Immune Respiratory Disease Associated with the Inadequate Control of Indoor Air Quality

Abstract

The prevalence of immunologically determined respiratory diseases is increasing throughout the world and this has been associated with an increased mortality from bronchial asthma. Consequently, there has been considerable interest in the factors that may influence the development of allergic disorders. The first few weeks following birth have been identified as important in determining the development of sensitivity to airborne allergens and subsequent allergic respiratory disorders. The expression of allergic diseases is both genetically determined and influenced to a significant degree by environmental factors related to indoor air quality. As well as possibly initiating allergic disease in the post-natal period, poor indoor air quality may cause respiratory disease in later life. These diseases may be allergic in origin (bronchial asthma or allergic alveolitis) or may be due to infections (Legionnaires’ disease). The contamination of indoor air by micro-organisms may occur from the structure of the building, the ventilation system or be introduced into the building from the outside air. The off-gassing of chemicals within buildings has attracted considerable attention over the past few years, but the evidence that this process can cause immunological disease in man is very limited. It is concluded that indoor air quality is an important potential cause of immunological respiratory disease in man which has been and still is frequently neglected.

Health hazard evaluation report: HETA-2000-0339-2852, Group Health Associates, Cincinnati, Ohio.

“…17 Allergic diseases which have been reported to be associated with exposures in indoor environments include allergic rhinitis (nasal allergy), allergic asthma, allergic bronchopulmonary aspergillosis (ABPA), and extrinsic allergic alveolitis (hypersensitivity pneumonitis). 15 Allergic respiratory diseases resulting from exposures to microbial agents have been documented in agricultural, biotechnology, office, and home environments.…”

Health hazard evaluation report: HETA-96-0093-2685, Microfibres, Inc. Pawtucket, RI.

“…Bacteria and Fungi ---------Allergic asthma, allergic rhinitis, hypersensitivity pneumonitis (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) Endotoxins ---------Fever, airway constriction, acute respiratory symptoms (flu-like illness) (22)(23)(24)(25)(26)(27)(28)(29) …”

Health hazard evaluation report: HETA-95-0331 and 95-0334-2626, Boston Harbor Tunnel Project, Winthrop, Massachusetts.

“…15 Clinically, little is known about the response to inhaled endotoxins. Exposure of previously unexposed persons to airborne endotoxin can result in acute fever, dyspnea, coughing, and small reductions in forced expiratory volume in one second (FEV 1 ), although some investigators have not been able to demonstrate acute changes in FEV 1 . 15 The effects of repeated exposure to aerosols of endotoxins in humans are not known.…”

“…Those 17 who did not have a chest radiograph were diagnosed with bronchitis (5), sinusitis (5), otitis media (3), viral infection (3), and allergies (1). Of the 21 who had a chest radiograph without reported pneumonia, 16 were diagnosed with bronchitis, five with otitis media, five with sinusitis, three with viral upper and lower respiratory infection, one with a bacterial upper respiratory infection, one with silicosis pneumonitis, and one with asthma.…”