LINKING INDOOR AIR QUALITY AND HEALTH

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LINKING INDOOR AIR QUALITY AND HEALTH

• Jan Sundell
• M.Sc.Eng., M.D., Prof.
• TxAIRE, University of Texas at Tyler
• Editor in Chief, Indoor Air
• NAFA
• Las Vegas, 2009

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IAQ and HEALTH, 1800-1900INDUSTRIALISM, CROWDED
CITIESCHOLERA, TYPHUS, TUBERCULOSIS

• ENVIRONMENTAL ISSUES
• WATER SUPPLY, SEWAGE TREATMENT, INDOOR AIR,
  DAMPNESS
• MIASMA, the cause!
• An unexplainable athmospheric poison
• HYGIENE!

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John Griscom (surgeon), New York, 1850

• ..deficient ventilation ...(is) more fatal than
  all other causes put together

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IAQ AND health, 1900-1962TBC... - CLEANLINESS

• ENVIRONMENTAL ISSUES
• HYGIENE!
• HOUSING, HOUSEWIFES, DAMPNESS ....
• BUT!
• LONDON SMOG, 1952!
• SILENT SPRING, 1962
• INDOOR AIR IS PROTECTIVE!

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IAQ and HEALTH, 1962-2009OUTDOOR!

• ENVIRONMENTAL ISSUES
• NATURE
• ENERGY
• SUSTAINABLE BUILDINGS
• INDUSTRIAL WORKPLACES
• GENES...

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IAQ and HEALTH, 1972-2009

• NOT ENVIRONMENTAL ISSUES!
• SBS, ALLERGIES, LUNGCANCER......
• ETS, DAMPNESS, MOULD, VOC, FORMALDEHYDE......

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IAQ and HEALTH 2009 DEVELOPING COUNTRIES

• UNVENTED BURNING OF SOLID FUELS
• Besides MALNUTRITION and POOR WATER QUALITY, the
  GREATEST KILLER IN THE WORLD
• More than 2.000.000 deaths per year
• WOMEN and CHILDREN
• WHO

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IAQ and HEALTH 2009DEVELOPED COUNTRIES

• ALLERGIES
• AIRWAYS INFECTIONS
• LUNGCANCER
• SICK BUILDING SYNDROME, MCS etc
• Legionaires Disease
• Etc...

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LIFE HAS INCREASED 30 YEARS DURING THE 20th
CENTURY!

• 5 years due to improvements in curative medicine,
• and 25 years due to the success of HYGIENE AND
  PUBLIC HEALTH!
• WHO

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The Amoy Gardens SARS outbreak
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Index patient
visited Flats 7, 16
Floor
th
Index patient visited a flat 7 on two nights in
March 2003
N

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Spread in the re-entrant
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Wind
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Non-infected flat
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Infected flats
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Wind
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Index patient
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Flat 7
Re-entrant
Flat 8
Li et al. Indoor Air, 2005
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Sick Building Syndrome
Mucous membrane symptoms Irritation of eyes,
throat, and nose General symptoms Headache,
fatigue etc Skin symptoms Mainly facial
flushing, redness, itching etc
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RISK FACTORS FOR SBSOCCUPATIONAL

• Computers
• Photo copying machines, Laser Printers
• Papers

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Ventilation and SBS
Sundell et al. (1994)
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Ventilation and sick leave
Milton et al. (2000)
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WHY ARE ALLERGIES INCREASING?

• CHANGES?
• GENES - NO
• ENVIRONMENT YES
• BUT WHAT ENVIRONMENT??

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THE RIDDLE OF ALLERGIES (2002)

• ALLERGIES HAVE INCREASED!
• Up to 50 of children has or have had symptoms of
  allergic disease!
• IN SWEDEN more in the north!
• IN EUROPE more in the west!
• IN USA more among the poor!
• MOST in countries that speak ENGLISH (UK, New
  Zeeland, Australia)
• Also high in Peru...

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Dampness indicatorsDamp spots
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Visible mould
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Dampness indicatorsLeakage
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Dampness indicatorsCondensation
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NORDDAMP, EUROEXPO Results

• Consistent associations between dampness and
  health effects
• All over the world
• Cough, wheeze, asthma. OR 1.4-2.2
• But, also e.g. general symptoms and airways
  infections
• Dampness?
• Agents in air and on dust?
• Mites!
• THE MOST CONSISTENT AND THE STRONGEST RISK FACTOR
  FOR ALLERGIES IN THE SCIENTIFIC LITERATURE!
• ???
• A strong need for more and better
  multidisciplinary studies

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STUDIES in Sweden, Bulgaria, Singapore,
Greenland, Denmark, Taiwan, USA,
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DESIGN
Step 1 Cross-Sectional study 1999-2001 Questionn
aire n 14 077 children (1-6 y) ( 80 )
Follow-up study 2003 Cross-Sectional
study Questionnaire n 14 077 children (4-9y)
Step 2 Case-Control study October 2001-February
2002 Exposure measurements Clinical
investigations n400 children/dwellings

• Step 3
• Experimental studies
• Climate chamber
• Intervention study

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Sweden, Bulgaria, Singapore
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And Spanish speaking Texans!
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And, English speaking Texans!!
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Dampness at birth and current
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Condensation on windows vs. rhinitis among
children
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Perception of dry air
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The hygiene hypothesis?ASTHMA and PETS?
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Examination of Children
Breath condensate
Blood sample
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Ventilation measurements
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Samples from childrens bedroom
Linda Hägerhed
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A lot of dust!
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WHY IS DAMPNESS A RISK FACTOR?

• TOXIC MOLD (USA)

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A moldy odor along the skirting board (in Sweden
and China!)
Adj Odds Ratio (95 CI)
Hägerhed-Engman et al., 2005
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VENTILATION RATES (ach) IN SWEDISH HOMES

• 1948, Rydberg
• 1968, Sundell
• 1991, ELIB

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Ach-OR for cases in single family homes
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Dust samples from 390 homes

• Dust was collected above floor level on a filter
  in childrens bedroom
• 346 valid samples
• (Dust samples gt25 mg)
• Six phthalates identified
• DEP
• DIBP
• DBP
• BBP
• DEHP
• DINP

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BBzP

• Adjusted OR
• Quartiles of exposure (concentrations in dust)

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DEHP and Asthma in Sweden

• Adjusted OR
• Quartiles of exposure (concentrations in dust)

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DEHP in Bulgaria (179 children)

• Adjusted OR
• Quartiles of exposure (concentrations in dust)

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NOT ONLY PVC

• Bulgarian data
• Incident data in Sweden
• Other risk compounds?!
• We have to publish it first!
• NEW CHEMICALS IN E.G. PVC, WATERBASED PAINTS, AND
  CLEANING PRODUCTS!!!!!

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NEW ADJUVANT (?) FACTORS,the most promising
explanation for the increase in allergies!

• NEW CHEMICALS?!

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NOT ONLY ALLERGIES

• MODERN DISEASES
• Asthma, allergies
• Birth defects, on boys
• Diabetes
• Obesity
• Neuro-developmental disorders
• Autism
• Aspberger
• Tourettes syndrome
• ?
• modern exposures
• MODERN EXPOSURES
• ENDOCRINE DISRUPTORS

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NOT ONLY OLD VOCs or PARTICLES!

• MODERN EXPOSURES
• New chemicals introduced during the last decades!
• Modern life!
• Plastics, waterbased paints, cleaning products,
  flame retardants, peticides.
• Many are endocrine disruptors
• Mechanisms?
• Classic toxicology??

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Air cleaning a solution?THE main preventable
HEALTH PROBLEMS!

• Airborne infections, including SARS, The Bird
  Flu, Legionnaires Disease, Common Cold...
• Asthma, allergies
• SBS, MCS...
• Cancer.........

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Air cleaning a solution?THE MAIN AIR QUALITY
PROBLEMS!

• INDOOR AIR CHEMISTRY!
• Ozone, terpenes! (reactive chemicals,
  particles...)
• Solutions Source control, reduce ozone,
  ventilation, air cleaning.

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Air cleaning a solution?THE MAIN AIR QUALITY
PROBLEMS!

• NEW ORGANIC SUBSTANCES!
• Plasticizers, flame retardants, pesticides,
  cleaning agents...
• Solutions Source control, ventilation, air
  cleaning.

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Air cleaning a solution?THE MAIN AIR QUALITY
PROBLEMS!Allergens, particlesPets, ETS,
chemistry..Solutions Source control,
ventilation, air cleaning
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AIR CLEANINGThe status today?

• Particles
• Inorganic gases
• Organic gases

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AIR CLEANINGThe status today

• Mechanical particle filters reduce particles, but
  act as a major source of contaminants!
• Electrostatic filters OK, but ozone!
• Gaseous filters reduce some contaminants, but
  increase others!!

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THE FUTURE OF AIR CLEANING TECHNOLOGIES?

• Air cleaning may play an important role, but
• New technologies are needed (to get rid of the
  health relevant pollutants!).

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Texas Allergy, Indoor Environment and Energy
Institute
TxAIRE
An Overview

• Jan Sundell

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Mission of TxAIRE

• Improve Indoor Air Quality
• Develop medically-based guidelines for
  residential air quality
• Develop technology to achieve the guidelines
• Reduce Residential Energy Costs
• Develop means to reduce energy costs associated
  with heating and cooling
• Provide long-term, pre-competitive research

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Research and Testing Facilities

• Residential live-In laboratories
• Component development and evaluation laboratory
• State-of-the-art testing equipment

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