School attendance and daily respiratory symptoms in children: influence of moisture damage

We investigated the effect of weekends and school holidays on the daily frequency and severity of respiratory and other symptoms among children attending schools with (index) or without (reference) moisture damage in Spain, the Netherlands, and Finland. Throughout 1 year, parents of 419 children with a respiratory condition attending index (n=15) or reference (n=10) primary schools completed three symptom diaries. We assessed associations between lower respiratory tract, upper respiratory tract or allergy, and other symptom scores and school day, weekend, or summer holiday using mixed regression models stratified by country and moisture damage. We evaluated interactions between moisture damage and type of day. We combined country‐specific estimates (incidence rate ratios [IRRs] and 95% confidence interval [CI]) in meta‐analyses. Symptom scores were lower during weekends and holiday. Lower respiratory tract symptoms were statistically significantly less common during holiday with strongest effect in index schools (IRR=0.7; CI=0.6–0.8). Reporting of other symptoms was more reduced during holiday in index (IRR=0.6; CI=0.4–0.9) than in reference (IRR=0.95; CI=0.8–1.2) schools (interaction P<.01). In conclusion, symptoms were less frequent and/or severe during summer holiday and weekends. This pattern was stronger among children attending moisture‐damaged schools, suggesting potential improvement in moisture damage‐related symptoms during school breaks.     

Building-related respiratory symptoms can be predicted with semi-quantitative indices of exposure to dampness and mold

Using a semi-quantitative mold exposure index, the National Institute for Occupational Safety and Health (NIOSH) investigated 13 college buildings to examine whether building-related respiratory symptoms among employees are associated with environmental exposure to mold and dampness in buildings. We collected data on upper and lower respiratory symptoms and their building-relatedness, and time spent in specific rooms with a self-administered questionnaires. Trained NIOSH industrial hygienists classified rooms for water stains, visible mold, mold odor, and moisture using semi-quantitative scales and then estimated individual exposure indices weighted by the time spent in specific rooms. The semi-quantitative exposure indices significantly predicted building-related respiratory symptoms, including wheeze [odds ratio (OR) = 2.3; 95% confidence interval (CI) = 1.1-4.5], chest tightness (OR = 2.2; 95% CI = 1.1-4.6), shortness of breath (OR = 2.7; 95% CI = 1.2-6.1), nasal (OR = 2.5; 95% CI = 1.3-4.7) and sinus (OR = 2.2; 95% CI = 1.2-4.1) symptoms, with exposure-response relationships. We found that conditions suggestive of indoor mold exposure at work were associated with building-related respiratory symptoms. Our findings suggest that observational semi-quantitative indices of exposure to dampness and mold can support action to prevent building-related respiratory diseases. PRACTICAL IMPLICATIONS: Current air sampling methods have major limitations in assessing exposure to mold and other biological agents that may prevent the demonstration of associations of bioaerosol exposure with health. Our study demonstrates that semi-quantitative dampness/mold exposure indices, based solely on visual and olfactory observation and weighted by time spent in specific rooms, can predict existence of excessive building-related respiratory symptoms and diseases. Relative extent of water stains, visible mold, mold odor, or moisture can be used to prioritize remediation to reduce potential risk of building-related respiratory diseases. From a public health perspective, these observational findings justify action to correct water leaks and repair water damage in order to prevent building-related respiratory diseases. This approach can also be a basis for developing practical building-diagnostic tools for water-incursion.     

Incense (bakhour) smoke exposure is associated with respiratory symptoms and impaired lung function among adults: A cross-sectional study in Eastern Province of Saudi Arabia

Burning incense (bakhour) is a common cultural practice in Saudi Arabia. However, its health risk assessment has rarely been studied. This study aims to investigate the association between exposure to incense smoke on lung function impairments and respiratory symptoms among young adults in Saudi Arabia. A community-based cross-sectional study was designed with a representative study sample (N = 125) in the Eastern Province of Saudi Arabia. Study participants, exposed group (n = 45), working in bakhour shop and matched control (n = 80), no history of occupational exposure to bakhour smoke, were recruited randomly from the population registry. Socio-demographic and respiratory symptom information were collected through a questionnaire developed based on European Community Respiratory Health Survey II (ECRHS II). Lung function measurements were conducted using a field spirometer. The overall prevalence of wheezing or whistling was 16.8%, with a higher prevalence in exposed group 35.5%. In adjusted models, exposed to incense smoke remained positively associated with respiratory symptoms: wheezing or whistling; breathlessness; chest tightness shortness of breath; woken up by an attack of coughing. Our study suggests that inhaled incense smoke in occupation or at home is a risk factor of lung function impairments among adult population in Saudi Arabia.     

Multivariate evaluation of VOCs in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not

Volatile organic compounds (VOCs) were sampled in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not. In total, nine persons and 34 buildings were included in the study. The obtained VOC data was evaluated using multivariate methods, to investigate possible systematic differences in air quality of 'problem' and 'non-problem' buildings. All individual compounds were included as variables in a multivariate partial least squares (PLS) data analysis. 'Problem' and 'non-problem' buildings separated into two distinct groups, showing that air samples of the two groups of building were chemically different. PRACTICAL IMPLICATIONS: The study showed that there was an identifiable systematic difference in the collected VOC data between buildings causing and not causing problems for people with non-specific building-related symptoms (also called sick building syndrome, SBS). This is an important indication that even such volatile organic compounds that can be sampled by commonly used adsorbents are of importance for the presence of such symptoms. By coordination of procedures for sampling and analysis of VOCs in buildings between laboratories, to get large datasets and more general models, the method can become a useful diagnostic measure in evaluating indoor air and to identify chemical compounds and sources that contribute to SBS problems.     

Protein profiles of nasal lavage fluid from individuals with work‐related upper airway symptoms associated with moldy and damp buildings

Upper airway irritation is common among individuals working in moldy and damp buildings. The aim of this study was to investigate effects on the protein composition of the nasal lining fluid. The prevalence of symptoms in relation to work environment was examined in 37 individuals working in two damp buildings. Microbial growth was confirmed in one of the buildings. Nasal lavage fluid was collected from 29 of the exposed subjects and 13 controls, not working in a damp building. Protein profiles were investigated with a proteomic approach and evaluated by multivariate statistical models. Subjects from both workplaces reported upper airway and ocular symptoms. Based on protein profiles, symptomatic subjects in the two workplaces were discriminated from each other and separated from healthy controls. The groups differed in proteins involved in inflammation and host defense. Measurements of innate immunity proteins showed a significant increase in protein S100‐A8 and decrease in SPLUNC1 in subjects from one workplace, while alpha‐1‐antitrypsin was elevated in subjects from the other workplace, compared with healthy controls. The results show that protein profiles in nasal lavage fluid can be used to monitor airway mucosal effects in personnel working in damp buildings and indicate that the profile may be separated when the dampness is associated with the presence of molds.     

Prevalence and risk factors associated with nonspecific building‐related symptoms in office employees in Japan: relationships between work environment,Indoor Air Quality,and occupational stress

A nationwide cross‐sectional study of 3335 employees was conducted in 320 offices in Japan to estimate the prevalence of building‐related symptoms (BRSs) and determine the risk factors related to work environment, Indoor Air Quality, and occupational stress. Data were collected through self‐administered questionnaires. The prevalences of general symptoms, eye irritation, and upper respiratory symptoms were 14.4%, 12.1%, and 8.9%, respectively. Multiple logistic regression analyses revealed that eye irritation was significantly associated with carpeting [odds ratio (OR), 1.73; 95% confidence interval (CI), 1.24–2.41], coldness perception (OR, 1.28; 95% CI, 1.13–1.45), and air dryness perception (OR, 1.61; 95% CI, 1.42–1.82). General symptoms were significantly associated with unpleasant odors (OR, 1.37; 95% CI, 1.13–1.65), amount of work (OR, 1.24; 95% CI, 1.06–1.45), and interpersonal conflicts (OR, 1.44; 95% CI, 1.23–1.69). Upper respiratory symptoms were significantly associated with crowded workspaces (OR, 1.36; 95% CI, 1.13–1.63), air dryness perception (OR, 2.07; 95% CI, 1.79–2.38), and reported dustiness on the floor (OR, 1.39; 95% CI, 1.16–1.67). Although psychosocial support is important to reduce and control BRSs, maintaining appropriate air‐conditioning and a clean and uncrowded workspace is of equal importance.