Building health and ill-health BSRIA November 2016 Paul Cullinan Royal Brompton Hospital and Imperial College London p.cullinan@imperial.ac.uk LUNGS AT WORK www.lungsatwork.org.uk
What I do when I go to work … construction ‘fabric’ asbestos poor IAQ good IAQ industrial toxins humidifier fevers SBS performance Legionella temperature extremes perfumes satisfaction ‘residence’ asbestos hypoxia mcs low absences mould VOC disease sickness illness wellbeing ‘science’ ‘medically unexplained’
‘comfort zone’ construction ‘fabric’ asbestos poor IAQ industrial toxins humidifier fevers SBS Legionella temperature extremes perfumes ‘residence’ asbestos hypoxia mcs mould VOC
Italy; malignant mesothelioma in women
Eternit in Italy Casale Monferrato (1907-1986)
a little more difficult … construction ‘fabric’ asbestos poor IAQ industrial toxins humidifier fevers SBS Legionella temperature extremes perfumes ‘residence’ asbestos hypoxia mcs mould VOC
Humidifiers make doctors nervous
Humidifiers make doctors nervous - humidifier lung in South Korea; mothers and children
‘Kew cough’ (humidifier fever) … a two -stage investigation into an influenza-like illness that had occurred among the staff at the Public Records Office in Kew in March 1984. Similar but milder symptoms had been recognised since the opening of the building in 1977 and had always been attributed to the AC system. The increase in the severity of the symptoms coincided with major repair and maintenance work on the humidifier and chiller units. Environmental and immunological investigations showed contamination of the water in the humidifier reservoirs by a variety of micro- organisms … improvement was recognised after cleaning and maintenance had been completed to a revised schedule.
Hypoxic air technology ‘normal’ air hypoxic air oxygen 20% 15% nitrogen 80% 85%
A lot more difficult construction ‘fabric’ asbestos poor IAQ industrial toxins humidifier fevers SBS Legionella temperature extremes perfumes ‘residence’ asbestos hypoxia mcs mould VOC ‘science’ ‘medically unexplained’ journals www
The ‘syndromes’; sick building syndrome as an example • sick building syndrome (SBS) • EMF syndrome • mould-associated syndrome • multiple chemical sensitivity • aerotoxic syndrome • acoustic vibration syndrome The symptoms of SBS may include: • headaches and dizziness • nausea • aches and pains • fatigue (extreme tiredness) • poor concentration • shortness of breath or chest tightness • dry skin, rashes • eye and throat irritation. • irritated, blocked or runny nose • sensitivity to odours
The ‘syndromes’ Symptoms Associated with Mould-Associated Illness: the symptoms of multiple chemical sensitivity • fatigue and weakness. • burning, stinging eyes. • headache, light sensitivity. • wheezing, breathlessness nausea. • poor memory, difficult word finding. • extreme fatigue/lethargy. • difficulty concentration. • headache/migraine/vertigo/dizziness. • morning stiffness, joint pain. • poor memory & concentration. • unusual skin sensations, tingling and numbness. • runny nose (rhinitis) • shortness of breath, sinus congestion or chronic cough. • sore throat, cough. • sinus problems. Aero-toxic syndrome: any combination of the following may be experienced: Wind turbine syndrome produces several • fatigue – feeling exhausted, even after sleep. symptoms related to the vestibular system’s • blurred or tunnel vision. (balance) organs: disturbed sleep, headaches, • shaking and tremors. tinnitus (ear ringing), and sense of quivering or • loss of balance and vertigo. vibration, nervousness, rapid heartbeat, nausea, • seizures. difficulty with concentration, memory loss, • loss of consciousness. irritability and anger • memory impairment. • headache.
The ‘syndromes’ • non- specific symptoms … • … that are difficult to measure • ‘new’ technologies/exposures • culturally- • and temporally-specific • ± ’herd’ behaviours • difficult (if not impossible) to demonstrate objectively • can be devastating • often involve a lot of money changing hands …
Problems with ‘perfumes’ “ Ms X is 57 and, since childhood, has had asthma, which in the early years was fairly difficult to control but which, largely, remitted in her teens. More recently (see below), it is reported to have become more difficult to manage. She has a long- standing set of “allergies” to solvents, paints, cigarette smoke, cleaning products, strong perfumes and similar agents. She is able to avoid many of these outside work but finds this difficult in her current job with the result that some of her related symptoms have worsened; perfumes, for example, used simply to make her sneeze but now cause her ‘serious irritation ’. The situation has been complicated further by her move to central London where she finds the exposure to traffic fumes greater. One result has been that she has found it very difficult to operate at work (she is an “on -line adviser” for XX) and as a result has been working from home. More significantly, she now finds herself largely housebound .”
Problems with ‘perfumes’ “ Ms X is 57 and, since childhood, has had asthma, which in the early years was fairly difficult to control but which, largely, remitted in her teens. More recently (see below), it is reported to have become more difficult to manage. She has a long- standing set of “ allergies ” to solvents, paints, cigarette smoke, cleaning products, strong perfumes and similar agents. She is able to avoid many of these outside work but finds this difficult in her current job with the result that some of her related symptoms have worsened; perfumes, for example, used simply to make her sneeze but now cause her ‘serious irritation ’. The situation has been complicated further by her move to central London where she finds the exposure to traffic fumes greater. One result has been that she has found it very difficult to operate at work (she is an “on -line adviser” for XX) and as a result has been working from home. More significantly, she now finds herself largely housebound. … relationships with her manager are not as cordial as one would wish ”
Problems with ‘perfumes’ (≈ multiple chemical sensitivity) “When scented products have been blamed for adversely affecting a person's health, some or all of the following symptoms are reported: • headaches • dizziness, lightheadedness • nausea • fatigue • weakness • insomnia • malaise “Allergic and asthmatic patients, as • confusion well as those with other conditions, • loss of appetite report that certain odours, even in • depression the smallest amounts, can trigger • anxiety an attack.” • numbness • upper respiratory symptoms • shortness of breath • difficulty with concentration • skin irritation”
Sample: Scent-Free Policy Policy: due to the health concerns arising from exposure to scented products, ABC Company Inc. has instituted this policy to provide a scent-free environment for all employees and visitors. Definitions: the use of scented products will not be allowed within the building at any time. In addition, all materials used for cleaning will be scent-free. Procedure: employees will be informed of this policy through signs posted in buildings, the policy manual, promotional materials and will receive orientation and training. Visitors will be informed of this policy through signs and it will be explained to them by their host. This policy is effective on 01/01/16.
Difficulties with mould … a spectrum of effects construction ‘fabric’ asbestos poor IAQ industrial toxins humidifier fevers SBS Legionella temperature extremes perfumes ‘residence’ asbestos hypoxia mcs mould VOC
Hypersensitivity pneumonitis from a leaky Portacabin used as an office
… and difficulties with VOCs construction ‘fabric’ asbestos poor IAQ industrial toxins humidifier fevers SBS Legionella temperature extremes perfumes ‘residence’ hypoxia mcs mould VOC
Susan; an office manager • red, itchy rash underarm after using a deodorant • consequently, for 2 + years, has been using “Simple” products September 2014 Saturday night: returned from holiday to freshly painted house Sunday morning: • awoke with rash; peak swelling at 24-36 hours July 2015 Newly repainted office • rash appeared by the afternoon • burning sensation took weeks to resolve October 2015 Tuesday: bedroom painted Thursday: symptoms began • most severe reaction • faint rash still present at Christmas
Methylisothiazolinone (MI) • synthetic biocide used since the 1980s • derivatives have >30 trade names • most commonly used are MI and methylchloroisothiazolinone(MCI) [Kathon] • potent sensitiser and a frequent cause of preservative contact allergy • 2005: MI permitted for use in cosmetic products at up to 100 ppm – 2% cosmetics – 16% ‘household products’
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