The major area of public concern and government policy, in terms of the impact of air pollution on human health, continues to be outdoor air. However, over the last two decades, indoor air quality (IAQ) has caused increasing concern due to the adverse effects that it may have on human health. The term "indoors" is used in relative literature to refer to a variety of environments, including homes, workplaces, and buildings used as offices or for recreational purposes. In addition, a number of studies have been carried out to measure various compounds inside vehicles during commuting activities. Most people in the developed world spend up to 90% of their time in an indoor environment and up to 60% of the workforce work in an office. (Tsakas & Siskos, 2010; McCurdy et al., 2000; Ashford & Caldart, 2008; Andersson & Klevard Setterwall, 1996) Decreased ventilation rates for energy conservation, along with increased use of synthetic materials in buildings, have resulted in increased health complaints from building occupants (Siskos, 2003). Many indoor pollutants are either known, or suspected to be, allergens, carcinogens, neurotoxins, immunotoxins or irritants, while all may contribute to sick building syndrome (SBS). The set of health symptoms associated with SBS includes nasal, ocular and generalised diseases. According to various studies performed in public buildings by the National Institute of Occupational Safety and Health (Soldatos et al., 2003), the three most significant symptoms that were experienced in more than 70% of the buildings are dry eyes, dry throat and headaches.
The IAQ and the presence of air pollutants in indoor environment is a worldwide issue, since many governments and environmental institutes have faced this serious phenomenon. Starting in the 1990s in Japan, tightly sealed buildings with low ventilation rates have been constructed. This, combined with the use of some new types of building materials has often resulted in IAQ problems. Many inhabitants suffering with SBS and multiple chemical sensitivity (MCS), have been reported (McCurdy et al., 2000; Zhang & Niu, 2004). As a result the Japanese Ministry of Health, Labour and Welfare have introduced indoor air guidelines for a range of VOCs including HCHO based on hazard assessments (Shinohara et al., 2009).
The importance of IAQ has also been recognised in Europe and has been identified as an important element within the European Collaborative Action (ECA) (ECA, 1998) and the European Environment and Health Action Plan (Dimitroulopoulou et al., 2006). In America, the State of California has adopted an active programme for the last two decades aiming to the reduction of indoor air pollution, which has led to a range of policy instruments (Waldman & Jenkins, 2004). Over recent years, important steps have been made towards setting IAQ standards and guidelines in the UK (Dimitroulopoulou et al., 2006) and recently, the UK Department of Health Committee on the Medical Effects of Air Pollutants (Short, 2001), launched a guidance document on the effects of indoor air pollutants. In many developing countries, exposure to indoor air pollution causes a major health burden (Committee on the Medical Effects of Air Pollutants, 2004). Increased concern regarding indoor air quality especially in the last two decades has led to a number of studies and meetings on the subject. For example, in Greece many researchers have conducted significant studies about IAQ issue (Siskos & co-workers, 2001, 2003, 2005, 2010; Helmis & co-workers, 2007, 2009; Santamouris et al., 2001). With increasing concern in relation to health effects, in recent years the problem has come into sharper focus. Additional new sources of contaminants are being introduced, which haven’t been measured before. In several countries, studies have been undertaken, in some cases involving comprehensive investigations of the factors governing air quality, so that effective control measures ranging from the setting of minimum ventilation standards, to controlling, or even banning, certain products such as urea-formaldehyde foam insulation or unvented paraffin or gas heaters. It is nevertheless recognized that some of the responsibility for maintaining acceptable and healthy indoor air quality will continue to rest with building owners and occupants of buildings.
Some studies have revealed a variety of contaminants of indoor air including odorous, non-odorous gases and vapours, and particles, and although there were suggestions that some of these contaminants could be responsible for health effects, proving causal relationships is exceedingly difficult even where elevated levels of potentially toxic substances exist (World Health Organization [WHO], 1989; Perry & Kirk, 1986; WHO, 1986; Priorities for Indoor Air Research and Action, 1991).
2. Indoor air pollutants and their sources
There are many indoor air contaminants, which can be separated based on their effects on human health, the frequency of their appearance, their usual concentration levels, their sources etc. This chapter is focused, primarily, on those species common to indoor and outdoor air environments and those who are measured more often in indoor environments.
The main source of indoor radon is its immediate parent radium-226 in the ground of the site and in the building materials (Nero, 1988, 1989). Outdoor air also contributes to the radon concentration indoors, via the ventilation air. Tap-water and the domestic gas supply are usually radon sources of minor importance, with a few exceptions. In most situations it appears that elevated indoor radon levels originate from radon in the underlying rocks and soils (Castren et al., 1985). This radon may enter living spaces in dwellings by diffusion or pressure driven flow if suitable pathways between the soil and living spaces are present. It should be noted, however, that in a minority of cases elevated indoor radon levels may arise due to the use of building materials containing high levels of radium-226. Examples of such materials, used in some buildings, are by-product gypsum, alum shale and volcanic tuffs.
The United Nation Scientific Committee on the Effects of Atomic Radiations (UNSCEAR) has made a very simple model to try to estimate the relative contribution of these sources: for a "typical" house, with a radon concentration of 50 Bq/m3 at ground floor, the contributions of soil, building materials and outdoor air are, respectively, 60%, 20% and 20%, while for the upper floors in high rise buildings, where the radon concentration-is estimated to be "typically" 20 Bq/m3, these values become 0%, 50% and 50% (UNSCEAR, 1993).
For those who live close to the ground, e.g. in detached houses or on the ground floor of apartment buildings without cellars, the most important radon source is radium in the ground.
The radium concentration in soil usually lies in the range 10 Bq/kg to 50 Bq/kg, but it can reach values of hundreds Bq/kg, with an estimated average of 40 Bq/kg (UNSCEAR, 1993). Typical radon concentrations in soil gas range from 10000 Bq/m3 into 50000 Bq/m3. The potential for radon entry from the ground depends mainly on the activity level of radium-226 in the subsoil and its permeability with regard to air flow. Example of terrains with a high radon potential are alum shales, some granites and volcanic rocks, due to high concentrations of radium-226 and the presence of eskers (gravel, sand and rounded stone deposited from subglacial streams during the ice ages), all these being characterised by high permeability. The ground could also be contaminated with waste tailings from uranium or phosphate mining operations with enhanced activity levels (Tyson et al., 1993).
The ingress of radon from the soil is predominantly one of pressure-driven flow, with diffusion playing a minor role (de Meijer et al., 1992). The magnitude of the inflow varies with several parameters, the most important being the air pressure difference between soil air and indoor air, the tightness of the surfaces in contact with the soil on the site, and the radon exhalation rate of the underlying soil. If there is no airtight layer between the basement and the ground, the underpressure indoors causes radon to be drawn in from the ground under the building. Underpressure occurs in most houses if either the adjustment of inlet and outlet of air in forced ventilation systems or the outdoor air supply for vented combustion appliances is inappropriate. The underpressure may be considerable for all types of ventilation systems when the inlet air is restricted too much. The tightness of the structures has to do with e building regulations and techniques and is very dependent on cracks, openings and joints. Structures are hardly ever so airtight that radon inflow is completely prevented. For example, to get a radon daughter concentration of less than 100 Bq/m3 EER in a house with a volume of 500 m3 and a ventilation rate of 0.5 air changes per hour, not more than 1 m3 per hour must be allowed to leak into the house if the radon gas concentration in soil air is about 50000 Bq/m3. Such values are quite typical.
2.1.2. Building materials
Building materials are generally the second main source of radon indoors, while in the Seventies they were considered the principal one (UNSCEAR, 1977; Meyer et al., 1986). Radon exhalation from building materials depends not only on the radium concentration, but also on factors such as the fraction of radon produced through material release, the porosity of the material and the surface preparation and finish of the walls. In general, no action needs to be taken concerning traditional building materials. Typical values for radium and thorium content in building materials are 50 Bq/kg or less (Nuclear Energy Agency Organisation for Economic Co-operation and Development - NENOECD, 1979). Building materials containing by-product gypsum (UNSCEAR, 1982) and concrete containing alum shale (Swedjemark & Mjones, 1984) may have much higher radium concentrations. The activity concentrations in brick and concrete may also be high if the raw materials have been taken from locations with high levels of natural radioactivity. Examples of such natural materials, used in some buildings, are volcanic tuffs and pozzolana (Sciocchetti et al., 1983; Campos Venuti et al., 1984; Battaglia et al., 1990), where radium and thorium content can reach some hundreds of Bqlkg. Other measurements of radioactivity content and exhalation of building materials are reported in NENOECD (1979).
Building materials are the main sources of radon-220 (also called "thoron") in indoor air. Due to its short half life (55 s), thoron originating in soil in effect is usually prevented from entering buildings and therefore makes negligible contribution to indoor thoron levels. For this reason and due to the greater difficulties of measurement, thoron concentration measurements are very much fewer than those for radon. Although the indoor thoron concentrations are usually low (Cliff, 1992; UNSCEAR, 1993), in some cases the doses due to this isotope and its daughters are significant and comparable to those due to radon- 222 (Sciocchetti et al., 1983, 1992; Guo et al., 1992; Bochicchio et al., 1993; Doi & Kobayashi, 1994).
2.1.3. Outdoor air
Outdoor air usually acts as a diluting factor, due to its normally low radon concentration, but in some cases, as in high rise apartments built with materials having very low radium content, it can act as a real source. The radon concentration in outdoor air is mainly related to atmospheric pressure, and (in case of non-perturbative weather) it shows a typical oscillating time pattern, with higher values during the night.
Until a few years ago the average level of radon gas concentrations in the atmosphere at ground level was, in most cases, assumed to be of the order of few Bq/m3 -e.g. in the range of 4 to 15 Bq/m3 in USA (Gesell, 1983), but more recent measurements seem to indicate higher values, reaching some tens of Bq/m3 (Hopper et al., 1991; Robé et al., 1992; Bochicchio et al., 1993; Deyuan, 1993; Grasty 1994; Price et al., 1994). Quite high radon concentrations in the outdoor air have been reported near substantial radon sources, such as mine tailings (Tyson et al., 1993), or in the case of particular weather conditions, such as thermal inversion or very low precipitation (Grasty, 1994).
Ambient air over oceans has very low values (~ 0.1 Bq/m3) of radon concentrations, due to the minimum presence of radium in the sea water and the high solubility of radon in water at low temperatures. Therefore radon concentration in outdoor air of islands and coastal regions is generally lower than in continental countries, e.g. United Kingdom and Japan have an average outdoor air value of ~4 Bq/m3.
Taking into account recent measurements, the mean value of outdoor radon concentrations adopted by UNSCEAR in its last report has been changed from 5 to 10 Bq/m3 for continental areas and somewhat less in coastal regions (UNSCEAR, 1993).
2.1.4. Tap water
In wells drilled in rock the radon concentrations of water may be high. When such water is used in the household, radon can be partially released into the indoor air, causing an increase in the average radon concentrations. In a few regions, such as Finland and Maine (USA), the tap water from wells drilled in rock has been shown to contribute significantly to radon concentrations indoors. Radon concentrations in tap-water from deep wells can range from 100 kΒq/m3 to 100 MΒq/m3 (UNSCEAR, 1988). The indoor radon concentrations in these regions may already be high due to high rates of radon entry from the ground. The world average radon concentration in all types of water supplies is assumed to be 10 kΒq/m3 (UNSCEAR, 1993).
2.1.5. Domestic gas
In some regions, natural gas used for cooking and heating contains elevated concentrations of radon, which is released on combustion. Normally this source is insignificant, and can be monitored at transmission and distribution points. Typically the radon level in natural gas is about 1000 Bq/m3. Natural gas, as it is usually supplied, contains gas from a number of wells and fields and thus can vary over time, depending on the proportions supplied by different sources (UNSCEAR, 1993).
2.2. Oxides of nitrogen
A large number of studies of NO and NO2 have been carried out in many different indoor air environments (Finlayson-Pitts, 1999; Pitts et al., 1985). Because of air exchange, indoor levels are generally higher when outdoor levels increase (Hoek et al., 1989; Rowe et al., 1991; Hisham & Grosjean, 1991; Spengler et al., 1994; Weschler et al., 1994; Baek et al., 1997). However, enhanced indoor levels can be found when combustion sources are present. These include gas stoves, paraffin heaters, water heaters, and cigarette smoke (Wade et al., 1975; Marbury et al., 1988; Ryan et al., 1988; Petreas et al., 1988; Hoek et al., 1989; Pitts et al., 1989; Spengler et al., 1994; Levy et al., 1998). While combustion generates primarily NO, the focus indoors has been on NO2 because of its health impact. Again, the use of gas stoves was highly correlated with indoor NO2, with an indoor/outdoor concentration ratio of 1.19 for homes with a gas range compared to 0.69 for those without a gas stove. The ratio was even higher for homes with a paraffin space heater, 2.3 compared to 0.85 without such a heater (Levy et al., 1998). Both the indoor and outdoor concentrations of NO2 were higher in cities where at least 75% of the homes had gas stoves; for example, the mean outdoor NO2 concentration in such gas-intensive cities was 38 ± 20 ppb, compared to 14 ± 6 ppb in cities where fewer than 25% of the households had gas stoves installed. High concentrations of NO2 have also been measured in indoor skating rinks where the use of ice resurfacing machines powered by propane, gasoline, or diesel fuel results in significant emissions (e.g., Brauer & Spengler, 1994; Brauer et al., 1997; Pennanen et al., 1997). Mean concentrations of NO2 of ~200 ppb have been reported, with some rinks having concentrations up to 3 ppm! The indoor-to-outdoor ratios of the arithmetic mean concentrations varied from about 1 to 41, with an overall mean of 20. In the absence of such sources of NOx, indoor and outdoor concentrations are quite similar (Weschler et al., 1994), since removal of NO and NO2 indoors, e.g., on surfaces, is relatively slow. However, as it has been discussed shortly, although the surface reaction of NO2 is relatively slow, it is still of interest since it generates nitrous acid (HONO). Different surfaces found inside homes have been found to have different removal rates for NO2. In short, there is a variety of evidence that there are higher levels of NO2 indoors when combustion sources are present and that the concentrations generated indoors can be quite substantial in some circumstances. One word of caution is in order, however, particularly in regards to earlier measurements of NO2.
2.2.2. HONO and HNO3
HONO is formed by the reaction of NO2 with water on surfaces. The reaction is usually represented as
Although the detailed mechanism is not known; gaseous HNO3 is not generated in equivalent amounts, something which has been attributed to its remaining being adsorbed on the surface. This overall reaction occurs on a variety of surfaces in the laboratory and hence might be expected to also occur on surfaces in other environments, such as homes. This, indeed, is the case. (Pitts et al., 1985) first used differential optical absorption spectrometry (DOAS) to establish unequivocally that NO2 injected into a mobile home forms HONO. Interestingly, the dependence of the rate of HONO generation on the NO2 concentration was similar to that measured in laboratory systems, consistent with production in, or on, a thin film of water adsorbed on surfaces. A number of studies have confirmed that the behaviour is similar to that in laboratory systems; i.e., the rate of production of HONO increases with NO2 and with relative humidity. Indoor levels of HONO as high as 8 ppb as a 24-h average and 40 ppb as a 6-h average have been reported in normal, in-use buildings and homes (Febo & Perrino, 1991; Spengler et al., 1993; Weschler et al., 1994). The ratio of HONO to NO2 indoors can be quite large, up to ~0.15 (e.g., Febo & Perrino, 1991; Brauer et al., 1990, 1993; Spengler et al., 1993). This can be compared to typical values of a few percent outdoors. High levels of HONO (up to ~ 30 ppb) have also been measured in automobiles in use in polluted urban areas, and again, the ratio of HONO to NO2 was quite large, ~0.4, compared to 0.02-0.03 measured outdoors in the same study (Febo & Perrino, 1995). The generation of NO was attributed by Spicer and co-workers to a reaction of gaseous NO2 with adsorbed HONO:
The same process was hypothesised to explain some time periods in a commercial office building when indoor NO actually exceeded outdoor NO (Weschler et al., 1994). As is the case in laboratory systems, equivalent amounts of HNO3 are not observed as might be expected from the stoichiometry of reaction (1), likely due to HNO3 remaining on the surface after formation and/or being taken up by surfaces. The accumulation of nitrate on indoor surfaces in a commercial building has been reported by Weschler and Shields (1996) and attributed to the formation and uptake of HNO3 via reactions of NO3 and/or oxidation of nitrite (i.e., adsorbed HONO) in an aqueous surface film. Subsequently, it was shown that HONO is also directly emitted by gas stoves (Pitts et al., 1989). In a house used for investigating indoor air pollution that had natural gas fueled appliances (a convective heater, a radiant heater, and a range with four burners), both the surface reaction of NO2 and the direct combustion emissions contributed significantly to the measured indoor HONO. When an appliance was operational, the contribution of direct emissions was the more important source (Spicer et al., 1993). In short, the "dark reaction" of NO2 with water on surfaces is ubiquitous and occurs not only in laboratory systems but also indoors. The combination of this heterogeneous reaction with combustion sources of HONO can produce significant concentrations of HONO indoors. As a result, there is a concern regarding the health impacts of nitrous acid, not only because it is an inhalable nitrite but also because it is likely the airborne acid present in the highest concentrations indoors.
2.2.3. CO and SO2
As for NOx, combustion sources such as gas stoves and paraffin heaters can be significant sources of indoor CO. The ratio of indoor to outdoor concentrations of CO in homes using gas stoves has been measured to be 1.2-3.8 (Wade et al., 1975), with the highest ratios found close to the source. Similarly, higher CO levels indoors compared to outdoors have been reported for restaurants in Korea, with those using charcoal burners as well as gas giving much higher concentrations (Baek et al., 1997). In buildings where motor vehicle exhaust can be entrained from outdoors or attached parking garages, elevated indoor CO levels may also result (Hodgson et al., 1991). On the other hand, in homes and offices where there was no direct indoor source of CO, the indoor to- outdoor ratio was about one, and sometimes less. For example, in Riyadh, Saudi Arabia, CO concentrations were measured indoors and outdoors; the indoor to- outdoor ratio varied from 0 to 2, but was typically below one (Rowe et al., 1989). There have been a number of measurements of CO in the "indoor environment" of automobiles. Given that cars are major CO sources in urban areas, one might expect higher concentrations of CO during commutes and this is indeed the case. Typical CO concentrations of ~9-56 ppm have been measured inside automobiles during commutes in major urban areas (Flachsbart et al., 1987; Koushki et al., 1992; Ott et al., 1994, 1995; Dor et al., 1995; Fernandez-Bremauntz & Ashmore, 1995). This can be compared to peak outdoor levels of ~ 10 ppm in highly polluted urban areas. Thus, a significant enhancement of CO inside automobiles during commutes is common. For example, Chan et al. (1991) report a ratio of the in-vehicle CO concentration to that outdoors of ~ 4.5 in Raleigh, North Carolina. As is the case for CO, SO2 levels indoors and outdoors tend to be similar if there are no combustion sources indoors.
2.2.4. Volatile Organic Compounds (VOCs)
Volatile organic compounds (VOC) are ubiquitous components not only of ambient air but also of indoor air environments, including offices, commercial and retail buildings, and homes (Shah & Singh, 1988; Finlayson-Pitts, 1999). There are three sources/categories for VOC: (1) entrainment of air from outside the building, (2) emissions from building materials, and (3) human activities inside buildings. As might be expected, given the nature of the sources, a very large variety of organic compounds have been identified and measured indoors (e.g., Brown et al., 1994; Crump, 1995; Kostiainen, 1995). These numbers in the hundreds of different compounds, with the particular species and their concentrations depending on the particular sources present as well as the air exchange rates. Some of the compounds associated with the three sources: entrainment from outdoors, emissions from building materials, and anthropogenic activities - are now briefly reviewed.
The dependence of VOC emissions from building materials on relative humidity is more complex, with some emissions increasing with relative humidity, but others not. For example, Sollinger et al. (1994) report that the VOC emissions from carpets did not change with relative humidity over the range from 0 to 45% RH. On the other hand, the emissions of formic and acetic acids from latex paints have been reported to increase dramatically with relative humidity; for example, for one paint sample the emission rate for acetic acid almost tripled when the relative humidity was changed from 4-5% to 5-23% (Reiss et al., 1995b). A number of different aldehydes have been measured indoors (Crump & Gardiner, 1989; Lewis & Zweidinger, 1992; Zhang et al., 1994; Daisey et al., 1994; and Reiss et al., 1995a), some of which are directly emitted and some of which are formed by chemical reactions indoors of VOCs such as styrene. Of these, there is an enormous amount of evidence for direct emissions of HCHO from building materials. Interest in formaldehyde emissions and levels in homes and other buildings stems from its well-known health effects, which include possible human carcinogenicity and eye, skin, and respiratory tract irritation (Feinman, 1988). Formaldehyde is emitted from urea-formaldehyde foam insulation as well as from resins used in reconstituted wood products such as particleboard and plywood (Meyer and Reinhardt, 1986); urea-formaldehyde resins comprise about 6-8% of the weight of particleboard and 8-10% of mediumdensity fiberboard (Meyer and Hermanns, 1986). Other sources include permanent press fabrics (such as draperies and clothing), floor finishing materials, furniture, wallpaper, latex paint, varnishes, some cosmetics such as fingernail hardener and nail polish, and paper products (Kelly, 1996; Howard et al., 1998a, 1998b).
Many measurements of HCHO have been made in indoor air environments. In conventional homes, average concentrations are typically about 10-50 ppb (Stock, 1987; Zhang et al., 1994; Reiss et al., 1995a). Sexton et al. (1989) measured concentrations of HCHO in 470 mobile homes in California and found geometric mean concentrations of 60-90 ppb, although maximum values of over 300 ppb were recorded in some cases. In a similar study in Wisconsin, levels up to 2.8 ppm were measured (Hanrahan et al., 1985). Higher levels are typically found in mobile homes because of the reconstituted wood products (e.g., particleboard and plywood) used in their construction. Interestingly, HCHO does not appear to be a significant product of natural gas combustion, as levels in dwellings with and without gas stoves turned on are not significantly different (e.g., Pitts et al., 1989; Zhang et al., 1994). Temperature is again an important determinant of HCHO levels.
Because O3 decomposes on surfaces, indoor levels are usually lower than those outdoors due to the decomposition that occurs as the air passes through air conditioning systems and impacts building surfaces (Reiss et al., 1994; Finlayson-Pitts, 1999). The measured ratio of indoor-to-outdoor concentrations of ozone vary from 0.1 to 1, but are typically around 0.3-0.5 (e.g., Druzik et al., 1990; Hisham & Grosjean, 1991; Liu et al., 1993; Weschler et al., 1989, 1994; Gold et al., 1996; Jakobi & Fabian, 1997; Avol et al., 1998; Drakou et al., 1998; Romieu et al., 1998). Buildings with low air exchange with outside air tend to have lower ratios, ~0.1-0.3 (Druzik et al., 1990; Weschler et al., 1994; Romieu et al., 1998). For example, Gold et al. (1996) estimate that at outdoor ozone concentrations of 170 ppb in Mexico City, the indoor-to-outdoor ratio of O3 at a school was 0.71 ± 0.03 with the windows and doors open, which maximised the exchange with outside air, 0.18 ± 0.02 with the windows and doors closed and the air cleaner off, and 0.15 ± 0.02 with the windows and doors closed and the air cleaner on. There are some additional sources of O3 indoors. These include dry-process photocopying machines, laser printers, and electrostatic precipitators (e.g., Leovic et al., 1996; Wolkoff, 1999). Indeed, it is not unusual to detect O3 by its odour during operation of some copy machines and laser printers. In the "indoor environment" in cars, ozone levels tend to be significantly less than in the surrounding area. For example, Chan et al. (1991) report that in-vehicle O3 concentrations during commutes in Raleigh, North Carolina, were only about 20% of those measured in the local area at a fixed station. There are several contributing factors to these low concentrations. One is that NO concentrations are higher near roadways, so that O3 is titrated to NO2 by its rapid reaction with NO. A second is that O3 can decompose on the surfaces of the automobile air conditioning system. A similar titration effect has been observed inside homes where there are combustion sources of NO.
With the epidemiological studies suggesting increased mortality associated with particles, there has been increasing interest in indoor particle concentrations compared to outdoor levels (Finlayson-Pitts, 1999). A number of studies have examined this over the years and are summarised in a review by Wallace (1996). In general, if there are no indoor sources of particles, the levels indoors tend to reflect those outdoors. For example, application of a mass balance model to measurements of indoor and outdoor particle concentrations in Riverside, California, indicated that 75% of PM2.5 and 65% of PM10 in a typical home were from outdoors (Wallace, 1996). Similar conclusions were reached by Koutrakis et al. (1991, 1992) for homes in two counties in New York. For example, they report that 60% of the mass of particles in homes is due to outdoor sources. However, the contribution to various individual elements in the particles varies from 22% for copper to 100% for cadmium. There are some differences in indoor levels of particulate matter in areas with low outdoor compared to high outdoor levels. In the case of high outdoor levels, the indoor concentrations tend to be somewhat lower than those outdoors; for example, Colome et al. (1992) report that the ratio of indoor-to-outdoor median concentrations of PM10 is 0.7 in residences in southern California. On the other hand, when outdoor levels are low, indoor levels tend to be higher Night time mass concentrations indoors tend to be smaller than those during the day, probably because of the decreased activity. Interestingly, when individuals wear personal exposure monitors to measure their actual exposure to particles, the measured mass concentrations tend to be higher than those measured with fixed monitors located indoors. A major source of increased particles indoors is cigarette smoking. (e.g. Spengler et al., 1981; Quackenboss et al., 1989; Neas et al., 1994). In addition to the contribution to the
Baek et al. (1997) also reported increased levels of a number of gases indoors in homes and offices in Korea due to the use of paraffin heaters. In studies of indoor air in eight mobile homes, Mumford
Where indoor heating and cooking involves the use of coal or biomass, indoor particle concentrations can be extremely large. For example, Florig (1997) and Ando et al. (1996) report that in China typical indoor total suspended particle (TSP)concentrations can be in the range from 250 to 900/μg m -3 in homes using coal and 950-3500 / μg m -3 in those using biomass fuels. These levels can be compared to annual average outdoor concentrations of 250-410 / μg m-3. The high concentrations associated with coal burning combined with the mutagenic nature of the emissions have been suggested to be responsible for enhanced lung cancer in China (Mumford et al., 1987). Similarly, Davidson et al. (1986) measured TSP concentrations of 2900-42,000/ μg m-3 in homes in Nepal that used biomass fuels, compared to outdoor levels of 280 / μg m-3. For particles with diameters less than 4 /μm, the levels ranged from 870 to 14,000/ μg m-3. Similar conclusions regarding the relative indoor and outdoor concentrations have been reached in studies of office and commercial buildings. For example, Ligocki et al. (1993) measured indoor and outdoor concentrations of particles and their components at five museums in southern California. The indoor-to-outdoor ratios of particle mass varied over a wide range, depending to a large extent on the ventilation and filtration systems in use. Ratios varied from 0.16 to 0.96 for particles with diameters less than 2.1/μm and from 0.06 to 0.3 for coarse particles with diameters greater than this.
2.2.7. Microbial pollutants
Microbial pollution is a risk to health and is associated with allergic illnesses. Published results indicate that 20% of the population can be sensitised by airborne fungal spores in the UK, while 40% of the inspected houses in Germany suffer from mould-related problems (Waubke & Kusterle, 1990). The medical consequences of immune response, allergic reactions, endotoxins, mycotoxins, and epidemiology have been extensively studied by Miller (1990), Morey (1990), Gravensen et al. (1990) and Burge et al. (1990). Similarly, Legionnaires ’ disease and Pontiac fever are associated with wet cooling towers and domestic hot-water systems in complex buildings.
Accordingly to the official published figures, some 560,000 people need treatment because of indoor pollution due to mites and mould in damp houses (House of Commons Environment Committee, 1991). Indoor airborne allergic components come from two sources: outdoor air-borne spores moving inside and allergic components originating inside the dwelling. The source of biological growth within buildings is associated with moisture and the formation of microclimates; it also depends upon the type of the buildings and their ventilation. Mould fungi thrive on surfaces on which there is nourishment and suitable humidity, for example on damp water pipes, windows and walls in kitchens and bathrooms, in central air-conditioning systems, circulation pumps, blowers, ventilation ductwork and air filters, central dehumidifiers, and inside damp structures. Allergenic substances can be airborne and inhaled, such as pollen, fungus and dust, digested, such as mouldy food or drink. Investigations suggest that airborne allergies cause more problems throughout the world than all other allergies combined. Additionally, cross-infection from patient to patient is of great concern in hospitals. The medical field that treats allergies recognises the following allergenic diseases: asthma, allergic rhinitis, serous otitis media, bronchopulmonary aspergillosis, and hypersensitivity pneumonitis.
Recently, attention has been focused on the cocktail effect of chemicals present in indoor air. Volatile organic compounds may be produced from the use of wood preservatives and remedial timber treatment chemicals, moth-proof carpets, fungicides, mouldicide-treated paints, furnishing materials such as particle board and foamed insulation which may emit formaldehyde. Biological pollutants alone or in synergetic effect with any of the above-mentioned volatile organic compounds may produce symptoms such as stuffy nose, dry throat, chest tightness, lethargy, loss of concentration, blocked, runny or itchy nose, dry skin, watering or itchy eyes or headache in sensitive people. The ‘sick building syndrome’ (SBS) or tight building syndromes may arise from a variety of causes. Because of the uncertainties about the causes of SBS and the rising levels of health related problems in buildings there is an increasing use of the term building-related illness (BRI) to cover a range of ailments which commonly affect building occupants.
2.2.8. Asbestos and manmade mineral fibres
Asbestos is known to cause a number of diseases after occupational exposure (Brown & Hoskins, 1993). Before the hazards associated with the inhalation of these mineral fibres were understood these exposures were often very large with frequent reports of dust clouds so great that visibility in the workplaces was considerably reduced. This type of exposure is quantitatively quite different from those in the general environment that have provoked a response which in some quarters approaches hysteria. In the USA at least there is massive expenditure on asbestos removal, management and litigation.
Asbestos is a collective, trivial, name given to a group of highly fibrous minerals that are readily separated into long, thin, strong fibres occurring on sufficient large bulk deposits for their industrial exploitation. Asbestos minerals were usually used for their insulating properties, or in a composite, where they added strength, as in cement, or increased friction, as in brake shoes. Chrysotile, or white asbestos has counted for over 90% of the world trade in asbestos minerals. It is a serpentine mineral while the others (amosite (brown asbestos); crocidolite (blue asbestos); anthophyllite; tremolite; and actinolite) are all amphibole minerals. Amphibole asbestos has grater acid and water resistance than chryusotile and was used where these properties made it more suitable. Sometimes users would be unaware of the differences between the types of asbestos and so different minerals could have been used for a single application.
Recently the concern over the health effects of asbestos has been extended to another group of fibrous materials- the man-made mineral fibres (MMMF). While this term is self-explanatory a variety of types are produced with diverse chemical compositions, properties and uses. While sometimes referred to as 'asbestos substitutes' the majority of uses for the manmade fibres are relatively novel and ones for which the natural fibres are unsuitable. For example refractory ceramic fibres are resistant to considerably higher temperatures than are any of the natural fibres. The development of synthetic fibrous insulation materials has been given a great impetus in recent years by the need for more thermally efficient buildings and industrial processes.
MMMF can be made from most types of glass, from rock such as basalt, diabase and olivine and from various types of slag. Ceramic fibres can be made from kaolin or from pure silica and other oxide starting materials. The MMMF have been classified into four broad groups based on the manufacture and use: continuous filament glass fibre made by extrusion and winding processes, insulation wool (including ceramic fibre), and special purpose fibres. The non-continuous fibres are made by dropping molten material onto spinning disks or by air or steam jet impingement on a stream of the molten material. They contain a wide range of fibre sizes and are contaminated by small glassy balls called shot which often account for 50% of the product by weight.
3. Factors that influence exposure to indoor air pollutants
The types and quantities of pollutants found indoors vary temporally and spatially. Depending on the type of pollutant and its sources, sinks and mixing conditions, its concentration can vary by a factor of 10 or more, even within a small area.
Human mobility constitutes an important kind of complexity in the determination of exposure to air pollutants. Human activity patterns differ between midweek and weekend, between one season and another, and between one part of one's life and another. Activity patterns determine when and how long one is exposed to both indoor and outdoor pollutants. Therefore, in reviewing the factors that influence air-pollution exposures, we have specifically separated them into two major components: time (activity) and concentration (location).
Information on the time spent in various activities is summarised first, and then the variations in concentration often encountered in different locations. Unfortunately, most of the studies discussed were not longitudinal and thus do not offer information on seasonal differences in time spent indoors and outdoors or on regional differences in activity patterns.
Outdoor concentrations of pollutants and rates of infiltration affect the concentrations to which people are exposed indoors. Building construction techniques, as they vary geographically, and their effect on pollution infiltration are particularly important. But the measurement techniques available are limited; the need for additional studies is discussed. The rates of infiltration on a neighbourhood scale have been studied by only a few researchers. Although their work has focused on energy conservation, their findings can easily be applied to the study of impact on indoor pollution.
Patterns of human behaviour and activity determine the time spent in any specific location, and thus knowledge of them is essential in estimating exposures of populations to pollutants. As indicated by Ott (Ott, 1995), a large number of variety of studies in which data on human activities were collected from population samples have been completed over the past 50 ye.
When one examines the literature on human activities, the term "time budget" ("zeitbudget", "budget de temps") is encountered often. A time budget produces a systematic record of how time is spent by a person in some specified period, usually 24 h. It contains considerable detail on a person's activities; including the locations in which the activities take place (Michelson, 1973).
One way of obtaining time budget information from the populations surveyed is to ask each respondent to maintain a diary of his or her activities over a 24-h period or longer. In another approach, the so-called "yesterday" survey approach, the interviewer asks each responder about his or her activities on the preceding day.
Several summaries of the historical development of time-budget research have been published (Chapin, 1974; Converse, 1968; Ottensman, 1972). Ott (Ott, 1995) discussed the literature on activity patterns in the context of estimation of exposure to air pollution. Owing to the small number of field monitoring studies, the geographic distribution of indoor air pollutants has not been determined. However, it is instructive to review the geographic distribution of the major factors that affect variations in the concentrations of pollutants and their impact on the quality of the indoor environment. Outdoor air quality, air-infiltration rates, and sources of emission of indoor air pollutants are the major factors. Outdoor air quality has been studied with respect to some pollutants, and the geographic distribution of these few pollutants is well understood. Descriptive statistics published annually by EPA and state and local air-quality agencies furnish much scientific information useful in discerning regional and local differences in concentrations of carbon monoxide, total suspended particles, ozone, NOx, sulfur dioxide, sulfates, and others. It should be noted that the geographic distribution of some criteria pollutants has been studied and is easily accessible from the literature; information on non-criteria pollutants is sparse and often collected and analyzed by questionable methods.
Concentrations of chemically non-reactive pollutants in residences generally correlate with those outdoors. Distribution of indoor air quality is extremely difficult to describe on a geographic scale, because indoor air quality is determined by complex dynamic relationships that depend heavily on occupant activity and highly variable structural characteristics. Weather, which has a regional character, influences indoor air concentrations of some chemicals, such as formaldehyde, and biologic contaminants, such as bacteria and molds. Therefore, the influence of relative humidity and other weather-related conditions affecting indoor environmental quality needs to be studied geographically. Research specifically addressed to geographic distribution of indoor air quality is needed.
Typically, the air-infiltration rate for American residences is assumed to be 0.5- 1.5 ach. This assumption is supported by the results of several energy and air-quality studies that experimentally determined the range of ventilation rates for typical residences to be between 0.7 and 1.1 ach (Moschandreas & Morse, 1979). However, the sample that yielded the data is small, and statistical documentation for such statements is not strong.
The quality of indoor air is a function of outdoor air quality, emission from indoor sources, air-infiltration rates, and occupant activity is likely to vary within each metropolitan and suburban area, is indeed within each neighbourhood. Within a metropolitan area, it has been shown that an urban complex leads to the so-called urban heat reservoir (American Society of Heating, Refrigerating and Air-Conditioning engineers. ASHRAE, 1972). Urban characteristics-- such as city size, density of buildings, and population-- correlate with such meteorological factors as temperature, pressure and wind velocity (Gibson, & Cawley, 1977; Kostiainen, 1995). The urban heat island affects both urban pollution patterns and meteorological characteristics that affect the infiltration rates of buildings. Thus, although the exact nature of the impact on indoor air quality is not known, it is fair to expect that the heat island to have an impact on the indoor environment that is likely to be adverse. Also, the variations due to mechanical ventilation, structural differences, and air infiltration may vary within a neighbourhood as a function of such factors as house orientation, tree barriers, and terrain roughness.
Occupant activity, air-infiltration rates, the indoor sources of pollutants and their chemical natures are some of the factors that cause variations within a city. A study (Moschandreas et al., 1980) in the Boston metropolitan area obtained indoor air samples from 14 residences under occupied "real-life" conditions for 2 week each. The indoor air character not only was driven by outdoor concentrations, but was greatly affected by other factors, such as indoor activities.
Wind speed, temperature difference, pressure differential, terrain characteristics (roughness and barriers, such as trees and fences), building orientation, and structure characteristics may be affected by the location of one residence relative to another within a neighbourhood.
The indoor air quality of an individual building is often characterised by the 24-h average for the concentration of one pollutant measured at one sampling location. Because the activity patterns of persons are such that more time is spent in some indoor areas than in others, the question arises (Moschandreas et al., 1978): “Do indoor zones (independent areas) with distinct pollutant patterns exist?” At issue here is whether sampling from one monitoring zone is sufficient to characterise the air quality of an entire building.
In an extensive analytic study of indoor air quality, Shair and Heitner (1974) assumed that there are no pollutant gradients in the indoor environment. The experimental database of Moschandreas and co-workers (1980) verified that the gradients in concentrations of several gaseous pollutants in the residential environment are negligible. J.D. Spengler, R.E. Letz, J.B. Ferris, Jr., T. Tibbets, and C. Duffy reported (at the annual meeting of the Air Pollution Control Association, 1981) on weekly nitrogen dioxide measurements in 135 homes in Portage, Wisconsin. On the average, kitchen concentrations were twice those in bedrooms in homes that had gas stoves. A study of the air quality in a scientific laboratory by West (1977) showed an almost uniform distribution of an intern tracer continuously released in the room. Similar experiments performed by Moshandreas et al. in residential environments showed that equilibrium is reached throughout a house within an hour. Episodic release of sulphur hexafluoride tracer gas also illustrates this point. The source location was the living room; adjacent locations were the kitchen and the hall. Episodic release of this inert gas in 24 residences was followed by uniform indoor distributions within 30 min (Moschandreas et al., 1978; Peterka & Cermak, 1977). The one-zone concept does not require instantaneous mixing, because it is based on the behaviour of hourly average pollutant concentrations.
Moschandreas and associates (1980) used a different database derived from the monitoring of 14 indoor environments in the Boston metropolitan area. Analysis of variance was used to reach the following conclusions:
Pollutants (ozone and sulphur dioxide) generated principally outdoors have little or no interzonal statistical difference indoors.
Pollutants with strong indoor generation have interzonal statistical differences in residences with gas facilities and offices, but not in electric-cooking residences. In general, the observed differences are not large, and the health differences are not expected to be serious.
Depending on indoor activity and outdoor episodic pollutant activity, the indoor arithmetic 24-h average may or may not adequately represent the variation of hourly indoor concentrations.
Although more than one zone would be preferable, hourly pollutant concentrations obtained from one indoor zone adequately characterise the indoor environment.
The most important factors that influence exposure to indoor air pollutants are the one described under. It should be noticed that these conclusions are not applicable to short-lived pollutants. Contaminants associated with tobacco smoke, bathroom odours, allergens, and other pollutants related to dust are expected to vary considerably in a given residence. Additional documentation is needed to determine the extent of this variation.
3.2. Site characteristics
The characteristics of a building site that influence indoor air quality are addressed as three related subjects: air flow around buildings, proximity to major sources of outdoor pollution, and type of utility service available.
The air flow around a building has been shown to be determined by the local characteristics of the geometry of surrounding buildings (Peterka & Cermak, 1977), the location and type of surrounding vegetation (White, 1995), the terrain (Geiger, 1965), and the size and shape of the building itself. Pollutants can be transferred by the air flow from the street level, over the façade of the building and onto the roof (Cermak, 1976). Field tests of isolated buildings have been used to develop scaling coefficients for both isothermal and and stratified cases of surface wind pressures, turbulence, and dispersion (Davenport, 1960.). Air flow around the building creates low pressure on the leeward side and/or the sides adjacent to the windward face, as well as the roof. Air pollutants released from stacks, flues, vents, and cooling towers in the region can re-enter the building through make-up air intakes for ventilation (Cermak, 1976).
Trees and forests have been generally studied as shelter belts in an agricultural context. Shelter belts affect air flow around buildings. When an air current reaches a shelter belt, part of it is deflected upward with only a slight change in velocity, part passes through the crowns of the trees with very low velocity, and part is deflected beneath the canopy with rapidly decreasing velocity (Federer, 1971). The changes in velocity of air flow outside may change the infiltration rate and thus affect indoor air quality.
The location of a building relative to a major outdoor pollution source can affect indoor air quality. For example, buildings near major streets or highways often have high carbon monoxide and lead concentrations, owing to the infiltration of these pollutants.
The type of utility service available is also related to the site of the building and may affect the character of its indoor environment. The availability of particular fuels (e.g., natural gas and oil) influences the types and concentrations of pollutants (e.g., combustion products) emitted by space-and water- heating. Service moratoria, development timing, and development scale are institutional elements that contribute to the variability of utility services and thus can affect indoor air quality.
Occupancy factor that affect indoor air quality include the type and intensity of human activity, spatial characteristics of a given activity, and the operation schedule of a building.
Several human activities-such as smoking, cleaning and cooking- generate gaseous and particulate contaminants indoors. The number of occupants of a space and the degree of their physical activity (i.e., metabolic rate at rest or under intense activity) are related to the production of various pollutants, such as carbon dioxide, water vapour, and biologic agents. If the only source of indoor carbon dioxide is that caused by occupants, ventilation rates may be proportional to the number of people and their metabolic rates (Mclntyre, 1980). Although studies have shown no constant relationship between carbon dioxide concentrations and the concentrations of other pollutants, carbon dioxide concentration is often used as a general indicator of the adequacy of ventilation in an occupied space.
Building occupancy is often expressed as occupant density and the ratio of building volume to floor area. The importance of occupancy in indoor air quality is illustrated by the fact that the choice of natural or mechanical ventilation is based on occupant density and the spatial characteristics of the building under consideration.
Occupancy schedule and associated building use may affect the type, concentration, and time and space distribution of indoor pollutants. Because most buildings are unoccupied for substantial portions of each day, the manipulation of “operating schedule” is a means of controlling energy use (American Institute of Architects Research Corporation. Phase Two Report for the Development of Energy Performance Standards for New Buildings, 1979). Efforts to conserve energy through the design of ventilation systems can result to the degradation of indoor air quality. However, detailed studies relating ventilation capacity, occupancy schedules, energy requirements, and indoor air quality have only recently been implemented.
Elements of building design that affect the indoor environment include interior-space design (space planning), envelope design, and selection of materials.
The evolution of space planning in many building types has resulted in flexibility in assigning functions to specific locations. However, this flexibility is accompanied by a decrease in the ability to predict exposure to air pollutants. In particular, “open-plan” offices and schools have serious technical problems of redundant service distribution, limited acoustic control, incomplete air diffusion, and incomplete pollutant dispersion indoors, compared with “fixed-plan” floor layouts.
Evaluation of the success of a floor plan in achieving space efficiency, structural economy, and energy efficiency is usually in terms of net area per occupant and ratio of net usable area to total area. Explicit planning for environmental quality must be included to ensure that spatial arrangements are acceptable to the occupants.
A building’s structural envelope consists of both primary elements -foundations, floors, walls, and roofs- and secondary “skin” elements -facings, claddings, and sheathing. To various degrees, the function of these is to maintain the integrity of the structure under the stresses caused by structural load, wind pressure, thermal expansion, precipitation, earth movement, and fire. The integrity of the building envelope is a major consideration in uncontrolled air movement into and out of the building –usually referred to as “infiltration”. This is a major factor in indoor air quality. There has been no systematic survey of infiltration rates of buildings in the United States. The dominant factor in determining a building’s infiltration rate is the total area of effective leakage, as measured with fan pressurisation. Following the leakage area in importance are the terrain and shielding near the building, the mean climatic conditions during heating (or cooling) periods, and the building height (Sherman, 1981). There is much evidence (Dickerhoff et al., 1980), both in the United States and in Europe, that houses in mild climates are “very leaky”, whereas houses in severe climates are “tight”.
Greater height of a building increases the “stack effect”, or updraught, and exposes the building to higher wind speeds. Thus, higher wind pressures drive air through existing openings, referred to as “leakage”, increasing the infiltration rate.
The dominant building factors that determine infiltration have not been identified, but a catalogue of leakage openings found in typical structures is as follows:
Walls: Leakage around sill plates (the openings at the bottom of wallboard), electric outlets, plumbing penetrations, and headers in attics for both interior and exterior walls.
Windows and doors: Window type is more important than manufacturer in determining window leakage. This source of leakage tends to be overrated; it contributes only about 20% of the total leakage of a house
Fireplaces: This includes dampers, glass screens, and fireplace caps.
Heating and cooling systems: The variables include combustion air for furnaces, dampers for stack air draft, air-conditioning units, and location of ductwork.
Vapour barrier and insulation penetrations.
Utility accesses: This includes recessed lighting and plumbing and electric penetrations leading to attic or outside.
Terminal devices in conditioned space: This includes leakage of dampers, especially those for large air-handling systems.
Structural types: Examples are drop ceilings above cupboards or bathtubs, prism-shaped enclosures over staircases in two-story houses, and elevator and utility shafts that lead from basement to attic.
Wall and ceiling materials and floor finishes are the constituents of the building interior. Modular components, weight, strength, thermal insulation, thermal stability, sound insulation, fire resistance, ease and speed of installation and ease of maintenance are among the criteria considered in the selection of materials for walls, ceiling and floors. But emphasis on first cost, ease of installation, maintenance and long service life has also led to the use of materials that may be sources of indoor contaminants.
Depending on the type of ownership (owner-occupied or developer-owned), building operation may vary considerably, and this variation may have an impact on indoor air quality. “Building operation” pertains to the following elements of a building: the building envelope, service and plant, building facilities, equipment and landscaping. Cleaning, preventive maintenance, and replacement and repair of defects are also included in building operation. The staff responsible for building operation includes management, engineering, and custodial personnel. The care responsibilities are operation of the heating, ventilation, and air-conditioning systems and building services, such as hot water, lighting and power distribution. Building operation has an impact on indoor air quality in numerous ways, but the magnitude of this impact is not known.
4. Health effects of indoor air pollution
Indoor air pollution, apart from the health impact, has socio-economic costs. The potential economic impact of poor indoor air quality is quite high, and has been estimated to be in the order of tens of billions of ECU per year in Western Europe. This includes costs of medical care, loss of income during illness, days lost due to illness, poor working performance and lower productivity. Labour costs are significantly greater per square metre of office space than energy and other environmental control costs (ECA, 1989). In the US, the loss in productivity for each employee which is attributable to IAQ problems is currently estimated to be 3% (14 minutes/day) and 0.6 added sick days annually. Other estimates have been made by calculating the impact of IAQ on productivity. For instance, in Norway, the authorities estimate that the costs to society related to poor IAQ are in the order of 1 to 1.5 billion ECU per year or about 250 - 350 ECU per inhabitant. This estimation only includes costs related to adverse health effects requiring medical attention and does not include reduced working efficiency or job-related productivity losses. Thus, from an economic consideration, remedial action to improve indoor air quality is likely to be cost effective even if an expensive retrofit is required.
As far as it concerns the health effects on IAP, it is very interesting to present the methods of studying health effects, the criteria for the assessment of the impact of IAP on the community and the diverse effects of IAP on human health (ECA, 1991).
4.1. Methods of studying health effects
Methods of studying health effects of indoor pollutants can be grouped into three broad categories:
Human studies, subdivided into observational and experimental studies.
Epidemiological studies of pollutants are mostly observational, i.e. the investigator has no means of experimentally exposing humans to pollutants, or of allocating subjects to exposed and unexposed groups. Critical issues are therefore the validity and precision of exposure assessment, and the control for confounding factors in these studies. Recent developments have stressed the importance of reducing exposure misclassification, and of studying restricted, well defined, homogenous populations to address these issues. The main advantage is that humans are studied under realistic conditions of exposure. By themselves, observational epidemiological studies are not usually sufficient to support causality of an observed association, so that additional information is needed from other types of studies. Experimental studies are among these; however, these are only suitable for studying moderate, reversible, short term effects in persons who are healthy or only moderately ill. Their main advantage is that exposure conditions and subjects election are under the control of the investigator.
b. Animal studies, which can be subdivided into a number of categories depending on their length (acute, subchronic, chronic) or end-point (morbidity, mortality, carcinogenicity, irritation, etc.). Here, the investigator has full control over exposure conditions and health effects studied. However, the principle limitations lie in the fact that extrapolation from the studied animal species to man is always necessary. Also, while in human populations health effects with low incidences are often of interest (e.g., specific cancers), it is not feasible to study very large groups of animals to detect these low incidences. In practice, therefore, animal experiments are often carried out using very high experimental doses to compensate for the relatively small number of animals used and as a consequence, an additional extrapolation from high to low doses is also often necessary.
c. In vitro studies, in which effects of pollutants on cell or organ cultures are studied. These studies have the advantage that they are less costly than animal studies, and that results can generally be obtained in a shorter period of time. They are useful for studying mechanisms of action, but it is not usually possible to predict effects on whole organisms from their results in a quantitative way.
4.2. Criteria for the assessment of the impact of IAP on the community
The process of risk characterisation for indoor pollutants occurs through several phases: hazard identification, exposure assessment, dose-effect evaluation, and finally qualitative and quantitative risk assessment. The final product of this process may be an individual risk estimate per exposure unit or the evaluation of the incidence of the concerned effects in a given population. The risk characterisation through a multi-stage process as described above is particularly informative because, by dividing the analysis of the scenario of each pollutant into steps, it allows the separate recognition of the importance of each variable in the scenario and the prediction of the changes of frequency or severity of effects obtainable by modifying (increasing or decreasing) exposure.
For some types of IAP, our understanding of human health risk is well defined. For most indoor air pollutants, however, the risk assessment process has its limitations.
First, it has been applied successfully only to individual pollutants for which information is available for exposure and dose-response relationships and for which the effect is clear, certain, and measurable, such as mortality and cancer. Little progress has been made in applying the risk assessment process to environmental issues involving pollutant mixtures or effects for which the causes are difficult to ascertain precisely, such as in heart disease, allergic reactions, headache, and malaise. A different approach is needed for the assessment and characterisation of the risks associated with most indoor air pollutants.
A basic and simple criterion for assessing the importance of the health risk related to indoor pollution makes reference to the severity of the effect concerned and to the size of the population affected. Important issues for the community may come from severe health impacts, particularly when affecting a large segment of the population. Minor impacts, such as those related to discomfort or annoyance may, however, become important when a large number of individuals in the community are concerned.
4.3. The impact of IAP on humans’ health
4.3.1. Respiratory health effects associated with exposure to IAP
Several effects on the respiratory system have been associated with exposure to IAP. These include acute and chronic changes in pulmonary function, increased incidence and prevalence of respiratory symptoms, augmentation of pre-existing respiratory symptoms, and sensitisation of the airways to allergens present in the indoor environment. Also, respiratory infections may spread in indoor environments when specific sources of infectious agents are present, or simply because the smaller indoor mixing volumes allow infectious diseases to spread more easily from one person to the next. The latter mechanism is particularly operative in schools, nursery schools, etc.
Observed changes in pulmonary function due to exposure to, e.g., tobacco smoke in the home, have mostly been due to acute or chronic airway narrowing leading to obstruction of air flow. This is measured as a reduction in the quantity of air that can be exhaled in one second after deep inspiration (FEVI), and a limitation in the various
measures of air flow such as Peak Expiratory Flow (PEF), Maximum Mid Expiratory
Flow (MMEF), and Maximum Expiratory Flow at x% of Forced Vital Capacity (MEFx). In growing children, it has also been suggested that lung development could be impaired by exposure to IAP.
Asthma, manifested by attacks of excessive airway narrowing leading to shortness of breath and wheezing, can be caused or aggravated by exposure to allergens at home, but it has also been associated with exposure to substances such as nitrogen dioxide and environmental tobacco smoke (ETS). Bronchitis, manifested in inflammatory changes in the airways and mucus hypersecretion has been linked to high levels of ambient air pollution in the past, and to exposure to ETS in the home in recent studies. Respiratory symptoms which have been associated with exposure to indoor air pollutants are symptoms mostly related to the lower airways such as cough, wheeze, shortness of breath and phlegm.
In contrast to the occurrence of chemical pollutants in indoor air, attention to which has grown considerably over the past two decades, the role of infectious agents in indoor air has been known for a long time. Infectious agents can be involved in the inflammatory conditions rhinitis, sinusitis, conjunctivitis and sinusitis, in pneumonia, in asthma and in alveolitis.
4.3.2. Allergic diseases associated with exposure to IAP
Allergic asthma and extrinsic allergic alveolitis (hypersensitivity pneumonitis) are the two most serious allergic diseases caused by allergens in indoor air. Allergic rhinoconjunctivitis and humidifier fever are other important diseases; it is not clear if or how the immunological system is involved in humidifier fever.
Allergic asthma is characterised by reversible narrowing of the lower airways. Pulmonary function during an attack shows an obstructive pattern in serious cases together with reduced ventilation capacity. Allergic asthma may be caused by exposure to indoor air pollutants, either acting as allergens or as irritants. Immunological specific IgE sensitisation to an airborne allergen is a major component of this disease, but non-specific hypersensitivity is also important for the asthmatic attacks occurring on exposure to irritants in the indoor air.
The prevalence of asthma varies considerably from country to country. Although asthmatic attacks seldom lead to death, the costs of medical care are considerable in terms of hospital admissions, medication, and lost work days.
Allergic rhinoconjunctivitis is also an IgE-mediated disease, but while asthma occurs in all age groups, allergic rhinoconjunctivitis is especially prevalent among children and young adults. The main symptoms are itching of the eye andlor the nose, sneezing, watery nasal secretion and some stuffiness of the nose. The severity of the symptoms varies with the exposure to the allergen. Individuals often suffer from both allergic asthma and allergic rhinoconjunctivitis and are seldom sensitive to only one allergen. Aeroallergens from house dust mites, pets, insects, moulds, and fungi in the indoor air have been shown to be associated with allergic asthma and/or rhinoconjunctivitis. Extrinsic allergic alveolitis, also called hypersensitivity pneumonitis, is characterised by recurrent bouts of pneumonitis or milder attacks of breathlessness and flu-like symptoms. Studies of the pulmonary function during an acute episode will usually show a restrictive pattern with a decreased diffusion capacity. The disease is believed to be an inflammatory reaction in the alveoli and bronchioles involving circulating antibodies and a cell-mediated immunological response to an allergen. For example it occurs in farmers as a result of handling mouldy hay ("farmer's lung") and in pigeon breeders due to bird droppings. However, the disease has also in a few cases been associated with exposure to IAP, most frequently related to humidifiers in homes and offices contaminated with bacteria, fungi, or protozoans.
Allergic asthma and extrinsic allergic alveolitis resolve with cessation of exposure to the allergen, but continued exposure in sensitised patients may result in permanent lung damage and death from pulmonary insufficiency.
Humidifier fever is a flu-like illness involving the immune system, in which X-ray abnormalities are usually absent. The exact cause is not clear. The disease may occur among persons exposed to humidification systems contaminated with microbial growth. The symptoms typically occur 4-8 h after the exposure on the first day back at work after a weekend, but resolve within 24 h. Despite continuous exposure the disease does not recur until after the next weekend. Even though pulmonary changes are seen during attacks of humidifier fever, the disease does not lead to permanent lung damage.
4.3.3. Cancer and effects on reproduction associated with exposure to IAP
Lung cancer is the major cancer which has been associated with exposure to IAP (radon or ETS). Asbestos exposure has been linked to cancer in workers and also in workers' family members, presumably due to asbestos fibres brought into the home on workers' clothing. However, there are no studies associating asbestos exposure in homes or public buildings from asbestos used as a construction material to the development of cancer. Effects on human reproduction have been associated with exposure to chemicals in the environment, but it is as yet unclear to what extent (if any) exposure to IAP is involved
4.3.4. Sensory effects and other effects on the nervous system associated with IAP
Sensory effects are defined as the perceptual response to environmental exposures. Sensory perceptions are mediated through the sensory systems and result in a conscious experience of smell, touch, itching, etc. Sensory effects are typically observed in buildings with indoor climate, problems because many chemical compounds found in the indoor air have odorous or mucosal irritation properties. Most indoor air chemicals with a measurable vapour pressure will be odorous when the concentration is high enough.
Sensory effects are important parameters in indoor air quality control for several reasons. They may appear as: (1) adverse health effects on sensory systems (e.g., environmentally-induced sensory dysfunctions); (2) adverse environmental perceptions which may be adverse per se or constitute precursors of disease to come on a long term basis (e.g., annoyance reactions, triggering of hypersensitivity reactions); (3) sensory warnings of exposure to harmful environmental factors (e-g., odour of toxic sulfides, mucosal irritation due to formaldehyde); (4) important tools in sensory bioassays for environmental characterisation (e.g.. using the odour criterion for general ventilation requirements or for screening of building materials to find those with low emissions of volatile organic compounds).
The senses responding to environmental exposure are not only hearing, vision, olfaction and taste, but also the skin and mucous membranes. As pointed out by WHO (1989), many different sensory systems that respond to irritants are situated on or near the body surface. Some of these systems tend to respond to an accumulated dose and their reactions are delayed. On the other hand, in the case of odor perception the reaction is immediate but also very much influenced by olfactory fatigue on prolonged exposures.
Responders are often unable to identify a single sensory system as the primary route of sensory irritation by airborne chemical compounds. The sensation of irritation is influenced by a number of factors such as previous exposures, skin temperature, competing sensory stimulation, etc. Since interaction and adaptation processes are characteristic of the sensory systems involved in the perception of odour and mucosal irritation, the duration of exposure influences the perception. Humans integrate different environmental signals to evaluate the total perceived air quality and assess comfort or discomfort. Comfort and discomfort by definition are psychological and for this reason the related symptoms, even when severe cannot be documented without using subjective reports. Sensory effects reported 10 be associated with IAP are in most cases multisensory and the same perceptions or sensations may originate from different sources. It is not known how different sensory perceptions are combined into perceived comfort and into the sensation of air quality. Perceived air quality is for example mainly related to stimulation of both the trigeminus and olfactorius nerves.
Several odorous compounds are also significant mucosal irritants, especially at high concentrations. The olfactory system signals the presence of odorous compounds in the air and has an important role as a warning system. In the absence of instrumentation for chemical detection of small amounts of some odorous vapours, the sense of smell remains the only sensitive indicator system. It is well known that environmental pollution can affect the nervous system. The effects of occupational exposure to organic solvents can be mentioned as an example. A wide spectrum of effects may be of importance, ranging from those at molecular level to behavioural abnormalities. Since the nerve cells of the CNS typically do not regenerate, toxic damage to them is usually irreversible. The nerve cells are highly vulnerable to any depletion in oxygen supply.
4.3.5. Cardiovascular effects associated with IAP
Increased mortality due to Cardiovascular Diseases (CVD) has been associated with exposure to ETS in some groups of non-smoking women married to smokers. Some investigators have also addressed the question whether total mortality is influenced by exposure to ETS, but results have been contradictory. As any effect on mortality would not be expected to occur until after many years of exposure, a problem in these types of study is the accuracy and reliability of the exposure classification. Attempts have also been made to relate ETS to electrocardiographic abnormalities and cardiovascular symptoms, but results have been inconclusive.
Carbon monoxide (CO) exerts its influence primarily through binding to the haemoglobin (Hb) in blood. The affinity of CO to Hb is about 200 times higher than the affinity of oxygen to Hb, so that at relatively low levels of CO in the air. Oxygen is replaced by CO. The percentage of Hb bound to CO (O/O carboxyhaemoglobin) is a measure of recent exposure to CO. Organs with a high oxygen demand, such as the heart and the brain, are particularly susceptible to a reduced oxygenation caused by CO exposure. Early effects include reduction of time to onset of chest pain in exposed, exercising heart disease patients. At higher levels of exposure, myocardial infarctions may be triggered by CO.
5. Basic control strategies
There are some basic control methods for lowering concentrations of indoor air pollutants (Ashford & Caldart, 2008), which are described bellow:
Source Management includes source removal, source substitution, and source encapsulation. Source management is the most effective control method when it can be practically applied. Source removal is very effective. However, policies and actions that keep potential pollutants from entering indoor are even better than preventing IAQ problems. Source substitution includes actions such as selecting a less toxic art material or interior paint than the products which are currently in use. Source encapsulation involves placing a barrier around the source so that it releases fewer pollutants into the indoor air (e.g., asbestos abatement, pressed wood cabinetry with sealed or laminated surfaces). Local Exhaust is very effecting on removing point sources of pollutants before they can disperse into the indoor air by exhausting the contaminated air outside. Well known examples include restrooms and kitchens where local exhaust is used. Other examples of pollutants that originate at specific points and that can be easily exhausted include science lab and housekeeping storage rooms, printing and duplicating rooms, and vocational/ industrial areas such as welding booths. Ventilation through use of cleaner (outdoor) air to dilute the polluted (indoor) air that people are breathing. Generally, local building codes specify the quantity (and sometimes quality) of outdoor air that must be continuously supplied to an occupied area. For situations such as painting, pesticide application, or chemical spills, temporarily increasing the ventilation can be useful in diluting the concentration of noxious fumes in the air. Exposure Control includes adjusting the time of use and location of use. An example of time of use for school students would be to strip and wax floors on Friday after school is dismissed, so that the floor products have a chance to off-gas over the location of use deals with moving the contaminating source as far as possible from occupants, or relocating susceptible occupants. Air Cleaning primarily involves the filtration of particles from the air as the air passes through the ventilation equipment. Gaseous contaminants can also be removed, but in most cases this type of system should be engineered on a case-by-case basis.
As it has been clearly proven above, indoor air pollution is a major public concern issue, which can be characterised as “global environmental phenomenon”. Also, it is obvious, that the causes which created this domestic environmental problem, such as modern way of living, decreased ventilation rates for energy conservation or increased use of synthetic materials in buildings, are not expected to be reduced (it is more probable that they are going to be increased). Nevertheless, the task of reducing levels of exposure to air pollutants is rather complex. It begins with an analysis to determine which chemicals are present in the air, at what levels, and whether likely levels of exposure are hazardous to human health and the environment. It must then be decided whether an unacceptable risk is present. When a problem is identified, mitigation strategies have to be developed and implemented so as to prevent excessive risk to public health in the most efficient and cost-effective way. In addition, analyses of air pollution problems are exceedingly complicated. Some are national in scope (such as the definition of actual levels of exposure of the population, the determination of acceptable risk, and the identification of the most efficient control strategies), while others are of a more basic character and are applicable in all countries (such as analysis of the relationships between chemical exposure levels, and doses and their effects). So, it is very essential for governments of all countries- especially the governments of the more developed ones- to adopt and implement these policies, in order to effectively face this worldwide issue in combination with the need of energy saving, the use of new building materials and the modern trend of living.