Building health and ill-health

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1 Building health and ill-health BSRIA November 2016 Paul Cullinan Royal Brompton Hospital and Imperial College London LUNGS AT WORK

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4 What I do when I go to work construction industrial toxins Legionella residence asbestos fabric asbestos humidifier fevers temperature extremes hypoxia poor IAQ SBS perfumes mcs good IAQ performance satisfaction low absences mould VOC disease sickness illness wellbeing science medically unexplained

5 comfort zone construction industrial toxins Legionella residence asbestos mould fabric asbestos humidifier fevers temperature extremes hypoxia VOC poor IAQ SBS perfumes mcs

6 Italy; malignant mesothelioma in women

7 Eternit in Italy Casale Monferrato ( )

8 a little more difficult construction industrial toxins Legionella residence asbestos mould fabric asbestos humidifier fevers temperature extremes hypoxia VOC poor IAQ SBS perfumes mcs

9 Humidifiers make doctors nervous

10 Humidifiers make doctors nervous - humidifier lung in South Korea; mothers and children

11 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 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.

12 Hypoxic air technology normal air hypoxic air oxygen 20% 15% nitrogen 80% 85%

13 A lot more difficult construction industrial toxins Legionella residence asbestos mould fabric asbestos humidifier fevers temperature extremes hypoxia VOC poor IAQ SBS perfumes mcs science journals medically unexplained www

14 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

15 The syndromes 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. 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 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. 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

16 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

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19 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.

20 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

21 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 confusion loss of appetite depression anxiety numbness upper respiratory symptoms shortness of breath difficulty with concentration skin irritation Allergic and asthmatic patients, as well as those with other conditions, report that certain odours, even in the smallest amounts, can trigger an attack.

22 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.

23 Difficulties with mould a spectrum of effects construction industrial toxins Legionella residence asbestos mould fabric asbestos humidifier fevers temperature extremes hypoxia VOC poor IAQ SBS perfumes mcs

24 Hypersensitivity pneumonitis from a leaky Portacabin used as an office

25 and difficulties with VOCs construction industrial toxins Legionella residence mould fabric asbestos humidifier fevers temperature extremes hypoxia VOC poor IAQ SBS perfumes mcs

26 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 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

27 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

28 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 There s nothing quite like the look of a freshly painted room: It speaks of new beginnings and possibilities. Unfortunately, there s nothing quite like the smell of one, either. A justpainted 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.

29 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

30 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 good IAQ performance satisfaction low absences mould VOC wellbeing

31 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 of the environmental conditions at their workstations on 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 webbased 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 on 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 on the correct keystroke rate (p = 0.011) and on the mouse-click rate (p = 0.008).

32 IAQ and performance in schools: EU Sinfonie

33 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

34 Enough of this and thank you The art of medicine consists of amusing the patient while Nature takes its course. Voltaire

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