BSRIA November 2016 Paul Cullinan Royal Brompton Hospital and - - PowerPoint PPT Presentation

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

good IAQ performance satisfaction low absences disease sickness illness wellbeing construction industrial toxins Legionella ‘residence’ asbestos ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC

What I do when I go to work …

‘science’ ‘medically unexplained’

‘comfort zone’

construction industrial toxins Legionella ‘residence’ asbestos ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC

Italy; malignant mesothelioma in women

Casale Monferrato (1907-1986)

Eternit in Italy

a little more difficult …

construction industrial toxins Legionella ‘residence’ asbestos ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC

Humidifiers make doctors nervous

Humidifiers make doctors nervous

• humidifier lung in South Korea; mothers and children

… 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.

‘Kew cough’ (humidifier fever)

Hypoxic air technology

‘normal’ air hypoxic air

• xygen

20% 15% nitrogen 80% 85%

A lot more difficult

construction industrial toxins Legionella ‘residence’ asbestos ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC ‘science’ journals ‘medically unexplained’ www

The ‘syndromes’; sick building syndrome as an example

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
• sick building syndrome (SBS)
• EMF syndrome
• mould-associated syndrome
• multiple chemical sensitivity
• aerotoxic syndrome
• acoustic vibration syndrome

Wind turbine syndrome produces several symptoms related to the vestibular system’s (balance) organs: disturbed sleep, headaches, tinnitus (ear ringing), and sense of quivering or vibration, nervousness, rapid heartbeat, nausea, difficulty with concentration, memory loss, irritability and anger Symptoms Associated with Mould-Associated Illness:

• fatigue and weakness.
• headache, light sensitivity.
• poor memory, difficult word finding.
• difficulty concentration.
• morning stiffness, joint pain.
• unusual skin sensations, tingling and numbness.
• shortness of breath, sinus congestion or chronic cough.

the symptoms of multiple chemical sensitivity

• burning, stinging eyes.
• wheezing, breathlessness nausea.
• extreme fatigue/lethargy.
• headache/migraine/vertigo/dizziness.
• poor memory & concentration.
• runny nose (rhinitis)
• sore throat, cough.
• sinus problems.

Aero-toxic syndrome: any combination of the following may be experienced:

• fatigue – feeling exhausted, even after sleep.
• blurred or tunnel vision.
• shaking and tremors.
• loss of balance and vertigo.
• seizures.
• loss of consciousness.
• memory impairment.
• headache.

The ‘syndromes’

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
• ften 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”

“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
• confusion
• loss of appetite
• depression
• anxiety
• numbness
• upper respiratory symptoms
• shortness of breath
• difficulty with concentration
• skin irritation”

Problems with ‘perfumes’ (≈ multiple chemical sensitivity)

“Allergic and asthmatic patients, as well as those with other conditions, report that certain odours, even in the smallest amounts, can trigger an attack.”

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 industrial toxins Legionella ‘residence’ asbestos ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC

Hypersensitivity pneumonitis from a leaky Portacabin used as an office

construction industrial toxins Legionella ‘residence’ ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC

… and difficulties with VOCs

Susan; an office manager

Saturday night: returned from holiday to freshly painted house Sunday morning:

• awoke with rash; peak swelling at 24-36 hours

September 2014 Newly repainted office

• rash appeared by the afternoon
• burning sensation took weeks to resolve

July 2015 October 2015 Tuesday: bedroom painted Thursday: symptoms began

• most severe reaction
• faint rash still present at Christmas
• red, itchy rash underarm after using a deodorant
• consequently, for 2+ years, has been using “Simple” products

• 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’

Methylisothiazolinone (MI)

“There’s nothing quite like the look of a freshly painted room: It speaks

• f new beginnings and possibilities.

Unfortunately, there’s nothing quite like the smell of one, either. A just- painted room reeks of volatile organic compounds (VOCs) that can cause eye, nose, and throat irritation, plus headaches, nausea, and

• dizziness. Some VOCs can cause cancer in animals, and some are

suspected or known to cause cancer in humans. Paint is cheap; your health is priceless.”

But what about the paint?

• traditional oil-based paints contain ‘solvents’
• spent solvents are classified as a toxic waste …
• … and are subject to environmental regulation
• paint manufacturers responded by
• developing (inferior) water-based paints
• re-framing the ‘VOC/indoor air’ debate

Alas …

• ‘low odour’ (water-based) paints are a breeding ground for fungi/bacteria
• but contamination can be controlled by …
• …MI

Susan:

• was sensitised by the use of MI-containing cosmetics …
• … and now reacts to traces of MI off-gassed by fresh paint

= ‘contact dermatitis’ without ‘contact’

good IAQ performance satisfaction low absences wellbeing

What I do not do when I go to work …

construction industrial toxins Legionella ‘residence’ asbestos ‘fabric’ asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs mould VOC

The ‘science’ in this field …

• is relatively scarce …
• … and relatively weak
• quasi-experimental
• ‘one exposure at a time’
• potentially confounded

Relationship between office work performance and indoor temperature based on data from 24 studies. 19 employees performing comparable sales order-entry tasks participated in a study of the effects

• f the environmental conditions at

their workstations

• n

their computer work performance. Air temperature, relative humidity, carbon dioxide, total volatile organic compounds, and respirable particulates at 10 microns were logged at each workstation. A web- based software system gathered contemporaneous computer work performance data (correct keystrokes, correction keystrokes, and total mouse clicks). Results showed an effect of day of the week

• n the correct keystroke rate (p =

0.01) and on the mouse-click rate (p = 0.007) with more being done on Mondays than Fridays and an interaction of workday and air temperature

• n

the correct keystroke rate (p = 0.011) and on the mouse-click rate (p = 0.008).

IAQ and performance in schools: EU Sinfonie

http://publications.jrc.ec.europa.eu/repository/handle/JRC91160

IMO

• people should work in decent surroundings
• quite a lot of this is common sense
• no measures to improve IAQ can compensate for work that is soul destroying

Enough of this … and thank you

“The art of medicine consists of amusing the patient while Nature takes its course.”

Voltaire