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Information provided from USEPA booklet, Indoor Air
Pollution.
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 indoors. 1 For infants, the elderly, persons
with chronic disease, 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 personnel. 2
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.
How to Use This Booklet
The health professional
should use this booklet as a tool in diagnosing an individual's signs and
symptoms that could be related to an indoor air pollution problem. The document
is organized according to pollutant or pollutant group. Key signs and symptoms
from exposure to the pollutant(s) are listed, with diagnostic leads to help
determine the cause of the health problem. A quick reference summary of this
information is included in this booklet. Remedial action is suggested, with
comment providing more detailed information in each section. References for
information included in each section are listed at the end of that section.
It must be noted that some
of the signs and symptoms noted in the text may occur only in association with
significant exposures, and that effects of lower exposures may be milder and
more vague, unfortunately underscoring the diagnostic challenge. Further, signs
and symptoms in infants and children may be atypical (some such departures have
been specifically noted).
The reader is cautioned
that this is not an all-inclusive reference, but a necessarily selective survey
intended to suggest the scope of the problem. A detailed medical history is essential,
and the diagnostic checklist may be helpful in this regard. Resolving the
problem may sometimes require a multidisciplinary approach, enlisting the
advice and assistance of others outside the medical profession. The references
cited in the notes throughout and in the For Assistance and Additional
Information section will provide the reader with additional information.
References
1 U.S. Environmental Protection
Agency, Office of Air and Radiation. Report to Congress on Indoor Air Quality,
Volume II: Assessment and Control of Indoor Air Pollution, pp. i, 4-14.
EPA-400-1-89-001C, 1989.
2 The U.S. Environmental Protection
Agency sets and enforces air quality standards only for ambient air. The Toxic
Substances Control Act (TSCA) grants EPA broad authority to control chemical
substances and mixtures that present an unreasonable risk of injury to health
and environment. The Federal Insecticide, Fungicide, and Rodenticide Act
(FIFRA) authorizes EPA to control pesticide exposures by requiring that any
pesticide be registered with EPA before it may be sold, distributed, or used in
this country. The Safe Drinking Water Act authorizes EPA to set and enforce
standards for contaminants in public water systems. EPA has set several
standards for volatile organic compounds that can enter the air through
volatilization from water used in a residence or other building. As to the
indoor air in workplaces, two Federal agencies have defined roles concerning
exposure to (usually single) substances. The National Institute for
Occupational Safety and Health and Human Services (NIOSH), part of the
Department of Health and Human Services, reviews scientific information,
suggests exposure limitations, and recommends measures to protect workers'
health. The Occupational Safety and Health Administration (OSHA), part of the
Department of Labor, sets and enforces workplace standards. The U.S. Consumer
Product Safety Commission (CPSC) regulates consumer products which may release
indoor air pollutants. In the United States there are no Federal Standards that
have been developed specifically for indoor air contaminants in
non-occupational environments. There are, however, some source emission
standards that specify maximum rates at which contaminants can be released from
a source.
For more extensive
information, see the publication cited above, in particular Chapter 7,
"Existing Indoor Air Quality Standards," and Chapter 9, "Indoor
Air Pollution Control Programs.
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