Transcript Dr. Kenneth Dangman – University of Connecticut Health Center

INDOOR AIR QUALITY:
EFFECTS ON HUMAN HEALTH
Kenneth H. Dangman, PhD, MD, MPH,
Eileen Storey, MD, MPH, and
Michael J. Hodgson, MD, MPH
from the
Division of Occupational Environmental Medicine
University of Connecticut Health Center
June 15, 2005
Effects of Air Pollution on the Health of Older Adults
Arlington, VA
Changes in building design
starting after the 1930s:
“Tighter” buildings with lower
heating/cooling costs
outdoor air  indoor air
(attenuation)
(concentration)
Point Sources: Synthetic building
materials, office machines, people,
cigarettes, microbial reservoirs 
Contaminants: VOCs, ozone, ETS,
CO, radon, bioaerosols
Are there known health effects
of poor indoor air quality on
older adults?
Indoor air pollution and
Older Adults:
Carbon Monoxide
Low level exposures lead to non-specific
symptoms (‘flu, gastroenteritis, fatigue, HA)
Elderly susceptible—Housebound, Less
physiological reserve
Exacerbation of CAD/angina, COPD,
dementia. Delayed neuropsych impairment
after 2-28 days  behavioral changes, ataxia,
memory deficits in 3%.
Limited correlation of COHb and severity of
clinical features (nl < 2-5%)
Harper & Croft-Baker, Age and Aging, 33: 105, 2004
Indoor air pollution and
Older Adults:
Particulate Matter
PM Sources: Tobacco smoke,
Heating/cooking fuels (biomass fuels,
wood, kerosene), Outdoor air infiltration
Apparent relationship to respiratory
symptoms/disease in adults
(Asthma/wheezing/shortness of breath)
Mishra, Effect of indoor air pollution from biomass combustion on
prevalence of asthma in the elderly, EHP 111: 71, 2003;
Simoni et al, Towards Healthy Air in Dwellings in Europe, THADE
Project Report, www.efanet.org
Building Related Illness (BRI)
in DOEM patients
Asthma
ILD (HP)
Rhinitis/Sinusitis/Laryngitis/
Vocal cord dysfunction syndromes
Dermatitis
Toxic Syndromes – Cl2, Pb, CO, etc.
Lung cancer (biomass fuels, ETS)
(Transmitted Infections —TB,
Legionella, Flu and other respiratory
viruses)
Sick Building Syndrome
Itchy, dry eyes
Nasal symptoms
Headache
Fatigue/sleepiness
Cough
Characterized by rapid
improvement upon going
outside
Point Sources-1:“Sewage Workers Lung Disease”
in a government building in DC (1977-87)
Photograph courtesy of Phil Morey, PhD, CIH
Hodgson M et al. Pulmonary disease associated with cafeteria flooding.
Point Sources-2:
(Asthma in a CT hospital building)
Clinical Evaluation
Medical History—chronology, environmental
context
Environmental History—work, home, elsewhere
Personal Habits
Physical Exam
Laboratory studies
Radiologic studies
Functional studies—bracketed spirometry
UCHC IH Walkthrough Inspection
Plexiglas plates over diffusers (18 in2);
foam inserts. Installed by Hospital
Engineering Dept to decrease/balance
airflow from diffusers, 2-5 yrs prior
Discolored for several years
Stained ceiling tiles—minor history of
leaks from the 2nd floor plumbing
Office located in a basement, with
carpet over concrete floor
Plexiglass plate:
Wipe Samples: culture results—
Cladosporium sp.
200 (CFU per in2)
Penicillium sp.
3,300
Bacillus sp.
730,000
Gram Neg sp.
64,000
After removal of the Plexiglas, and
general remediation of the workplace,
the patient was able to return to her job
Approach to Environment-BRI
Allergens - microbes, animals, chemicals
Irritants - chemicals, dust
Point Sources - water incursion,
malfunctioning equipment, new materials
Exposure mechanism (Pathways)
Dilution ventilation
What about
water incursion and
indoor mold growth?
Clinical Effects of Indoor
Fungi/Mold
(Established Mechanisms)
Infectious Disease
Hypersensitivity Responses and
Allergic Reactions
Irritant Responses
Toxic Effects
Mold-Induced
Allergic/Hypersensitivity Reactions
Upper Respiratory Syndromes
Rhinitis/Sinusitis
Asthma
Hypersensitivity Pneumonitis
Farmer’s Lung (Aspergillus species)
Summer house HP (Trichosporon cutaneum)
Irritant Agents from Molds
Volatile Organic Compounds (VOC’s)
–alcohols
–aldehydes
–organic acids
–aromatic compounds
(e.g., pinene, limonene)
(13)- b-D-glucans — irritation and
immunomodulation (Rylander et al)
Mold-Induced Irritant
Effects
Burning eyes
Nasal stuffiness
Sore throat
Laryngitis
Chest pain
Cough
Skin rash
Headache, fatigue
Stachybotrys chartarum
(Moisture Signature Fungi)
Soil fungus/plant parasite
commonly found indoors on wet
materials containing cellulose, such
as wallboard, jute backing on rugs,
wicker, straw, and paper materials
Thought to be allergenicMay
produce potent mycotoxins
– Trichothecenes (Satratoxins)
– Hemolysins
– Proteolytic enzymes (>6 types)
? mycotoxicosis
Modified from University of Tulsa website; http//pollen.utulsa.edu/Medical%20Botany/mycotoxins.ppt
Indoor Mold, Bioaerosols and
BRI
Two areas of uncertainty re: indoor molds:
– Exposure level in a given “problem” building
No established standards for indoor fungi in
air or on surfaces
– Health effects that result from those exposures
Dose response relationships not known
–Are there Sensitive Populations, such as the
elderly?
–Toxicity resulting from threshold dosages?
–Subspecies of Stachybotrys chartarum?
Indoor Mold, Bioaerosols and
BRI
Current approach
–Vigilant observation of the patient
–Prudent remediation of the structure
(water incursion)
In summary:
It is possible that Older Adults are more
susceptible to deleterious effects of indoor
air pollutants, including bioaerosols, than
younger people for a variety of reasons.
To understand the sum total of effects of
ambient air pollution on the Older Adult, it
will be necessary to include the role of
indoor environments, where it appears the
majority of elderly people spend most of
their time….
Indoor Air Pollution and
Older Adults—
Remaining questions:
Which Agents?
Pathophysiological Mechanisms?
Lower thresholds for toxic effects?
Longer recuperation times?
Future Directions
Assess the prevalence of
BRI and SBS in older adults
Evaluate housing stock
where older adults live
Evaluate the health impacts
of allergens and irritants in
the indoor environment on
older adults.