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Indoor air pollution and health

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    Indoor air pollution and health Edited by: e j bardana jr, a montanaro. (Pp 506; £129.00) 1997. New York: Marcel Dekker. ISBN0 8247 9479 6.

    Indoor air pollution has received less attention than outdoor air pollution. This is explained, in part, by the clearly visible coal smoke smogs of 50 years ago and the photochemical smogs of today, and also, by the perception that outdoor air pollution is the Government's business whereas indoor air is not. Great strides have been made in improving outdoor air: that indoor air has improved in parallel may be doubted. All occupational and environmental physicians know that sick building syndrome, legionnaire's disease, and multiple chemical sensitivity are conditions that have come to prominence recently. Dealing with sick building syndrome and multiple chemical sensitivity is not easy and an authoritative source of advice has long been needed. Readers will also be aware that the use of litigation to obtain redress for real or imagined injury is increasing rapidly, and again, a source of advice is needed. This book provides both.

    The editors have drawn together a series of contributions that deal with all aspects of indoor air including assessment, key pollutants, syndromes (sick building syndrome and multiple chemical sensitivity), control measures, the litigative framework (United States), clinical assessment of patients and methods of building construction that avoid problems. The book thus offers an unusually wide range of information.

    Seltzer has provided a long (50 pages) chapter on sources, concentrations, and assessment of indoor air pollution. This is an excellent and detailed review. There is little to argue with although the United States obsession with non-SI units leads to some confusion in the equations that explain conversion of ppm to mg/m3. The equation should read:

    ppm = mg/m3 × 22.45/MW

    The detailed blank forms provided for assessing indoor air quality are a most useful contribution. Environmental tobacco smoke and pollutants generated by combustion are well dealt with by Randset al and Lambert, respectively. In both chapters, the information is up to date and is reviewed in an even handed way. Indoor air pollution with pesticides is an area that has been largely ignored in the United Kingdom. Wagner's chapter provides a well structured review and deals briefly with assertions that exposure to even very low concentrations of organophosphorus compounds can give rise to disease. Useful guidance on how to investigate cases of alleged poisoning is provided. The chapter on multiple chemical sensitivity by Terr struck me as particularly good. Physicians practising conventional medicine seldom know much about non-traditional approaches: useful information is provided. Care is taken in dealing with these methods: where no objective evidence of efficacy has been obtained this is pointed out. Practical matters including the use of provocation challenge (Tsien and Spector) and the assessment of patients (Bardana) are well presented.

    If indoor air pollutants are bad for people, the litigation that they produce is good for lawyers. The legal aspects are tackled in two chapters: a formal presentation of the United States legal position by Hirsh and a more provocative essay by Selner entitled “The future”. This chapter is a gem. The author issues a call to all scientists to stand up against “junk science” and to require the rigorous application of rules of scientific logic to assertions of harm. Whether this call will be heeded remains moot.

    In their preface the editors say “we know of no other text that has addressed the issue of the indoor environment from so broad a platform”. I agree: this is an unusual and important book; although at £129.00, too few will buy it.