easy to use alternative to BS for endotoxin sampling.     

Determinants of endotoxin levels in carpets in New Zealand homes

Endotoxin in house dust has been shown to be associated with asthma severity. Little is known about the influence of housing characteristics on endotoxin distribution. Using standardized methods, dust was sampled from a 1m(2) site and the whole accessible carpet area in selected Wellington, New Zealand homes (n = 77). Endotoxin was measured using a Limulus Amoebocyte Lysate assay. Relative humidity and temperature were recorded using sensors placed in carpet bases. Questionnaires were used to collect information on housing characteristics. All analyses were performed for endotoxin units (EU)/mg and EU/m2 for each site. Geometric mean endotoxin levels were 22.7 EU/mg [geometric standard deviation (GSD) = 2.4] or 30,544 EU/m2 (GSD = 3.2) from the 1m(2) site, and 28.4 EU/mg (GSD = 3.4) or 5653 EU/m2 (GSD = 6.4) from the whole room. After controlling for confounding, endotoxin was positively associated with dogs inside [geometric mean ratio (GMR): 0.9-2.0], total household occupants (GMR: 1.7-2.0, for 1 m2 sample only), vacuum cleaners <1-year old (GMR: 2.3-2.7), reusing vacuum dust collection bags (GMR: 1.4-3.1), steamcleaning or shampooing the carpet (GMR: 1.4-2.2) and high relative humidity (GMR: 1.4-1.6). Lower endotoxin was associated with floor insulation (GMR: 0.4-0.8), and north-facing living rooms (GMR: 0.4-0.8). This study has identified home characteristics that could be modified to reduce endotoxin exposure.     

Determinants,reproducibility, and seasonal variation of ergosterol levels in house dust

This study aimed to clarify the determinants that affect the concentrations of ergosterol and viable fungi in house dust and to examine the seasonal variation and reproducibility of ergosterol concentrations indoors. In studying the determinants, dust samples from living room floors and vacuum cleaner dust bags were collected from 107 farming and 105 non‐farming homes. Ergosterol levels were determined with gas chromatography‐mass spectrometry, and the dust bag dust was cultivated for enumeration of fungal genera. Lifestyle and environmental factors, for example using of the fireplace, and visible mold observations in homes, explained 20–26% of the variation of fungal concentrations. For the reproducibility study, samples were collected from five urban homes in four different seasons. The reproducibility of ergosterol determinations within a sample was excellent (ICC = 89.8) for floor dust and moderate (ICC = 63.8) for dust bag dust, but poor when sampling the same home throughout a year (ICC = 31.3 and 12.6, respectively) due to large temporal variation in ergosterol concentrations. In conclusion, environmental characteristics only partially predicted the variation of fungal concentrations. Based on these studies, we recommend repeated sampling of dust over time if one seeks to adequately describe overall fungal levels and exposure in a home.     

Temporal variability of indoor dust concentrations of semivolatile organic compounds

The determinants of the temporal variability of indoor dust concentrations of semivolatile organic compounds (SVOCs) remain mostly unexplored. We examined temporal variability of dust concentrations and factors affecting dust concentrations for a wide range of SVOCs. We collected dust samples three times from 29 California homes during a period of 22 months and quantified concentrations of 47 SVOCs in 87 dust samples. We computed intraclass correlation coefficients (ICCs) using three samples collected within the same house. We calculated correlation coefficients (r) between two seasons with similar climate (spring and fall) and between two seasons with opposite climate (summer and winter). Among 26 compounds that were detected in more than 50% of the samples at all three visits, 20 compounds had ICCs above 0.50 and 6 compounds had ICCs below 0.50. For 19 out of 26 compounds, correlation coefficients between spring and fall (r = 0.48-0.98) were higher than those between summer and winter (r = 0.09-0.92), implying seasonal effects on dust concentrations. Our study showed that within-home temporal variability of dust concentrations was small (ICC > 0.50) for most SVOCs, but dust concentrations may vary over time for some SVOCs with seasonal variations in source rates, such as product use.     

Formaldehyde concentrations in household air of asthma patients determined using colorimetric detector tubes

Formaldehyde is a colorless, pungent gas commonly found in homes and is a respiratory irritant, sensitizer, carcinogen, and asthma trigger. Typical household sources include plywood and particleboard, cleaners, cosmetics, pesticides, and others. Development of a fast and simple measurement technique could facilitate continued research on this important chemical. The goal of this research is to apply an inexpensive short‐term measurement method to find correlations between formaldehyde sources and concentration, and formaldehyde concentration and asthma control. Formaldehyde was measured using 30‐min grab samples in length‐of‐stain detector tubes in homes (n = 70) of asthmatics in the Boston, MA area. Clinical status and potential formaldehyde sources were determined. The geometric mean formaldehyde level was 35.1 ppb and ranged from 5 to 132 ppb. Based on one‐way ANOVA, t‐tests, and linear regression, predictors of log‐transformed formaldehyde concentration included absolute humidity, season, and the presence of decorative laminates, fiberglass, or permanent press fabrics (P < 0.05), as well as temperature and household cleaner use (P < 0.10). The geometric mean formaldehyde concentration was 57% higher in homes of children with very poorly controlled asthma compared to homes of other asthmatic children (P = 0.078). This study provides a simple method for measuring household formaldehyde and suggests that exposure is related to poorly controlled asthma.     

Domestic exposure to endotoxin and respiratory morbidity in former smokers with COPD

Indoor air pollution has been linked to adverse chronic obstructive pulmonary disease (COPD) health, but specific causative agents have not yet been identified. We evaluated the role of indoor endotoxin exposure upon respiratory health in former smokers with COPD. Eighty‐four adults with moderate to severe COPD were followed longitudinally and indoor air and dust samples collected at baseline, 3 and 6 months. Respiratory outcomes were repeatedly assessed at each time point. The associations between endotoxin exposure in air and settled dust and health outcomes were explored using generalizing estimating equations in multivariate models accounting for confounders. Dust endotoxin concentrations in the main living area were highest in spring and lowest in fall, while airborne endotoxins remained steady across seasons. Airborne and dust endotoxin concentrations were weakly correlated with one another (r_s = +0.24, P = 0.005). Endotoxin concentrations were not significantly associated with respiratory symptoms, rescue medication use, quality of life, or severe exacerbations. In vitro whole‐blood assays of the pro‐inflammatory capacity of PM₁₀ filters with and without endotoxin depletion demonstrated that the endotoxin component of indoor air pollution was not the primary trigger for interleukin‐1β release. Our findings support that endotoxin is not the major driver in the adverse effects of indoor PM upon COPD morbidity.     

Geographical variation and the determinants of domestic endotoxin levels in mattress dust in Europe

Endotoxin exposures have manifold effects on human health. The geographical variation and determinants of domestic endotoxin levels in Europe have not yet been extensively described. To investigate the geographical variation and determinants of domestic endotoxin concentrations in mattress dust in Europe using data collected in the European Community Respiratory Health Survey follow-up (ECRHS II). Endotoxin levels were measured in mattress dust from 974 ECRHS II participants from 22 study centers using an immunoassay. Information on demographic, lifestyle, and housing characteristics of the participants was obtained in face-to-face interviews. The median endotoxin concentration in mattress dust ranged from 772 endotoxin units per gram (EU/g) dust in Reykjavik, Iceland, to 4806 EU/g in Turin, Italy. High average outdoor summer temperature of study center, cat or dog keeping, a high household crowding index, and visible damp patches in the bedroom were significantly associated with a higher endotoxin concentrations in mattress dust. There is a large variability in domestic endotoxin levels across Europe. Average outdoor summer temperature of study center, which explains only 10% of the variation in domestic endotoxin level by center, is the strongest meteorological determinant. The observed variation needs to be taken into account when evaluating the health effects of endotoxin exposures in international contexts. PRACTICAL IMPLICATIONS: The incoherent observations of the health effects of endotoxin may be partly owing to the geographical heterogeneity of endotoxin exposure. Therefore, the observed variation should be considered in further studies. Measurements of indoor endotoxin are recommended as an indicator for the level of exposures of individual domestic environments.     

Housing characteristics and indoor air quality in households of Alaska Native children with chronic lung conditions

Alaska Native children experience high rates of respiratory infections and conditions. Household crowding, indoor smoke, lack of piped water, and poverty have been associated with respiratory infections. We describe the baseline household characteristics of children with severe or chronic lung disease participating in a 2012–2015 indoor air study. We monitored indoor PM2.5, CO₂, relative humidity %, temperature, and VOCs and interviewed caregivers about children's respiratory symptoms. We evaluated the association between reported children's respiratory symptoms and indoor air quality indicators using multiple logistic regression analysis. Compared with general US households, study households were more likely overcrowded 73% (62%–82%) vs 3.2% (3.1%–3.3%); had higher woodstove use as primary heat source 16% (9%–25%) vs 2.1% (2.0%–2.2%); and higher proportion of children in a household with a smoker 49% (38%–60%) vs 26.2% (25.5%–26.8%). Median PM2.5 was 33 μg/m³. Median CO₂ was 1401 ppm. VOCs were detectable in all homes. VOCs, smoker, primary wood heat, and PM2.5>25 μg/m³ were associated with higher risk for cough between colds; VOCs were associated with higher risk for wheeze between colds and asthma diagnosis. High indoor air pollutant levels were associated with respiratory symptoms in household children, likely related to overcrowding, poor ventilation, woodstove use, and tobacco smoke.