Indoor Air Quality
Editors Note:
As we go back to school and the winter months approach, many of us will be spending more and more time indoors. Thomas P. Lotz, RRT, MEd, CEO of the American Lung Association of the MidSouth serving Alabama, Louisiana, and Mississippi spoke to us about the importance of keeping our indoor air clean and some tips for keeping our lungs healthy.
Medscape: There has been a lot of talk about the impact of indoor air quality and disease. Can you tell us about that?
Thomas P. Lotz, RRT, MEd: There are many sources of indoor air pollution in any home. Pollutants come from building materials, furnishings, asbestos-containing insulation, wet or damp carpet, and cabinetry or furniture made of certain pressed wood products. Products for household cleaning and maintenance, personal care, hobbies, central heating and cooling systems and humidification devices also negatively affect indoor air quality. Combustion sources such as oil, gas, kerosene, coal, wood, and tobacco products are another category of pollutants. Outdoor sources such as radon, pesticides, and outdoor air pollution usually result in high indoor levels as well.
Immediate effects may show up after a single exposure or repeated exposures. These include irritation of the eyes, nose, and throat; headaches; dizziness; and fatigue. Such immediate effects are usually short-term and treatable. Sometimes the treatment is simply eliminating the person's exposure to the source of the pollution, if it can be identified. Symptoms of some diseases, including asthma, hypersensitivity pneumonitis, and humidifier fever, may also show up soon after exposure to some indoor air pollutants.
The likelihood of immediate reactions to indoor air pollutants depends on several factors. Age and preexisting medical conditions are 2 important influences. In other cases, whether a person reacts to a pollutant depends on individual sensitivity, which varies tremendously from person to person. Some people can become sensitized to biologic pollutants after repeated exposures, and it appears that some people can become sensitized to chemical pollutants as well.
Certain immediate effects are similar to those from colds or other viral diseases, so it is often difficult to determine if the symptoms are a result of exposure to indoor air pollution. For this reason, it is important to pay attention to the time and place symptoms occur. If the symptoms fade or go away when a person is away from home, for example, an effort should be made to identify indoor air sources that may be possible causes. Some effects may be made worse by an inadequate supply of outdoor air or from the heating, cooling, or humidity conditions prevalent in the home.
Other health effects may show up either years after exposure has occurred or only after long or repeated periods of exposure. These effects, which include some respiratory diseases, heart disease, and cancer, can be severely debilitating or fatal. It is prudent to try to improve the indoor air quality in your home even if symptoms are not noticeable.
While pollutants commonly found in indoor air are responsible for many harmful effects, there is considerable uncertainty about what concentrations or periods of exposure are necessary to produce specific health problems. People also react very differently to exposure to indoor air pollutants. Further research is needed to better understand which health effects occur after exposure
Medscape: Can you tell us about the American Lung Associations State of the Air 2007 report?
Mr. Lotz: The American Lung Association State of the Air 2007 report grades communities across the nation based on the number of days they have unhealthful levels of air pollution. The grades come from the color-coded alert system called the Air Quality Index, which may be familiar from newspaper, radio, television, and online weather forecasts. Everybody should look for the air quality forecasts in your community and know how to protect yourself and your family from air pollution. You can also take steps to help clean up the air you breathe. Two types of air pollution are especially dangerous to breathe: ozone (smog) and particle pollution (soot).
Ozone (O3), or smog, is an irritating, invisible gas that is formed most often by a reaction of sunlight and vapors emitted when fuel is burned by cars and trucks, factories, power plants, and other sources. Smog usually peaks in the summer months, from May through October, when temperatures are highest and sunlight is strongest. Ozone reacts chemically with internal body tissues that it comes in contact with, such as those in the lung. It especially irritates the respiratory tract, like getting a sunburn or rubbing sandpaper on a wound. Smog can cause health problems the day you breathe in high levels of smog, or after long-term exposure. It's particularly dangerous for people with asthma and other chronic lung diseases, senior citizens, children, and teens. Smog can cause asthma attacks, coughing and wheezing, shortness of breath, chest pain when inhaling deeply, and even premature death. Breathing high levels of smog repeatedly over the long term may also lead to reduced lung function, inflamed lung lining, and increased breathing problems.
Particle pollution is the most dangerous, and deadly, of the widespread outdoor air pollutants. Soot is an old name for particle pollution. Particle pollution is too small to really see -- you can see the haze it creates when the sunlight hits it. Particles can be so microscopic that they're one-seventh to one-thirtieth the diameter of a single human hair or smaller. Particle pollution comes from many sources. The particles are usually a complex mixture that can include ash, soot, diesel exhaust, chemicals, metals, and aerosols. In the eastern United States, many particles come from power plants that burn coal to produce electricity. In the western United States, many come from diesel buses, trucks, and heavy equipment, as well as agriculture and wood burning. The body's natural defenses help to cough or sneeze larger particles out of our bodies. But those defenses don't keep out smaller particles, and they get lodged deep in the lungs, where they stay and can cause major damage. Some of the particles are so tiny that they can pass through the lungs into the bloodstream and travel throughout your body like oxygen. First and foremost, breathing particle pollution can kill. Deaths can occur on the very day that particle levels are high, or within 1-2 months afterward. Breathing particle pollution year-round can shorten life by 1 to 3 years. It causes many other health effects, premature births to serious respiratory disorders, even when the particle levels are very low. It makes asthma worse and causes wheezing, coughing, and respiratory irritation in anyone with sensitive airways. It also triggers heart attacks, strokes, irregular heartbeat, and premature death.
Medscape: What is sick building syndrome?
Mr. Lotz: Sick building syndrome is a term that refers to a set of symptoms that affect a number of building occupants during the time they spend in the building and diminish or go away during periods when they leave the building. It cannot be traced to specific pollutants or sources within the building.
Medscape: What are there concerns about the air quality in the home?
Mr. Lotz: There are some concerns about the quality of air we breathe at home. A particular concern is radon, which is a tasteless, colorless, and odorless gas that is a decay product of uranium and occurs naturally in soil and rock. Radon gas has been identified as the second leading cause of lung cancer, second only to cigarette smoking, and it is estimated to be responsible for 21,000 deaths from lung cancer annually. This number includes smokers whose risk for cancer is increased by radon exposure. Radon breaks down into components called radon progeny, sometimes called "radon daughters," which emit high-energy alpha particles. These emissions raise the risk of lung cancer.
The main source of high-level radon pollution in buildings is surrounding uranium-containing soil such as granite, shale, phosphate, and pitchblende. Radon enters a home through cracks in walls, basement floors, foundations, and other openings. It may also contaminate the water supply, especially in private wells. It has been estimated that approximately one third of radon-induced lung cancer could be avoided if homes with radon concentrations exceeding the US Environmental Protection Agency (EPA) action level underwent changes to reduce radon concentrations to below that level. However, eliminating all radon exposure is not possible. Elevated levels of radon have been identified in every state. It is possible for 1 home to have elevated levels of radon while a neighboring home does not. Testing is the only way to determine levels of radon in a structure. Testing can be done through do-it-yourself home test kits or through a professional testing firm. Radon levels can be lowered through a variety of repairs, from sealing cracks in floors and walls to changing the flow of air into the building. Repairs to decrease radon levels should be made by an EPA or state-certified contractor.
An estimated 1 out of every 15 homes in the United States has radon levels above 4 pci/L, the EPA-recommended action level. Radon, a naturally occurring gas, can enter the home through cracks in the foundation floor and walls, drains, and other openings. Indoor radon exposure is estimated to be the second leading cause of lung cancer.
Secondhand smoke is a major indoor air pollutant, and contains about 4000 chemicals, including 200 known poisons, such as formaldehyde and carbon monoxide, as well as 43 carcinogens.
Formaldehyde is a common chemical, found primarily in adhesive or bonding agents for many materials found in households and offices, including carpets, upholstery, particle board, and plywood paneling.
Asbestos is the name given to a group of microscopic mineral fibers that are flexible and durable and will not burn. Asbestos fibers are light and small enough to remain airborne; they can be inhaled into the lungs and can cause asbestosis (scarring of the lung tissue), lung cancer and mesothelioma, a relatively uncommon cancer of the lining of the lung or abdominal cavity.
Many asbestos products are found in the home, including roofing and flooring materials, wall and pipe insulation, spackling compounds, cement, coating materials, heating equipment, and acoustic insulation. These products are a potential problem indoors only if the asbestos-containing material is disturbed and becomes airborne, or when it disintegrates with age.
Heating systems and other home appliances using gas, fuel, or wood, can produce several combustion products, of which the most dangerous are carbon monoxide (CO) and nitrogen dioxide (NO2). Fuel burning stoves, furnaces, fireplaces, heaters, water heaters, and dryers are all combustion appliances. Carbon monoxide is an odorless, colorless gas that interferes with the distribution of oxygen to the body.
Household cleaning agents, personal care products, pesticides, paints, hobby products, and solvents may be sources of hundreds of potentially harmful chemicals. Such components in many household and personal care products can cause dizziness, nausea, allergic reactions, eye/skin/respiratory tract irritation, and cancer.
Almost all pets can cause allergies, including dogs, cats, birds, and small animals such as hamsters and guinea pigs. Thus, pets can trigger asthma and allergy symptoms. Pet allergies and animal dander, the tiny scales or particles from hair, feathers, skin, or saliva, may stay in the home for months after the pet is gone because it remains in house dust. Cockroaches and their droppings can also trigger asthma and allergy symptoms.
When moisture in the air is high, mold and mildew can be a problem in bathrooms, kitchens, and basements. Mold and mildew can be powerful triggers for asthmatics.
Dust mites are tiny, microscopic animals usually found in house dust. Several thousand mites can be found in a pinch of dust. Mites are one of the major triggers for people with allergies and asthma. They live and grow on pillows and mattresses, window curtains, carpeting, and stuffed animals.
Medscape: What role does poor air quality play in lung disease?
Mr. Lotz: Air pollution hurts the body by irritating and destroying lung tissue and by weakening the defense system of the lungs. Mucus lines our lungs and traps germs and particles before they enter the lungs. Tiny cells with waving hairs called cilia push the mucus up and out of the lungs. Air pollution can paralyze and destroy the cilia, causing the germs and particles to build up in the mucus.
Occupational lung disease is the number 1 work-related illness in the United States based on the frequency, severity, and preventability of diseases. These illnesses are usually caused by extended exposure to irritating or toxic substances that may cause acute or chronic respiratory ailments, although severe single exposures can cause chronic lung disease as well. Smoking can increase the severity of these diseases.
Asbestosis is a progressive disease involving scarring of lung tissue as a result of exposure to the microscopic fibers of asbestos. An estimated 1.3 million employees in construction and industry face significant asbestos exposure on the job. Between 1980 and 2002, 6343 deaths were due to asbestosis.
Mesothelioma is a rare cancer of the chest lining caused by asbestos exposure. By the year 2030 there are estimates that asbestos will have caused 60,000 instances of mesothelioma that result in death.
Coal workers' pneumoconiosis, also called black lung disease, is caused by the inhalation of coal dust that becomes imbedded in the lungs, causing them to harden, making breathing very difficult. An estimated 2.8% of coal miners are affected; about 0.2% have scarring on the lungs, the most severe form of the disease. Each year, close to 400 people die from black lung disease.
Silicosis results from exposure to free crystalline silica in mines; foundries; blasting operations; and stone, clay and glass manufacturing that cause scar tissue to form in the lungs. Silicosis substantially raises the risk of tuberculosis. Each year 200 people die with silicosis listed as an underlying or nonunderlying cause of death on their death certificates, a rate that has been stable since the early 1990s. About 1 million workers are believed to have been exposed to silica dust.
Hypersensitivity pneumonitis results from repeated exposure to fungus spores from moldy hay, bird droppings, or other organic dusts that causes the air sacs of the lungs to become inflamed; parts of the lungs may then develop fibrous scar tissue and cease to function normally in breathing. Deaths from hypersensitivity pneumonitis have been generally increasing from less than 20 per year in 1979 to 57 in 1999.
Medscape: What about tobacco smoke?
Mr. Lotz: The bulk of scientific evidence including the 2006 Surgeon General's Report and the Environmental Protection Agency demonstrate that secondhand smoke causes lung cancer, cardiovascular disease, and premature death and disease in children and adults that do not smoke. Children exposed to secondhand smoke are at an increased risk for Sudden Infant Death Syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
Medscape: What are some things people can do to improve the air quality in their homes, schools, and work environments?
Mr. Lotz: Be aware of the quality of air you breathe and check local air quality levels daily. Local air quality index alerts and pollution forecasts are often given with local weather reports and printed in newspapers. Avoid strenuous outdoor activities and congested streets and rush hour traffic when air pollution levels are high.
Insulate and weatherize your home, convert existing wood stoves and fireplaces to natural gas or propane, and buy paints, cleaning supplies, and personal care products with low levels of volatile organic compounds (VOCs). VOCs are part of ozone.
To help prevent growth of mold when humidity is high, make sure bathrooms, kitchens, and basements have good air circulation and are cleaned often. The basement in particular may need a dehumidifier.
Testing is the only way to determine levels of radon in a structure. Testing can be done through do-it-yourself home test kits or through a professional testing firm. Home test kits labeled "meets EPA requirements" should be used. Radon levels can be lowered through a variety of repairs, from sealing cracks in floors and walls to changing the flow of air into the building. Sub-slab depressurization uses pipes and fans to remove radon gas from beneath the concrete floor and foundation before it can enter the building. Radon is vented above the roof, where it safely disperses. Repairs to decrease radon levels should be made by an EPA or state-certified contractor.
To protect your family's health, designate your home smoke free and have smokers smoke outside. Contact your nearest American Lung Association office to help you quit smoking if you are ready.
You may have asbestos-containing substances in your home or office, especially those built before 1978. If the material is in good condition, leave it alone! To be certain, however, you may want to have the materials inspected, and, if necessary, repaired or removed. Repair usually involves either sealing or covering asbestos material. Sealing or encapsulation involves coating materials so that asbestos is sealed in. This process is only effective for undamaged asbestos-containing substances. If materials are soft or crumbly or otherwise damaged, sealing is not appropriate. Covering involves placing something over or around the material that contains asbestos to prevent release of fibers. Asbestos removal is an expensive and hazardous process and should be a last resort. Situations where removal may be required include remodeling, major structural changes, and if the asbestos material is damaged and cannot be otherwise repaired. Any action to minimize dust generation from naturally occurring asbestos sources will generally help reduce exposure. Removal is complex, and should be done only by a contractor with special training. Improper removal may increase the health risks to those exposed!
Install a carbon monoxide detector in your home and ask about the formaldehyde content of pressed wood products, including building materials, cabinetry, and furniture before you purchase them. If you experience adverse reactions to formaldehyde, you may want to avoid the use of pressed wood products and other formaldehyde-emitting goods. Maintain moderate temperature and humidity levels and provide adequate ventilation. The rate at which formaldehyde is released is accelerated by heat and may also depend somewhat on the humidity level. Increasing the rate of ventilation in your home will also help in reducing formaldehyde.
Medscape: Thank you Mr. Lotz for spending some time with us.
Mr. Lotz: Thank you.
Editors Note:
As we go back to school and the winter months approach, many of us will be spending more and more time indoors. Thomas P. Lotz, RRT, MEd, CEO of the American Lung Association of the MidSouth serving Alabama, Louisiana, and Mississippi spoke to us about the importance of keeping our indoor air clean and some tips for keeping our lungs healthy.
Medscape: There has been a lot of talk about the impact of indoor air quality and disease. Can you tell us about that?
Thomas P. Lotz, RRT, MEd: There are many sources of indoor air pollution in any home. Pollutants come from building materials, furnishings, asbestos-containing insulation, wet or damp carpet, and cabinetry or furniture made of certain pressed wood products. Products for household cleaning and maintenance, personal care, hobbies, central heating and cooling systems and humidification devices also negatively affect indoor air quality. Combustion sources such as oil, gas, kerosene, coal, wood, and tobacco products are another category of pollutants. Outdoor sources such as radon, pesticides, and outdoor air pollution usually result in high indoor levels as well.
Immediate effects may show up after a single exposure or repeated exposures. These include irritation of the eyes, nose, and throat; headaches; dizziness; and fatigue. Such immediate effects are usually short-term and treatable. Sometimes the treatment is simply eliminating the person's exposure to the source of the pollution, if it can be identified. Symptoms of some diseases, including asthma, hypersensitivity pneumonitis, and humidifier fever, may also show up soon after exposure to some indoor air pollutants.
The likelihood of immediate reactions to indoor air pollutants depends on several factors. Age and preexisting medical conditions are 2 important influences. In other cases, whether a person reacts to a pollutant depends on individual sensitivity, which varies tremendously from person to person. Some people can become sensitized to biologic pollutants after repeated exposures, and it appears that some people can become sensitized to chemical pollutants as well.
Certain immediate effects are similar to those from colds or other viral diseases, so it is often difficult to determine if the symptoms are a result of exposure to indoor air pollution. For this reason, it is important to pay attention to the time and place symptoms occur. If the symptoms fade or go away when a person is away from home, for example, an effort should be made to identify indoor air sources that may be possible causes. Some effects may be made worse by an inadequate supply of outdoor air or from the heating, cooling, or humidity conditions prevalent in the home.
Other health effects may show up either years after exposure has occurred or only after long or repeated periods of exposure. These effects, which include some respiratory diseases, heart disease, and cancer, can be severely debilitating or fatal. It is prudent to try to improve the indoor air quality in your home even if symptoms are not noticeable.
While pollutants commonly found in indoor air are responsible for many harmful effects, there is considerable uncertainty about what concentrations or periods of exposure are necessary to produce specific health problems. People also react very differently to exposure to indoor air pollutants. Further research is needed to better understand which health effects occur after exposure
Medscape: Can you tell us about the American Lung Associations State of the Air 2007 report?
Mr. Lotz: The American Lung Association State of the Air 2007 report grades communities across the nation based on the number of days they have unhealthful levels of air pollution. The grades come from the color-coded alert system called the Air Quality Index, which may be familiar from newspaper, radio, television, and online weather forecasts. Everybody should look for the air quality forecasts in your community and know how to protect yourself and your family from air pollution. You can also take steps to help clean up the air you breathe. Two types of air pollution are especially dangerous to breathe: ozone (smog) and particle pollution (soot).
Ozone (O3), or smog, is an irritating, invisible gas that is formed most often by a reaction of sunlight and vapors emitted when fuel is burned by cars and trucks, factories, power plants, and other sources. Smog usually peaks in the summer months, from May through October, when temperatures are highest and sunlight is strongest. Ozone reacts chemically with internal body tissues that it comes in contact with, such as those in the lung. It especially irritates the respiratory tract, like getting a sunburn or rubbing sandpaper on a wound. Smog can cause health problems the day you breathe in high levels of smog, or after long-term exposure. It's particularly dangerous for people with asthma and other chronic lung diseases, senior citizens, children, and teens. Smog can cause asthma attacks, coughing and wheezing, shortness of breath, chest pain when inhaling deeply, and even premature death. Breathing high levels of smog repeatedly over the long term may also lead to reduced lung function, inflamed lung lining, and increased breathing problems.
Particle pollution is the most dangerous, and deadly, of the widespread outdoor air pollutants. Soot is an old name for particle pollution. Particle pollution is too small to really see -- you can see the haze it creates when the sunlight hits it. Particles can be so microscopic that they're one-seventh to one-thirtieth the diameter of a single human hair or smaller. Particle pollution comes from many sources. The particles are usually a complex mixture that can include ash, soot, diesel exhaust, chemicals, metals, and aerosols. In the eastern United States, many particles come from power plants that burn coal to produce electricity. In the western United States, many come from diesel buses, trucks, and heavy equipment, as well as agriculture and wood burning. The body's natural defenses help to cough or sneeze larger particles out of our bodies. But those defenses don't keep out smaller particles, and they get lodged deep in the lungs, where they stay and can cause major damage. Some of the particles are so tiny that they can pass through the lungs into the bloodstream and travel throughout your body like oxygen. First and foremost, breathing particle pollution can kill. Deaths can occur on the very day that particle levels are high, or within 1-2 months afterward. Breathing particle pollution year-round can shorten life by 1 to 3 years. It causes many other health effects, premature births to serious respiratory disorders, even when the particle levels are very low. It makes asthma worse and causes wheezing, coughing, and respiratory irritation in anyone with sensitive airways. It also triggers heart attacks, strokes, irregular heartbeat, and premature death.
Medscape: What is sick building syndrome?
Mr. Lotz: Sick building syndrome is a term that refers to a set of symptoms that affect a number of building occupants during the time they spend in the building and diminish or go away during periods when they leave the building. It cannot be traced to specific pollutants or sources within the building.
Medscape: What are there concerns about the air quality in the home?
Mr. Lotz: There are some concerns about the quality of air we breathe at home. A particular concern is radon, which is a tasteless, colorless, and odorless gas that is a decay product of uranium and occurs naturally in soil and rock. Radon gas has been identified as the second leading cause of lung cancer, second only to cigarette smoking, and it is estimated to be responsible for 21,000 deaths from lung cancer annually. This number includes smokers whose risk for cancer is increased by radon exposure. Radon breaks down into components called radon progeny, sometimes called "radon daughters," which emit high-energy alpha particles. These emissions raise the risk of lung cancer.
The main source of high-level radon pollution in buildings is surrounding uranium-containing soil such as granite, shale, phosphate, and pitchblende. Radon enters a home through cracks in walls, basement floors, foundations, and other openings. It may also contaminate the water supply, especially in private wells. It has been estimated that approximately one third of radon-induced lung cancer could be avoided if homes with radon concentrations exceeding the US Environmental Protection Agency (EPA) action level underwent changes to reduce radon concentrations to below that level. However, eliminating all radon exposure is not possible. Elevated levels of radon have been identified in every state. It is possible for 1 home to have elevated levels of radon while a neighboring home does not. Testing is the only way to determine levels of radon in a structure. Testing can be done through do-it-yourself home test kits or through a professional testing firm. Radon levels can be lowered through a variety of repairs, from sealing cracks in floors and walls to changing the flow of air into the building. Repairs to decrease radon levels should be made by an EPA or state-certified contractor.
An estimated 1 out of every 15 homes in the United States has radon levels above 4 pci/L, the EPA-recommended action level. Radon, a naturally occurring gas, can enter the home through cracks in the foundation floor and walls, drains, and other openings. Indoor radon exposure is estimated to be the second leading cause of lung cancer.
Secondhand smoke is a major indoor air pollutant, and contains about 4000 chemicals, including 200 known poisons, such as formaldehyde and carbon monoxide, as well as 43 carcinogens.
Formaldehyde is a common chemical, found primarily in adhesive or bonding agents for many materials found in households and offices, including carpets, upholstery, particle board, and plywood paneling.
Asbestos is the name given to a group of microscopic mineral fibers that are flexible and durable and will not burn. Asbestos fibers are light and small enough to remain airborne; they can be inhaled into the lungs and can cause asbestosis (scarring of the lung tissue), lung cancer and mesothelioma, a relatively uncommon cancer of the lining of the lung or abdominal cavity.
Many asbestos products are found in the home, including roofing and flooring materials, wall and pipe insulation, spackling compounds, cement, coating materials, heating equipment, and acoustic insulation. These products are a potential problem indoors only if the asbestos-containing material is disturbed and becomes airborne, or when it disintegrates with age.
Heating systems and other home appliances using gas, fuel, or wood, can produce several combustion products, of which the most dangerous are carbon monoxide (CO) and nitrogen dioxide (NO2). Fuel burning stoves, furnaces, fireplaces, heaters, water heaters, and dryers are all combustion appliances. Carbon monoxide is an odorless, colorless gas that interferes with the distribution of oxygen to the body.
Household cleaning agents, personal care products, pesticides, paints, hobby products, and solvents may be sources of hundreds of potentially harmful chemicals. Such components in many household and personal care products can cause dizziness, nausea, allergic reactions, eye/skin/respiratory tract irritation, and cancer.
Almost all pets can cause allergies, including dogs, cats, birds, and small animals such as hamsters and guinea pigs. Thus, pets can trigger asthma and allergy symptoms. Pet allergies and animal dander, the tiny scales or particles from hair, feathers, skin, or saliva, may stay in the home for months after the pet is gone because it remains in house dust. Cockroaches and their droppings can also trigger asthma and allergy symptoms.
When moisture in the air is high, mold and mildew can be a problem in bathrooms, kitchens, and basements. Mold and mildew can be powerful triggers for asthmatics.
Dust mites are tiny, microscopic animals usually found in house dust. Several thousand mites can be found in a pinch of dust. Mites are one of the major triggers for people with allergies and asthma. They live and grow on pillows and mattresses, window curtains, carpeting, and stuffed animals.
Medscape: What role does poor air quality play in lung disease?
Mr. Lotz: Air pollution hurts the body by irritating and destroying lung tissue and by weakening the defense system of the lungs. Mucus lines our lungs and traps germs and particles before they enter the lungs. Tiny cells with waving hairs called cilia push the mucus up and out of the lungs. Air pollution can paralyze and destroy the cilia, causing the germs and particles to build up in the mucus.
Occupational lung disease is the number 1 work-related illness in the United States based on the frequency, severity, and preventability of diseases. These illnesses are usually caused by extended exposure to irritating or toxic substances that may cause acute or chronic respiratory ailments, although severe single exposures can cause chronic lung disease as well. Smoking can increase the severity of these diseases.
Asbestosis is a progressive disease involving scarring of lung tissue as a result of exposure to the microscopic fibers of asbestos. An estimated 1.3 million employees in construction and industry face significant asbestos exposure on the job. Between 1980 and 2002, 6343 deaths were due to asbestosis.
Mesothelioma is a rare cancer of the chest lining caused by asbestos exposure. By the year 2030 there are estimates that asbestos will have caused 60,000 instances of mesothelioma that result in death.
Coal workers' pneumoconiosis, also called black lung disease, is caused by the inhalation of coal dust that becomes imbedded in the lungs, causing them to harden, making breathing very difficult. An estimated 2.8% of coal miners are affected; about 0.2% have scarring on the lungs, the most severe form of the disease. Each year, close to 400 people die from black lung disease.
Silicosis results from exposure to free crystalline silica in mines; foundries; blasting operations; and stone, clay and glass manufacturing that cause scar tissue to form in the lungs. Silicosis substantially raises the risk of tuberculosis. Each year 200 people die with silicosis listed as an underlying or nonunderlying cause of death on their death certificates, a rate that has been stable since the early 1990s. About 1 million workers are believed to have been exposed to silica dust.
Hypersensitivity pneumonitis results from repeated exposure to fungus spores from moldy hay, bird droppings, or other organic dusts that causes the air sacs of the lungs to become inflamed; parts of the lungs may then develop fibrous scar tissue and cease to function normally in breathing. Deaths from hypersensitivity pneumonitis have been generally increasing from less than 20 per year in 1979 to 57 in 1999.
Medscape: What about tobacco smoke?
Mr. Lotz: The bulk of scientific evidence including the 2006 Surgeon General's Report and the Environmental Protection Agency demonstrate that secondhand smoke causes lung cancer, cardiovascular disease, and premature death and disease in children and adults that do not smoke. Children exposed to secondhand smoke are at an increased risk for Sudden Infant Death Syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma. Smoking by parents causes respiratory symptoms and slows lung growth in their children.
Medscape: What are some things people can do to improve the air quality in their homes, schools, and work environments?
Mr. Lotz: Be aware of the quality of air you breathe and check local air quality levels daily. Local air quality index alerts and pollution forecasts are often given with local weather reports and printed in newspapers. Avoid strenuous outdoor activities and congested streets and rush hour traffic when air pollution levels are high.
Insulate and weatherize your home, convert existing wood stoves and fireplaces to natural gas or propane, and buy paints, cleaning supplies, and personal care products with low levels of volatile organic compounds (VOCs). VOCs are part of ozone.
To help prevent growth of mold when humidity is high, make sure bathrooms, kitchens, and basements have good air circulation and are cleaned often. The basement in particular may need a dehumidifier.
Testing is the only way to determine levels of radon in a structure. Testing can be done through do-it-yourself home test kits or through a professional testing firm. Home test kits labeled "meets EPA requirements" should be used. Radon levels can be lowered through a variety of repairs, from sealing cracks in floors and walls to changing the flow of air into the building. Sub-slab depressurization uses pipes and fans to remove radon gas from beneath the concrete floor and foundation before it can enter the building. Radon is vented above the roof, where it safely disperses. Repairs to decrease radon levels should be made by an EPA or state-certified contractor.
To protect your family's health, designate your home smoke free and have smokers smoke outside. Contact your nearest American Lung Association office to help you quit smoking if you are ready.
You may have asbestos-containing substances in your home or office, especially those built before 1978. If the material is in good condition, leave it alone! To be certain, however, you may want to have the materials inspected, and, if necessary, repaired or removed. Repair usually involves either sealing or covering asbestos material. Sealing or encapsulation involves coating materials so that asbestos is sealed in. This process is only effective for undamaged asbestos-containing substances. If materials are soft or crumbly or otherwise damaged, sealing is not appropriate. Covering involves placing something over or around the material that contains asbestos to prevent release of fibers. Asbestos removal is an expensive and hazardous process and should be a last resort. Situations where removal may be required include remodeling, major structural changes, and if the asbestos material is damaged and cannot be otherwise repaired. Any action to minimize dust generation from naturally occurring asbestos sources will generally help reduce exposure. Removal is complex, and should be done only by a contractor with special training. Improper removal may increase the health risks to those exposed!
Install a carbon monoxide detector in your home and ask about the formaldehyde content of pressed wood products, including building materials, cabinetry, and furniture before you purchase them. If you experience adverse reactions to formaldehyde, you may want to avoid the use of pressed wood products and other formaldehyde-emitting goods. Maintain moderate temperature and humidity levels and provide adequate ventilation. The rate at which formaldehyde is released is accelerated by heat and may also depend somewhat on the humidity level. Increasing the rate of ventilation in your home will also help in reducing formaldehyde.
Medscape: Thank you Mr. Lotz for spending some time with us.
Mr. Lotz: Thank you.