Common Respiratory Injury from Indoor Mold-Exposure

The most widely recognized group of mold-exposure injuries involve the respiratory tract. Composed of the pathway air takes when entering the body, the respiratory tract includes the nose, mouth, throat, and lungs. But it’s not just oxygen that moves through your airway—millions of dust particles make a journey from the ambient environment into your body with each breath.

Of the matter within the dust, the organic components from mold and bacteria have the biggest impact on human health. According to environmental scientist William Fisk, whose work has been cited by the federal government,

“Building dampness and mold are associated with approximately 30 to 80% increases in a variety of respiratory and asthma-related health outcomes.”

In two meta-analyses studies, Fisk found the following increased respiratory risks associated with damp building exposure:

  • Cough — 77%
  • Wheeze — 81%
  • Asthma — 51%
  • Upper respiratory infection — 53%
  • Lower respiratory infections — 50%
  • Bronchitis — 45%
  • Respiratory infections — 50%

A Bad Argument — Mold is Not the Cause if there’s no Fungal Infection

A common misconception is that moldy air can only cause injury by direct fungal infection.

This has occurred in a medical-legal case in which the Defense’s medical expert claimed that the Plaintiff’s sinusitis could not be attributed to the subject property because a nasal swab culturing for mold had not been performed to prove the presence of a fungal sinusitis. The expert argued that without a positive culture for mold that matched the mold discovered in the subject property, causation could not be established.

I argued that this represented a flawed methodology.

First: The Plaintiff’s ears-nose-throat doctor didn’t claim the Plaintiff had an infectious fungal sinusitis, but rather an inflammatorychronic sinusitis.

Second: A mold swab isn’t needed to prove the presence of an inflammatory condition.

Third: The treating doctor had sufficient evidence through a medical interview, physical examination, direct video analysis, and a CT scan of the sinuses to make an authoritative diagnosis.

The Defense’s medical expert made a common mistake of overlooking inflammatory mechanisms of injury. Biological contaminants cause respiratory injury from impairment of immune defenses, body-wide inflammatory responses, and local mucosal damage—factors that directly injury the airway even in the absence of infection. These disruptions leave the occupant at increased risk for respiratory infections from any class of infectious microbes.

From most to least common respiratory infections of the upper and lower respiratory tract are:

  • Viruses such as the flu, COVID, and the common cold.
  • Bacteria such as Streptococcusthe leading cause of community-acquired pneumonia.
  • Fungi (mold) infection is relatively rare compared with viral and bacterial sources, but may include Aspergillosis and Valley Fever, two mold-induced forms of pneumonia.

And the outcome of the case: The Defense settled the matter after my rebuttal report without deposing me.

Remodeling — The Bad Type not Associated with a Better Kitchen

Long-term irritation can cause a process known as tissue remodeling. This process refers to a change in the organization and content to existing tissues as a response to injury. Tissue remodeling results in long-term changes, lasting months to years beyond the injury that jump-started the process.

In the respiratory tract, tissue remodeling reduces its function. Remodeling changes include:

  • Damage to the delicate epithelial cells that line the airway.
  • Disorganization of the supporting structures such as collagen and smooth muscle cells.
  • Invasion of immune cells into the tissues resulting in chronic inflammation.
  • Excessive scarring (fibrosis) that narrows the airways and reduces oxygen absorption.
  • Overgrowth of smooth muscles in size and number which narrows the airway and may be oversensitive, resulting in dangerous spasms that choke of airflow further.
  • Lung stiffening that prevent them from expanding and contracting efficiently.

Tissue remodeling is a key mechanism for why a respiratory injury can persist for years beyond the period of exposure to a water-damaged building. After remodeling, respiratory symptoms such as difficulty breathing, sinus congestion, and chronic cough can devastate quality of life. These changes increase the risk of respiratory infections, asthma onset or aggravation, and chronic obstructive pulmonary disease.

Executive Summary

Respiration exposes the airway to millions of particles with each breath.

Biological pollutants such as mold cause inflammatory and respiratory problems including sinusitis and asthma.

Tissue remodeling is a process that can explain persistent respiratory symptoms that persist beyond the period of exposure to the subject property.