PERIODICUM BIOLOGORUM UDC 57:61

VOL. 111, No 1, 37–40, 2009 CODEN PDBIAD

ISSN 0031-5362

Overview

Indoor air pollution and effects on human health

Abstract
EUGENIJA @U[KIN1
E NEIL SCHACHTER2 Background and Purpose: Indoor pollutants could be significant pub-
JADRANKA MUSTAJBEGOVI]1 lic health risks. People in modern societies spend about 90% of their time in
JASNA PUCARIN-CVETKOVI]1 indoor environment. In spite of the evidence of harm to human health, poor
JAGODA DOKO-JELINI]1 indoor environments are generally hard to understand.
BRANKA MU^I]-PUCI]3
1 Materials and Methods: There are numerous indoor atmospheric pol-
Andrija [tampar School of Public Health,
Rockefellerova 4, 10000 Zagreb, Croatia
lutants. Specifically, combustion sources, building materials, volatile or-
ganic compounds, central heating and cooling system are described.
2
Mount Sinai School of Medicine,
One Gustave L Levy Place, New York, Results: Indoor home environments are the site of a variety of biological
NY10029, USA and other environmental hazards. Indoor environmental quality has a sig-
3
nificant impact on public health and well-being. These hazards cause and
Department of Pediatric, exacerbate a variety of adverse health effects in humans, ranging from acute
Clinical Hospital Rebro, Ki{pati}eva 12
10000 Zagreb, Croatia
and chronic respiratory symptoms and diseases to cancer. We review the ef-
fects of indoor allergen exposure and sensitization on asthma, focusing on
Correspodence: dust mite, fungi, indoor pollutants such as ozone, particulate matter nitro-
Eugenija @u{kin gen dioxide, environmental tobacco smoke, sulfur dioxide, carbon monox-
Andrija [tampar School of Public Health ide and dampness of buildings. Additionally, the effects of lead, as well as
University of Zagreb Medical School
Rockefellerova 4
carcinogenic effects of asbestos, radon, and smoking habits are described.
HR-10000 Zagreb, Croatia Conclusions: Preventive measures, such as identification of a source of
E-mail: [email protected]
chemical, physical, or biological pollutants that may have deleterious health
effects, and improvement of such harmful environmental conditions should
be undertaken.
Key words: environmental pollution, health
effects, prevention

INTRODUCTION

A s early as several centuries ago B.C. the famous Greek »father of me-
dicine« Hippocrates (460-370 B.C.) was aware of the adverse ef-
fects of polluted air and the damage of living in damp housing.Poor in-
door environmental quality is an important health risk worldwide. Peo-
ple in modern societies spend about 90% in indoor environments,
which has a significant impact on public health and well-being (1).
Numerous health risks have been identified in homes and are a pub-
lic health priority (2). Hazards in indoor environments include biologi-
cal and chemical contaminants as well as the effects of physical agents.
Main sources of indoor pollution include combustion sources (oil, gas,
kerosene, coal, wood and tobacco products), volatile organic com-
pounds, building materials (asbestos), carpets, house cleaning and
maintenance, personal care or hobbies, central heating and cooling sys-
tem and humidification devices, lack of ventilation, too much humid-
Received January 9, 2008. ity, water infiltration or leakage, carbon monoxide and other gases, ra-
don and other noxious agents (3, 4).
Eugenija @u{kin et al. Indoor air pollution and health

TABLE 1
Some of the sources and potential health effects of indoor air pollutants.

Pollutant Indoor Sources Potential Health Effects

Environmental Cigarette and cigar smoke, unventilated or Headache, fatigue, poor memory, cough, respiratory
tobacco smoke, malfunctioning gas appliances, wood stoves, tobacco irritation, bronchitis, pneumonia in children,
carbon smoke, cooking gases, gas heaters, formaldehyde, emphysema, lung cancer, heart disease, eye, nose and
monoxide, volatile organic compounds, odors, products for throat irritation, nausea, angina, impaired vision and
nitrogen oxides household cleaning and maintenance, combustion mental functioning, fatal at high concentrations,
and other gases, pollution, aerosol sprays, solvents, glues, cleaning wheezing, nasal congestion, skin irritation, dizziness,
organic agents, pesticides, paints, moth repellents, air confusion, asthma, loss of coordination, damage to
chemical, fresheners, drycleaned clothing, treated water, products liver, kidney and brain; various types of cancer, damage
pesticides, used to kill pests such as insecticides, termiticides and to the central nervous system and liver, allergic
formaldehyde herbicides. Also lawn and garden products, pressed reactions; cancer
wood products such as plywood and particleboard;
furnishings; wallpaper; durable press fabrics
Respirable Cigarettes, wood stoves, fireplaces, aerosol sprays, and Eye, nose and throat irritation, increased susceptibility
particles, house dust, textile, wallboard, wood, decorating to respiratory infections and bronchitis, lung cancer,
asbestos hazards, insulation, damaged or deteriorating asbestosis, mesothelioma
insulation, fireproofing, and acoustical materials
Radon Soil under buildings, some earth-derived construction Lung cancer
materials, and groundwater
Lead Sanding or open-flame burning of lead paint; house Nerve disorders, anemia; damage of kidney; growth
dust retardation
Biological House dust, dust mites, pets, bedding; poorly Coughing, shortness of breath, allergic rhinitis,
organisms and maintained air conditioners, humidifiers and asthma, eye, nose, and throat irritation, humidifier
other organic dehumidifiers, wet or moist structures, furnishings, fever, influenza, other infectious diseases, myalgia,
pollutants insects, cockroach parts, pollen, animal dander and malaise, fatigue, hypersensitivity pneumonitis,
saliva, protein in animal urine, bacterial endotoxins digestive problems, itching
and fungal materials

Chemical hazards include numerous chemical agents, to which subjects could be exposed without a risk for de-
such as nitrogen and sulfur oxides, ozone, pesticides, for- veloping disease.
maldehyde, infectious agents, and biological agents (mi-
Deleterious health effects may show up after a single
crobial organisms, mold, dust mites) (5-8).
or repeated exposure to certain indoor pollution depend-
Temperature, relative humidity, extensive cold or hot ing on age, preexisting medical conditions and individ-
surfaces, and draft effects also modify the effects of chem- ual sensitivity.
ical and biological contaminants. Some agents include
allergens, and agents such as colorless, odorless gases and
aerosolized toxins, physical stimuli such as bright lights COMBUSTION PRODUCTS
and loud sounds (9). Chaiear et a. recently (10) described Diverse indoor combustion sources contribute to the
persons suffering from erythema and other skin changes, quality of indoor air environment (11). Indoor combustion
conjuctive infection caused by indoor radiation pollution products include mostly environmental tobacco smoke,
due to ultraviolet C radiation from germicidal ultraviolet woodsmoke, carbon monoxide, nitrogen and sulfur diox-
lamps. ide, soot and organics from incomplete combustion.
Table 1 presents some of the sources of indoor air pol- Combustion products – dangerous gases and particles
lutants and their potential health effects. can be generated by different appliances such as water
Identification or recognition of the deleterious effects heaters, unvented gas or kerosene space heaters, etc.
of some agents are determined by evaluating the risk of Among such gases, the most frequent are carbon monox-
developing certain diseases or impairment. It is very im- ide and nitrogen oxides.
portant to estimate the dose-effect relationship of a cer-
tain agent on individual bases. Larger doses of noxious
agents may have detrimental effect on the whole body. VOLATILE, NONVOLATILE AND OTHER
Such effects depend on individual sensitivity to certain NONBIOLOGICAL AGENTS
harmful agent/s. Simultaneous exposure to different en- These compounds include household and office pro-
vironmental agents may have cumulative noxious effects. ducts such as formaldehyde, pesticides, solvents, clean-
There are Maximal Allowable Concentrations (MAC) for ing agents, heavy metals (airborne lead, mercury vapor,
almost all environmental agents (organic and physical) asbestos, radon).

38 Period biol, Vol 111, No 1, 2009.

Indoor air pollution and health Eugenija @u{kin et al.

Chemicals When radon is inhaled, its radioactive breakdown

The chemicals we breathe (such as perfumes, formal- products deliver a radioactive assault to the lungs, which
dehyde, pesticides, solvents, cleaning agents, benzene, increases the risk of lung cancer. For smokers, the risk of
perchloroethylene, hair sprays, household products (fin- lung cancer is significant due to the synergistic effects of
ishes, rug and oven cleaners, paints, thinners, dry clean- radon and smoking. However, radon may also be the
ing fluids), some copiers and printers, glues and adhe- leading cause of lung cancer among nonsmokers. Radon
sives, markers and photo solutions are among some of is responsible for about 21,000 lung cancer deaths every
the common products that may emit organic compounds. year (18).
Volatile organic compounds are among major pollutants
of indoor air which have a significant impact on indoor
BIOLOGICAL ORGANISMS AND OTHER
air quality and thus affect human health (12).
ORGANIC POLLUTANTS
Multiple chemical sensitivity (MCS) is a syndrome in
which multiple symptoms are caused by extremely low Biological organisms include bacteria, molds, fungi,
concentrations of environmental chemicals (13). Com- mildew, pollen, dust mites and other insects, arthropod
mon symptoms include irritation of the eye, nose and parts, animal dander (tiny scales from hair, feathers or
throat, hoarseness of voice, headache, fatigue, difficulty skin), animal saliva, infectious agents (bacteria and vi-
in concentrating, depressed mood, memory loss, weakness, ruses), mycotoxins and pollen.
dizziness, heat intolerance and arthralgia (14). Symp- Increased exposure to indoor allergens and selected
toms are precipitated by a wide array of common envi- outdoor allergens such as grass pollen and molds, partic-
ronmental agents. ularly house-dust, cockroaches, animal allergens as well
as smoking are important risk for developing of respira-
Asbestos tory diseases, particularly asthma and allergic sensitiza-
Indoor exposures to this agent are generally quite low, tion (19).
they may be higher than outdoor concentrations, and can Bacteria, fungi and molds can flourish in improperly
be substantial following remodeling, pesticide applica- maintained air ducts, air conditioners, humidifiers,
tion, or other product use. Asbestos exposure only exists dehumidifiers, air-cleaning filters, carpets and in im-
if the asbestos-containing material is distributed and mi- properly ventilated places where moisture is likely to col-
croscopic asbestos fibers are released into the air (15). lect, such as bathrooms, kitchens, laundry rooms and
Breathed-in asbestos fibers in the lungs can increase basements.
the risk of lung cancer and mesothelioma. Smoking dras-
tically increases the risk of lung cancer from asbestos ex- Adverse health effect associated with certain fungi is
posure. Average indoor asbestos levels are extremely low small molecular toxin (mycotoxin) produced by these
so that the related health risk is assumed to be low from fungi. The most frequent disease related to biological
the mere presence of asbestos-containing material. factors include legionaire’s disease, allergic reactions, hy-
persensitivity pneumonitis, humidifier fever and tuber-
Lead culosis.
Everyone is exposed to trace amounts of lead through
Molds
inhalation of lead vapors since many consumer products
and paints contain lead. Molds are the major pollutant in the indoor environ-
Lead toxicity causes hematological, gastrointestinal ment. About 5% of individuals are predicted to have
and neurological dysfunction. Anemia is common and some allergic airway symptoms from molds over life
damage to the nervous system may cause impaired men- time. Indoor mold can usually be seen or smelled. Mold
tal function. Other symptoms are appetite loss, abdomi- can be found behind painted walls, carpets, cabinets,
nal pain, constipation, fatigue, sleeplessness, irritability walls, ceilings, and even in cleanly-maintained kitchen
and headache. Severe or prolonged exposure may also material and furnishings which provide ample nutrition
cause chronic nephropathy, hypertension and reproduc- for many species of molds.
tive impairment (16). Lead inhibits some enzymes, alters Health problems that arise from exposure to mold in-
cellular calcium metabolism, stimulates synthesis of clude allergic illness, irritant effects, infection and toxic
binding proteins in kidney, brain and bone, and slows effects. For people that are sensitive to molds, symptoms
down nerve conduction. such as nasal and sinus irritation or congestion, dry
hacking cough, wheezing, skin rashes or burning, watery
Radon or reddened eyes may occur (20). Mold can also trigger
Radon in air is ubiquitous. Radon gas, a naturally oc- asthma attacks in persons with asthma. Superficial fun-
curring radioactive soil gas, can infiltrate the air in the gal infections of skin and nails are relatively common in
house. Radon enters homes through cracks in the foun- normal individuals. Headaches, memory problems,
dation, floor drains, sump pumps and other openings nosebleeds and body aches and pains are sometimes re-
(17). ported in mold complaints.

Period biol, Vol 111, No 1, 2009. 39

Eugenija @u{kin et al. Indoor air pollution and health

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