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Indoor Air Pollution: Introduction for Health Professionals

CPSC Document #455
A Joint Publication of the

Consumer Product Safety Commission
American Medical Association
Environmental Protection Agency
American Lung Association


DISCLAIMER

Information provided in this document is based upon current scientific and technical understanding of the issues presented and agency approval is limited to the jurisdictional boundaries established by the statutes governing the co-authoring agencies. Following the advice given will not necessarily provide complete protection in all situations or against all health hazards that may be caused by indoor air pollution.

Introduction

Indoor air pollution poses many challenges to the health professional. This booklet offers an overview of those challenges, focusing on acute conditions, with patterns that point to particular agents and suggestions for appropriate remedial action.

The individual presenting with environmentally associated symptoms is apt to have been exposed to airborne substances originating not outdoors, but indoors. Studies from the United States and Europe show that persons in industrialized nations spend more than 90 percent of their time indoors1. For infants, the elderly, persons with chronic diseases, and most urban residents of any age, the proportion is probably higher. In addition, the concentrations of many pollutants indoors exceed those outdoors. The locations of highest concern are those involving prolonged, continuing exposure - that is, the home, school, and workplace.

The lung is the most common site of injury by airborne pollutants. Acute effects, however, may also include non-respiratory signs and symptoms, which may depend upon toxicological characteristics of the substances and host-related factors.

Heavy industry-related occupational hazards are generally regulated and likely to be dealt with by an on-site or company physician or other health personnel2. This booklet addresses the indoor air pollution problems that may be caused by contaminants encountered in the daily lives of persons in their homes and offices. These are the problems more likely to be encountered by the primary health care provider.

Etiology can be difficult to establish because many signs and symptoms are nonspecific, making differential diagnosis a distinct challenge. Indeed, multiple pollutants may be involved. The challenge is further compounded by the similar manifestations of many of the pollutants and by the similarity of those effects, in turn, to those that may be associated with allergies, influenza, and the common cold. Many effects may also be associated, independently or in combination with, stress, work pressures, and seasonal discomforts.

Because a few prominent aspects of indoor air pollution, notably environmental tobacco smoke and "sick building syndrome" have been brought to public attention, individuals may volunteer suggestions of a connection between respiratory or other symptoms and conditions in the home or, especially, the workplace. Such suggestions should be seriously considered and pursued, with the caution that such attention could also lead to inaccurate attribution of effects. Questions listed in the diagnostic leads sections will help determine the cause of the health problem. The probability of an etiological association increases if the individual can convincingly relate the disappearance or lessening of symptoms to being away from the home or workplace.


Table of Contents

Diagnostic Quick Reference
a Cross-reference from symptoms to pertinent sections of this booklet

Diagnostic Checklist
additional questions for use in patient intake and medical history

Environmental Tobacco Smoke (ETS)
impacts on both adults and children; EPA risk assessment findings

Other Combustion Products
carbon monoxide poisoning, often misdiagnosed as cold or flu; respiratory impact of pollutants from misuse of malfunctioning combustion devices
- Carbon Monoxide (CO)
- Nitrogen dioxide and Sulfur dioxide

Animal Dander, Molds, Dust Mites, Other Biologicals
a contributing factor in building-related health complaints
-Tuberculosis
- Legionnaires Disease
- Allergic Reactions
- Hypersensitivity Pneumonitis
- Humidifer Fever
- Mycotoxins

Volatile Organic Compounds (VOCs)
common household and office products are frequent sources
- Formaldehyde
- Pesticides

Heavy Metals: Airborne Lead and Mercury Vapors
lead dust from old paint; mercury exposure from some paints and certain religious uses
- Airborne Lead
- Mercury Vapor

Sick Building Syndrome (SBS)
what is it; what it isn't; what health care professionals can do

Two Long-Term Risks: Asbestos and Radon
two highly publicized carcinogens in the indoor environment
- Asbestos
- Radon

Questions That May Be Asked
current views on multiple chemical sensitivity, clinical ecologists, ionizers and air cleaners, duct cleaning, carpets and plants
- What is "multiple chemical sensitivity" or "total allergy"?
- Who are "clinical ecologists"?
- What are ionizers and other ozone generating air cleaners?
- Can other air cleaners help?
- Should I have my ducts cleaned?
- Can carpet make people sick?
- Can plants control indoor air pollution?

For Assistance and Additional Information
resources for both health professionals and patients

References

Source: Consumer Product Safety Commission

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