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Sick Building Syndrome (SBS)
A Word About Radon and Asbestos...
SBS and BRI are associated with acute or immediate health problems; radon and asbestos cause long-term diseases which occur years after exposure, and are therefore not considered to be among the causes of sick buildings. This is not to say that the latter are not serious health risks; both should be included in any comprehensive evaluation of a building's IAQ
http://www.epa.gov/iaq/pubs/sbs.html

Quali piante per pulire l'aria in casa?
http://www.a-cservices.com/plants.htm#How Plants Clean  Air

Division of Air Pollution Control
http://swdoweb.epa.state.oh.us/airpoll.htm

Indoor Air Quality (IAQ) - Information Clearinghouse [IAQ INFO]
http://www.epa.gov/iaq/iaqinfo.html

Key Signs/Symptoms of Lead Poisoning in Adults...

gastrointestinal discomfort/constipation/anorexia/nausea
fatigue, weakness
personality changes
headache
hearing loss
tremor, lack of coordination

... and in Infants and Small Children

irritability
abdominal pain
ataxia
seizures/ loss of consciousness
(chronic) learning deficits
hyperactivity, reduced attention span

Key Signs/Symptoms of Mercury Poisoning

muscle cramps or tremors
headache
tachycardia
intermittent fever
acrodynia
personality change
neurological dysfunction

Diagnostic Leads

Does the family reside in old or restored housing?
Has renovation work been conducted in the home, workplace, school, or day care facility?
Is the home located near a busy highway or industrial area?
Does the individual work with lead materials such as solder or automobile radiators?
Does the child have sibling, friend, or classmate recently diagnosed with lead poisoning?
Has the individual engaged in art, craft, or workshop pursuits?
Does the individual regularly handle firearms?
Has the home interior recently been painted with latex paint that may contain mercury?
Does the individual use mercury in religious or cultural activities?

Remedial Action

Wet-mop and wipe furniture frequently to control lead dust. Have professional remove or encapsulate lead containing paint; individuals involved
in this and other high exposure activities should use appropriate protective gear and work in well-ventilated areas. Do not burn painted or treated
wood.

Comment

Airborne Lead

Most health professionals are aware of the threat of lead (Pb) toxicity, particularly its long term impact on children in the form of cognitive and
developmental deficits which are often cumulative and subtle. Such deficits may persist into adulthood48. According to the American Academy of
Pediatrics, an estimated three to four million children in the U.S. under age six have blood lead levels that could cause impaired development, and
an additional 400,000 fetuses are at similar risk49.

Lead toxicity may alternatively present as acute illness. Signs and symptoms in children may include irritability, abdominal pain, emesis, marked
ataxia, and seizures or loss of consciousness. In adults, diffuse complaints -- including headache, nausea, anorexia (and weight loss),
constipation, fatigue, personality changes, and hearing loss -- coupled with exposure opportunity may lead to suspicion of lead poisoning.

Lead inhibits heme synthesis. Since interruption of that process produces protoporphyrin accumulation at the cellular level, the standard screening
method is investigation of blood lead (PbB) levels which reveal recent exposure to lead. Acute symptomology in adults is often associated with
PbB at levels of 40 g/ dl or higher. There is good evidence for adverse effects of lead in very young children at much lower levels.50,51 The
Centers for Disease Control and Prevention has set 10 g/ dl as the level of concern52. Increased maternal Pb exposure has also been deemed
significant in pregnancy, since an umbilical cord PbB of greater than 10 g/ dl has been correlated with early developmental deficits. If sufficiently
high PbB levels are confirmed, chelation therapy may be indicated. Suspected low level lead contamination cannot be accurately identified by a
erythrocyte protoporphyrin (EP) finger-stick test, but requires blood lead analysis.

Lead poisoning via ingestion has been most widely publicized, stressing the roles played by nibbling of flaking paint by infants and toddlers and
by the use of lead-containing foodware (glass, and soldered metal-ceramic ware) by adults. Lead dust flaking or "chalking" off lead painted walls
generated by friction surfaces is a major concern. Airborne lead, however, is also a worrisome source of toxicity. There is no skin absorption
associated with inorganic lead.

Airborne lead outdoors, originating chiefly from gasoline additives, has been effectively controlled since the 1980s through regulation at the
federal level. Much of this lead still remains in the soil near heavily trafficked highways and in urban areas, however, and can become airborne at
times. It may enter dwellings via windows and doors, and contaminated soil can also be tracked inside.

Indoors, the chief source is paint. Lead levels in paints for interior use have been increasingly restricted since the 1950s, and many paints are now
virtually lead free. But older housing and furniture may still be coated with leaded paint, sometimes surfacing only after layers of later, non-lead
paint have flaked away or have been stripped away in the course of restoration or renovation. In these circumstances, lead dust and fumes can
permeate the air breathed by both adults and children.

Additional sources of airborne lead include art and craft materials, from which lead is not banned, but the U.S. Consumer Product Safety
Commission (CPSC) requires its presence to be declared on the product label if it is present in toxic amounts. Significant quantities are found in
many paints and glazes, stained glass, as well as in some solder. Hazardous levels of atmospheric lead have been found at police and civilian
firing ranges. Repair and cleaning of automobile radiators in inadequately ventilated premises can expose workers to perilous levels of airborne
lead. The use of treated or painted wood in fireplaces or improperly vented wood stoves may release a variety of substances, including lead and
other heavy metals, into the air.

Mercury Vapor

While old paint has been the most publicized source of airborne heavy metal (i.e., lead), new paint has emerged as a concern as well. A 1990
report detailed elevated levels of mercury in persons exposed to interior latex (water-based) paint containing phenylmercuric acetate (PMA)53.
PMA was a preservative that was used to prolong the product's shelf life.

Initial action by the U.S. Environmental Protection Agency resulted in the elimination of mercury compounds from indoor latex paints at the point
of manufacture as of August 1990, with the requirement that paints containing mercury, including existing stocks originally designed for indoor
use, be labeled or relabeled "For Exterior Use Only". As of September 1991, phenylmercuric acetate is forbidden in the manufacture of exterior
latex paints as well. Latex paints containing hazardous levels of mercury may still remain on store shelves or in homes where they were left over
after initial use, however.

An additional matter of concern, recently noted by the CPSC, is the sprinkling of mercury about the home by some ethnic/religious groups54.
According to the CPSC, mercury for this purpose is purveyed by some herbal medicine or botanical shops to consumers unaware of the dangers
of the substance.

48.Needleman, H.L. Schell, A. et al. "The Long-Term Effects of Exposure to Low Doses of Lead in Childhood: An 11-Year Follow-up
Report." The New England Journal of Medicine 1990; 322:83-88.
  49.American Academy of Pediatrics. "Lead Poisoning: Next Focus of Environmental Action." Statement issued January 1991.
  50.Bellinger, D., Sloman, J. et al. "Low-Level Lead Exposure and Children's Cognitive Function in the Preschool Years." Pediatrics 1991;
87:219-27.
  51."Lower "Threshold of Concern" for Children's Lead Levels". FDA Consumer, December 1991. p.6.
  52.Centers for Disease Control. "Preventing Lead Poisoning in Young Children". October 1991.
  53.Agocs, Mary M., Etzel, Ruth A. et al. "Mercury Exposure from Latex Interior Paint." The New England Journal of Medicine. 1990;
323:1096-11011.
  54.Consumer Product Safety Commission. Safety Alert: Mercury Vapors.

Asbestos and radon are among the most publicized indoor air pollutants. Both are known human carcinogens. Their carcinogenic effects are not
immediate but are evident only years, even decades, after prolonged exposure.

Asbestos

Once widely used in structural fireproofing, asbestos may be found predominantly in heating systems and acoustic insulation, in floor and ceiling
tiles, and in shingles in many older houses. It was formerly used in such consumer products as fireplace gloves, ironing board covers, and certain
hair dryers.

When asbestos-containing material is damaged or disintegrates with age, microscopic fibers may be dispersed into the air. Over as long as
twenty, thirty, or more years, the presence of these fibers within the lungs may result in asbestosis (asbestos-caused fibrosis of the lung, seen as a
result of heavy occupational exposure)58, lung cancer and pleural or peritoneal cancer, or mesothelioma59. For lung cancer, the effect of tobacco
smoking in combination with asbestos exposure appears to be synergistic by approximately fivefold60. Occupational exposure may also be
associated with increased risk of gastrointestinal malignancies. Attention should be focused on those populations with continual exposure and
documented health effects, e.g. maintenance workers.

Products and materials containing asbestos are not necessarily so labeled. Construction professionals or state or local environmental agencies
may inspect and analyze suspect materials. Manufacturers of particular products may also be able to supply information.

The risk of disease depends on exposure to airborne asbestos fibers. Average levels in buildings are low, and the risk to building occupants is
therefore low.

Removal of asbestos is not always the best choice to reduce exposure. The EPA requires asbestos removal only in order to prevent significant
public exposure and generally recommends an in-place management program when asbestos has been discovered and is in good condition61.

Radon

Radon is the second leading cause of lung cancer, following smoking. Radon is odorless, colorless, and tasteless. It is a naturally occurring
radioactive gas resulting from the decay of radium, itself a decay product of uranium. Radon in turn breaks down into radon decay products,
short-lived radionuclides. These decay products, either free or attached to airborne particles, are inhaled, and further decay can take place in the
lungs before removal by clearance mechanisms.

It is the emission of high-energy alpha particles during the radon decay process that increases the risk of lung cancer. While the risk to
underground miners has long been known, the potential danger of residential radon pollution has been widely recognized only since the late
1970s, with the documentation of high indoor levels.

When radon decay products are inhaled and deposited in the lungs, the alpha emissions penetrate the cells of the epithelium lining the lung.
Energy deposited in these cells during irradiation is believed to initiate the process of carcinogenesis. The EPA, the National Cancer Institute, the
Centers for Disease Control and Prevention, and others estimate that thousands of lung cancer deaths per year are attributable to radon, based
on data from epidemiologic studies of thousands of underground miners and from animal studies. Lung cancer is presently the only commonly
accepted disease risk associated with radon.

Tobacco smoke in combination with radon exposure has a synergistic effect. Smokers and former smokers are believed to be at especially high
risk. Scientists estimate that the increased risk of lung cancer to smokers from radon exposure is ten to twenty times higher than to people who
have never smoked.

The EPA estimates that as many as six million homes throughout the country have elevated levels of radon. Since 1988, EPA and the Office of
the Surgeon General have recommended that homes below the third floor be tested for radon.

Short term testing is the quickest way to determine if a potential problem exists, taking from two to ninety days to complete. Low-cost radon test
kits are available by mail order, in hardware stores, and through other retail outlets62.

Measurement devices should be state-certified or display the phrase, "Meets EPA Requirements". Trained contractors who meet EPA's
requirements can also provide testing services. The most commonly used devices are charcoal canisters, electret ion detectors, alpha track
detectors, and continuous monitors placed by contractors. Short term testing should be conducted in the lowest lived in area of the home, with
the doors and windows shut. Long term testing can take up to a full year but is more likely to reflect the home's year round average radon level
than short term testing. Alpha track detectors and electret ion detectors are the most common long-term testing devices.

Corrective steps include sealing foundation cracks and holes, and venting radon-laden air from beneath the foundation. Professional expertise
should be sought for effective execution of these measures.

57.Kreiss, Kathleen. "The Sick Building Syndrome: Where Is the Epidemiologic Basis? "American Journal of Public Health 1990;
80:1172-73.
  58.The first death attributed to occupational asbestos exposure occurred in 1924; the details were recently recounted: Selikoff, I.J. and
Greenberg, M. "A Landmark Case in Asbestosis." Journal of the American Medical Association 1991; 265:898-901.
  59.For a detailed discussion of asbestos-related pulmonary disease, see: Rom, W.N., Travis, W.D. and Brody, A.R. "Cellular and Molecular
Basis of the Asbestos-related Diseases." American Review of Respiratory Disease 1991; 143:408-22.
  60.U.S. Environmental Protection Agency, Office of Research and Development. Airborne Asbestos Health Assessment Update.
EPA-600-8-84-003F. June 1986.
  61."Asbestos in Your Home", American Lung Association, U.S. Consumer Product Safety Commission, U.S. Environmental Protection
Agency. September 1990. ALA Publication No. 3716.
  62.See Samet, J.M., Marbury, Marian C. and Spengler, J.D. "Health Effects and Sources of Indoor Air Pollution, Part II." American Review
of Respiratory Disease 1988; 137:221-42. This continuation of the overview cited earlier provides a table of commercial sources of
testing equipment for sampling and monitoring levels of a variety of indoor air pollutants, including radon.

For information on lead, contact the National Lead Information Center (1-800-LEAD FYI).

ASBESTOS

For the patient (may be helpful to the professional as well):

American Lung Association. "Indoor Air Pollution Fact Sheet - Asbestos". 1991. Publication No. 1188C.

RADON

For the health professional:

American Medical Association and U.S. Environmental Protection Agency. "Radon: The Health Threat with a Simple Solution. A
Physician's Guide". AMA. EPA-402-K-93-008. 1993.
Fabrikant, J. I. "Shelter and Indoor Air in the Twenty-First Century - Radon, Smoking and Lung Cancer Risks". Environmental Health
Perspectives. 1990. 86:275-280.
National Academy of Sciences. Comparative Dosimetry of Radon in Mines -and Homes. National Academy Press. Washington, D.C.
1991.
National Research Council, Committee on the Biological Effects of Ionizing Radiation. "Health Risks of Radon and Other Internally
Deposited Alpha-Emitters". BIER IV. Washington, DC: National Academy Press, 1988.
Nero, A.V., Jr. "Radon and Its Decay Products in Indoor Air: An Overview". In: Nazaroff, W.W., Nero, A.V., Jr., eds. Radon and Its
Decay Products In Indoor Air. New York: John Wiley and Sons Inc. 1988:1-53.
Roscoe, R.J. et al. "Lung Cancer Mortality Among Non-Smoking Uranium Miners Exposed to Radon Daughters". Journal of the
American Medical Association. 262(5): 629-633. 1989.
Samet, J.M. "Radon and Lung Cancer". JNCI. 1989. 81: 745-757.
Samet,J.M., Stolwijk J., Rose, S.L. "Summary: International Workshop on Residential Radon Epidemiology". Health Phys. 1991. 60:
223-227.
U.S. Department of Health and Human Services, Public Health Service, Agency for Toxic Substances and Disease Registry, Radon
Toxicity. 1992.
U.S. Environmental Protection Agency. National Residential Radon Survey: Summary Report. EPA-402-R-91-0111. 1992.
U.S. Environmental Protection Agency. Technical Support Document for the 1992 Citizens Guide to Radon. 1992.

For the patient (may be helpful to the professional as well):

American Lung Association. "Indoor Air Pollution Fact Sheet - Radon". 1992. Publication No. 1183C.
American Lung Association. "Facts About Radon: The Health Risk Indoors". Publication No. 0174C.
U.S. Environmental Protection Agency. "A Citizens Guide to Radon (second edition)". EPA-402-K-02-001. 1992.