Prolonged exposure to damp and moldy workplaces and new-onset asthma.

PURPOSE: Epidemiological evidence shows that indoor dampness is associated with respiratory symptoms, the aggravation of preexisting asthma, and the development of new-onset asthma. Follow-up studies indicate that symptoms compatible with asthma constitute risk factors for the future development of asthma. The aims of the study were (1) to assess whether asthma-like symptoms (cough, dyspnea, and wheeze) that occur in relation to exposure to damp and moldy work environments lead to the later development of asthma and (2) to assess the importance of continued exposure to indoor dampness and molds at work in the development of asthma. METHODS: We followed 483 patients with asthma-like symptoms related to damp workplaces but without objective evidence of asthma in baseline examinations. The development of asthma and present work conditions were established with the use of a questionnaire 3-12 years later. RESULTS: A total of 62 patients (13%) reported having developed asthma during the study period. Continued exposure to a damp or moldy environment was associated with a more than fourfold increase in the risk of asthma (odds ratio 4.6, 95% confidence interval 1.8-11.6). Working in a non-remediated environment at follow-up was the strongest risk factor for developing asthma. The remediation of damp buildings seemed to be associated with a decrease in the risk of asthma. CONCLUSIONS: The results indicate that exposure at work to dampness and molds is associated with the occurrence of new-onset asthma. Exposed workers suffering from asthma-like symptoms represent a risk group for the development of asthma. The risk appears especially high if the exposure continues. Due to inherent weaknesses of patient series, the findings need corroborative studies.

New-onset adult asthma in relation to damp and moldy workplaces.

OBJECTIVE: Damp and moldy indoor environments aggravate pre-existing asthma. Recent meta-analyses suggest that exposure to such environments may also induce new-onset asthma. We assessed the probability of molds being the cause of asthma in a patient series examined because of respiratory symptoms in relation to workplace dampness and molds. METHODS: Altogether 694 such patients had been clinically assessed between 1995 and 2004. According to their histories, they had all been exposed to molds at work and had suffered from work-related lower respiratory symptoms. The investigations had included specific inhalation challenge (SIC) tests with mold extracts and serial peak expiratory flow (PEF) recordings. Using internationally recommended diagnostic criteria for occupational asthma (OA), we categorized the patients into three groups: probable, possible, and unlikely OA (156, 45, and 475 patients, respectively). The clinical details of 258 patients were analyzed, and their levels of microbial exposure were evaluated. RESULTS: The agreement between the serial PEF recordings and SIC tests (both being either positive or negative) was 56%. In the group of probable OA, mold sensitization was found in 20%. The level of exposure and sensitization to molds was associated with probable OA. At 6 months, the follow-up examinations of 136 patients with probable OA showed that the symptoms were persistent, and no improvement in spirometry was noted despite adequate treatment. Only 58% of the patients had returned to work. CONCLUSIONS: Exposure to damp and moldy workplaces can induce new-onset adult asthma. IgE mediation is a rare mechanism, whereas other mechanisms are unknown.

Healthy people in healthy premises: the Finnish Indoor Air and Health Programme 2018-2028.

Clean and fresh indoor air supports health and well-being. However, indoor air can contain pollutants that can cause a variety of symptoms and reduce well-being. Individual exposure agents can also increase the risk of certain diseases. Finns have taken major steps to improve the quality of indoor air for several decades. The primary focus of these activities has been the prevention and reduction of exposure to poor indoor air quality through guidance and regulation directing remediation of damaged buildings. Nevertheless, reported symptoms related to poor indoor air quality are common in Finland. In addition to exposure to indoor air pollutants, this may be partly due to the lively public discussion on the health risks caused by poor indoor air quality, conflicting views between experts, and mistrust towards public authorities, building owners and builders. Because of the scale of the indoor air problems in Finland, people's needs for reliable information and support, and the major costs involved, there is a call for new evidence-based methods, perspectives and solutions. Therefore, the Finnish Institute for Health and Welfare initiated the Finnish Indoor Air and Health Programme 2018-2028 together with a number of collaborators and stakeholders. The primary, long-term objective of the programme is to reduce hazards to health and well-being linked to indoor environments in Finland. To fulfill this objective, the programme will focus on the promotion of human health and well-being, the prevention of hazards, improved communication and engage the whole health-care sector to manage better patients´ symptoms and complaints. The 10-year Finnish Indoor Air and Health Programme consists of four areas that aim (1) to increase understanding of the effects of indoor environments on health and well-being; (2) to develop the management of problems linked to indoor environments; (3) to improve the treatment and working and functional capacity of people with symptoms and illnesses; and (4) to strengthen the competence in matters related to indoor environments. The progress of the programme and reaching the predefined, quantitative goals will be monitored throughout the programme.

Renovation of a "sick building": the challenge of attaining the confidence of occupants.

BACKGROUND: This case study focused on the renovation of a building with severe mold and HVAC problems. The users did not trust the success of the planned remedies, and the situation became conflict-prone. The aims of the study were to improve communication and cooperation between experts participating in the renovation process and the future users of the building and monitor the success of the remedies. METHODS: An intervention was implemented with the aim of making the renovation easily understood by the future users of the building and preventing the escalation of unnecessary concern among them. The follow-up methods comprised a questionnaire study, technical inspections, quality measurements of the indoor air, structural follow-up measurements, and interviews of key persons. RESULTS: The renovation itself seems to have been successful, and the model to improve communication and cooperation appears to be a promising one. The confidence of the future users was attained, and the relocation took place as planned. CONCLUSIONS: In order to succeed in the renovation of a "sick building," both technical expertise and investment in information and communication are needed.

Man-made vitreous fibers in office buildings in the Helsinki area.

Several sources of man-made vitreous fibers (MMVFs) may exist in an office environment causing irritation symptoms among occupants. In 258 office buildings, the occurrence and density of settled MMVFs on surfaces were measured by two sampling methods. Altogether, 1113 samples of settled dust were collected from surfaces with plastic bags and gelatine tape and were analyzed with a scanning electron microscope and a stereomicroscope, respectively. Tape samples from 68 buildings were collected from frequently cleaned (n = 162) and seldom cleaned (n = 57) room surfaces in 56 and 29 offices, respectively, and from supply air ducts (n = 24) in 10 offices. MMVFs longer than 20 microm were counted with a stereomicroscope. Irritation symptoms were recorded with a questionnaire. More than 60% of the surface dust and almost 90% of the samples collected from supply air ducts contained MMVFs. The density of MMVFs longer than 20 microm ranged from < 0.1 to 5 fiber cm(- 2). The mean density of the MMVFs was about two times higher on the seldom cleaned surfaces than on the frequently cleaned surfaces. The density was usually under 0.2 MMVF cm(- 2) in surface dust of offices without emission sources of MMVFs. The measurements combined with qualitative analysis of settled dust can help to localize relevant sources of fiber emissions. Altogether, in 40% of the buildings, several occupants had repeated irritation symptoms that were verified by occupational health care personnel.

Airborne concentrations of volatile organic compounds, formaldehyde and ammonia in Finnish office buildings with suspected indoor air problems.

A database of indoor air concentrations of volatile organic compounds (VOCs) (n = 528), formaldehyde (n = 76), and ammonia (n = 47) in office environments was analyzed to suggest interpretation guidelines for chemical measurements in office buildings with suspected indoor air problems. Indoor air samples were collected for VOCs from 176 office buildings, 23 offices for formaldehyde, and 14 office buildings for ammonia in 2001-2006. Although the buildings had reported indoor air complaints, a walk-through inspection by indoor air specialists showed no exceptional sources of indoor air pollutants. The measurements of chemical pollutants did not indicate any clear reason for the complaints. The geometric mean concentration of total volatile organic compounds (TVOC) was 88 microg m(-3) in office rooms and 75 microg m(-3) in the open plan offices. The mechanical supply and exhaust ventilation significantly (p < 0.004) decreased the indoor air concentration of TVOC. The highest mean concentration and frequency distributions were determined for the individual VOCs. The most common VOCs found in > or = 84% of the indoor samples include toluene, xylene (p,m), 1-butanol, nonanal, and benzene. According to concentrations, the most abundant VOCs were 2-(2-ethoxyethoxy)ethanol, acetic acid, 1,2-propanediol, and toluene. The geometric mean concentration of formaldehyde and ammonia in the office buildings was 11 microg m(-3) (3-44 microg m(-3) and 14 microg m(-3) (1-49 microg m(-3), respectively. On the basis of statistical analyses, the guideline value indicating a usual concentration of the pollutant in office buildings is 70 microg m(-3) for TVOC, 7 microg m(-3) for most individual VOCs, 10 microg m(-3) for formaldehyde, and 12 microg m(-3) for ammonia. The guidance value suggested for TVOC is 250 microg m(-3), for formaldehyde 15 microg m(-3), and for ammonia 25 microg m(-3). If the guidance value is exceeded, this may indicate the existence of an exceptional source and the need for additional environmental investigations. The levels should not be used for the evaluation of health risks. The guideline values are applicable in a subarctic climate for modern, urban office buildings.

Association between Four-Level Categorisation of Indoor Exposure and Perceived Indoor Air Quality.

The aim of this study was to develop and test a tool for assessing urgency of indoor air quality (IAQ) measures. The condition of the 27 buildings were investigated and results were categorized. Statistical test studied the differences between the categories and the employees’ complaints about their work environment. To study the employees’ experiences of the work premises, a validated indoor air (IA) questionnaire was used. This study reveals a multifaceted problem: many factors affecting IAQ may also affect perceived IAQ, making it difficult to separate the impurity sources and ventilation system deficiencies affecting to employee experiences. An examination of the relationship between the categories and perceived IAQ revealed an association between the mould odour perceived by employees and mould detected by the researcher. A weak link was also found between the assessed categories and environmental complaints. However, we cannot make far-reaching conclusions regarding the assessed probability of abnormal IA exposure in the building on the basis of employee experiences. According to the results, categorising tool can partly support the assessment of the urgency for repairs when several factors that affect IAQ are taken into account.

Controlling occupational allergies in the workplace.

OBJECTIVES: In recent years, the prevalence of work-related asthma has increased. Therefore, more attention needs to be paid to occupational allergens and their avoidance and control in workplaces. However, risk assessment of occupational allergen exposure is difficult because the relationship between exposure concentration, sensitization, and symptoms has not been fully established. This paper introduces a systematic and comprehensive approach to assessing and managing allergen risks at workplaces. MATERIALS AND METHODS: This approach relies on the cooperation and active communication during the whole process between management, employees, and health care personnel, with the assistance of experts when needed. In addition to gathering background information, including allergic symptoms, through questionnaires addressed to the management and employees, hazard identification is also processed in the workplace through observations and measurements. The methods generally recommended to reduce allergen exposure are compared with those used in the workplace. The process is to be carefully planned and documented to allow later follow-up and re-evaluation. RESULTS: The multi-faceted approach encompasses several risk assessment techniques, and reveals the prevalence of work-related allergic symptoms. The process effectively focuses on the potential means for controlling allergen exposure. CONCLUSION: Based on this approach, the synopsis on the critical points that require implementation of effective control measures can be presented.

Indoor air particles in office buildings with suspected indoor air problems in the Helsinki area.

OBJECTIVES: Airborne particle concentrations can be used as quality indicators of indoor environments. The previous lack of reference data has limited the use of particle measurements in office environments. The aim of this study was to describe the concentrations of airborne particles (≥ 0.5 µm and ≥ 5.0 µm) in 122 Finnish office buildings with suspected indoor air problems. MATERIALS AND METHODS: The database consisted of indoor air and supply air particle samples collected in 2001-2006 from the Helsinki area. The particle concentrations (≥ 0.5 µm and ≥ 5.0 µm) were measured in the indoor air (528 samples from 122 office rooms) and in the supply air (384 samples from 105 office rooms) with an optical particle counter. Airborne particle concentrations ≥ 0.5 µm were categorized according to the efficiency of supply air filtration and health survey data. RESULTS: The mean concentrations in the indoor air equaled 1900 particles/l and in the supply air 1300 particles/l. The efficiency of supply air filtration decreased the fine particles counts in both the indoor and supply air. The counts of large particles, ≥ 5.0 µm, were low in the indoor air. Airborne counts of ≥ 0.5 µm particles (geometric mean) were statistically higher in the offices whose occupants had work-related symptoms (eye and/or upper respiratory symptoms or upper respiratory infections) than in the offices whose occupants had no such symptoms. However, the symptoms may also be linked to other indoor air problems or particle characteristics not studied in this work. CONCLUSIONS: This study indicates typical airborne particle levels (≥ 0.5 µm and ≥ 5.0 µm) in Finnish office buildings with suspected indoor air problems. The results can be used to evaluate the quality of indoor environment, possible indoor air problems, and the need for additional investigations.

Occupational rhinitis in damp and moldy workplaces.

BACKGROUND: Numerous studies confirm the association between exposure to indoor air dampness and molds and different health outcomes. Of these, upper respiratory tract problems are the most commonly reported work-related symptoms in damp indoor environments. The aim of this study was to describe a clinically investigated patient series with occupational rhinitis induced by molds. METHODS: Nasal provocation test (NPT) with commercial fungal allergens was performed in 369 patients during 1995-2004 at the Finnish Institute of Occupational Health. Of these, 60 (16%) were positive. In addition to positive NPT, the diagnosis of occupational rhinitis was based on verified exposure to molds, work-related nasal symptoms, and clinical investigations. We wanted to review the patient files of these 60 patients retrospectively, and 56 patients gave their informed consent. RESULTS: The mean age of the patients was 43.7 years (SD +/- 9.5). Fifty (89.3%) patients were women. In 23% of the patients, IgE-mediated allergy to molds could be established. Atopy significantly increased IgE sensitization to molds (OR, 10.3 [95% CI, 2.0-52.5]). The most common mold to induce occupational rhinitis was Aspergillus fumigatus. Exposure time was over 5 years in 63% of the patients. Association between the IgE sensitization to molds and exposure level was statistically significant (Fisher's exact test, p = 0.046). CONCLUSION: This is the first clinically investigated series on occupational rhinitis in relation to a moldy environment. Based on our findings, we conclude that molds growing in conjunction with moisture damages can induce occupational rhinitis. IgE-mediated allergy to molds was not common. Atopy and significant exposure level increased IgE sensitization to molds. zri00508.