Eduardo de Oliveira Fernandes

The INDEX Project : executive summary of a European Union project on indoor air pollutants

The prevalence of allergies, asthma and other respiratory diseases in large populations has increased in recent decades. Among other factors, this phenomenon has been connected to adverse health effects of air pollution. Although some causal links between occupational exposures and their health effects are shown, still little is known about the health risks of lifelong exposure to indoor air pollutants. To assess the health risks of indoor air pollutants at prevailing concentration levels in Europe, the Joint Research Centre of the European Commission carried out a project called “Critical Appraisal of the Setting and Implementation of Indoor Exposure Limits in the EU” (INDEX). The aims of the project were: ( 1 ) to assess health risks of indoor‐originated chemical pollutants that might be regulated in the EU and ( 2 ) to provide suggestions and recommendations on potential exposure limits or other risk management measures. The results of the INDEX project should contribute to the development of an EU strategy for the management of indoor air quality. The highest priority was given in this study to: formaldehyde, nitrogen dioxide, carbon monoxide, benzene and naphthalene. Exposure limits, recommendations and management options were also given to minimize the health risks for these compounds.

Why, when and how do HVAC - systems pollute the indoor environment and what to do about it ? The European AIRLESS project

From 1998 to 2000, a European project named AIRLESS was conducted by 12 institutes, universities and companies from seven European countries. The objective was to develop strategies, principles and protocols to improve and control the performance of HVAC-systems and its components for incorporation in codes and guidelines. The first step was to define air pollution caused by and/or originating from HVAC-systems, to investigate ways to prevent this pollution and to define strategies to keep this pollution away. A summary of this first phase of the AIRLESS project is presented.

Levels and Indoor–Outdoor Relationships of Size-Specific Particulate Matter in Naturally Ventilated Portuguese Schools

Indoor exposure to particulate matter (PM) has received great interest due to the epidemiological evidence of its health impact, particularly in susceptible populations such as children. The present study investigated indoor concentrations of three PM size fractions in 11 naturally ventilated schools with static heating systems, and the relationship between indoor and outdoor PM concentrations. The study was performed in Porto, Portugal, during winter and included school buildings and individual classrooms with walk-through surveys, as well as indoor and outdoor air monitoring. Mean 12-h indoor daytime concentrations PM10, PM2.5, and PM1 were 140, 95, and 91 μg/m3, respectively. During the day, PM2.5 and PM1 concentrations were lower indoors than outdoors (indoor/outdoor ratios of 0.83 and 0.8, respectively), whereas PM10 showed the opposite trend. Concentrations decreased significantly during the night, 49% for PM10 and 27% for PM2.5 and PM1. These findings reflect the significant contribution from the activities of occupants inside classrooms to higher indoor levels of PM10 levels, whereas the fine fraction of PM2.5 and PM1 is primarily influenced by outdoor concentrations. This study provides a link between size-specific PM in Portuguese schools with contribution of outdoor versus indoor air. Our results suggest that exposure to PM is high and highlights the need for strategies that provide healthier school environments.

Qualidade do ar interior e sintomas respiratórios em escolas do Porto

Aim: To evaluate the association between the indoor air quality in Porto schools and the prevalence of allergic and respiratory symptoms in adolescents. Material and methods: Temperature, relative humidity, carbon dioxide (CO2) and volatile organic compound (VOC) concentrations were evaluated in nine Porto schools. Questionnaires were distributed to 9 classes of 7th, 8th and 9th year students in each school, total 1607 adolescents, with a mean age of 14.0 years (standard deviation = 0.3). Information was collected on participants’ socio-demo-graphic and social characteristics, behaviour, and housing conditions. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was used to evaluate respiratory symptoms. Results: 5.8% of participants stated they had had asthma, 9.2% wheezing, 22.0% sneezing and 6.6% itchy rash In the 12 months preceding the evaluation. After adjustment for parental educational attainment level, CO2 > 2100 ppm values were associated with exercise-induced wheeze [OR = 1.86 (95%CI:1.20-2.89)] and night cough [OR = 1.40 (4.20-2.89)]. We observed an increasing odds ratio in wheezing symptoms over the last 12 months, in asthma ‘at some point’ and asthma over the last 12 months, and night cough at schools with higher VOC values. The association was not statistically significant, however. Conclusion: Lower indicators of indoor air quality, particularly CO2, were associated with a greater respiratory symptomatology. Rev Port Pneumol 2008; XIV (4): 487-507

Volatile organic compounds in asthma diagnosis: a systematic review and meta-analysis.

We aimed to assess the value and classification rate of exhaled volatile organic compounds (VOCs) in asthma diagnosis. A PRISMA‐oriented systematic search for published studies regarding exhaled VOCs in asthma diagnosis was conducted based on predefined criteria. Studies presenting sensitivity and specificity values for the test were included in the meta‐analysis. Pooled diagnosis odds ratios (DOR), area under the curve (AUC) and positive and negative likelihood ratios (LR) for exhaled VOC profiles were calculated; and publication bias, threshold effect and heterogeneity were estimated. Eighteen studies were selected for the qualitative analysis and six met the criteria for inclusion in the quantitative analysis. Mean (95% CI) pooled DOR, positive and negative LR were 49.3 (15.9–153.3), 5.86 (3.07–11.21) and 0.16 (0.10–0.26), respectively. The AUC value was 0.94. Only three of the 18 reviewed studies performed an external validation of the model using a different data set. The results from the revised studies suggest that exhaled VOCs are promising biomarkers for asthma diagnosis and that several compounds, mainly alkanes, may be significantly associated with asthma inflammation. However, there are still various constraints associated with standardization and externally validated studies are needed to introduce exhaled VOC profiling in a clinical scenario.

Perceived Indoor Environment and Occupants' Comfort in European "Modern" Office Buildings: The OFFICAIR Study

Indoor environmental conditions (thermal, noise, light, and indoor air quality) may affect workers’ comfort, and consequently their health and well-being, as well as their productivity. This study aimed to assess the relations between perceived indoor environment and occupants’ comfort, and to examine the modifying effects of both personal and building characteristics. Within the framework of the European project OFFICAIR, a questionnaire survey was administered to 7441 workers in 167 “modern” office buildings in eight European countries (Finland, France, Greece, Hungary, Italy, The Netherlands, Portugal, and Spain). Occupants assessed indoor environmental quality (IEQ) using both crude IEQ items (satisfaction with thermal comfort, noise, light, and indoor air quality), and detailed items related to indoor environmental parameters (e.g., too hot/cold temperature, humid/dry air, noise inside/outside, natural/artificial light, odor) of their office environment. Ordinal logistic regression analyses were performed to assess the relations between perceived IEQ and occupants’ comfort. The highest association with occupants’ overall comfort was found for “noise”, followed by “air quality”, “light” and “thermal” satisfaction. Analysis of detailed parameters revealed that “noise inside the buildings” was highly associated with occupants’ overall comfort. “Layout of the offices” was the next parameter highly associated with overall comfort. The relations between IEQ and comfort differed by personal characteristics (gender, age, and the Effort Reward Imbalance index), and building characteristics (office type and building’s location). Workplace design should take into account both occupant and the building characteristics in order to provide healthier and more comfortable conditions to their occupants.

Smart Cities Initiative: how to foster a quick transition towards local sustainable energy systems

The European Commission has recently launched the Smart Cities Initiative to demonstrate and disseminate how to foster a quick transition towards local sustainable energy systems. Within this initiative, the three main challenges faced by pioneering cities, are to reduce or modify the demand for energy services, to improve the uptake of energy efficient technologies and to improve the uptake of renewables in the urban environment. We find that enough resources will need to be provided to a significant number of pioneering cities, and propose that the initiative would allocate these resources through project competition, rewarding innovation, ambition and performance, which have been ingredients of success at Member State level.

Identification and Levels of Airborne Fungi in Portuguese Primary Schools

Several studies found associations between exposure to airborne fungi and allergy, infection, or irritation. This study aimed to characterize airborne fungi populations present in public primary schools in Porto, Portugal, during winter through quantification and identification procedures. Fungal concentration levels and identification were obtained in a total of 73 classrooms. The AirIdeal portable air sampler was used in combination with chloramphenicol malt extract agar. Results showed a wide range of indoor fungi levels, with indoor concentrations higher than outdoors. The most prevalent fungi found indoors were Penicillium sp. (>70%) and Cladosporium sp. As evidence indicates that indoor fungal exposures plays a role in asthma clinical status, these results may contribute to (1) promoting and implementing public health prevention programs and (2) formulating recommendations aimed at providing healthier school environments.

A systematic review of evidence and implications of spatial and seasonal variations of volatile organic compounds (VOC) in indoor human environments

ABSTRACT Many volatile organic compounds (VOC) are classified as known or possible human carcinogens, irritants, and toxicants, and VOC exposure has been associated with asthma and other respiratory symptoms/diseases. This review summarizes recent quantitative data regarding VOC in four categories of indoor environments (schools, housing, offices, and other indoor) and compares the types and concentration levels of individual VOC that were detected, measured, and reported according to season (cold and warm). The influence of outdoor air on concentrations of indoor VOC was also assessed as ratios of indoor versus outdoor. Papers published from 2000 onward were reviewed and 1383 potentially relevant studies were identified. From these, 177 were removed after duplication, 1176 were excluded for not meeting the review criteria, and 40 were included in this review. On average, higher mean concentrations of indoor VOC were found in housing environments, in offices, and in the cold season. Volatile organic compounds are commonly present in indoor air and specific compounds, and their concentrations vary among indoor environments and seasons, indicating corresponding differences in sources (indoors and outdoors). Actions and policies to reduce VOC exposures, such as improved product labeling and consumer education, are recommended.

Children's health and indoor air quality in primary schools and homes in Portugal-Study design

The main aim of the research project “On the Contribution of Schools to Children’s Overall Indoor Air Exposure” is to study associations between adverse health effects, namely, allergy, asthma, and respiratory symptoms, and indoor air pollutants to which children are exposed to in primary schools and homes. Specifically, this investigation reports on the design of the study and methods used for data collection within the research project and discusses factors that need to be considered when designing such a study. Further, preliminary findings concerning descriptors of selected characteristics in schools and homes, the study population, and clinical examination are presented. The research project was designed in two phases. In the first phase, 20 public primary schools were selected and a detailed inspection and indoor air quality (IAQ) measurements including volatile organic compounds (VOC), aldehydes, particulate matter (PM2.5, PM10), carbon dioxide (CO2), carbon monoxide (CO), bacteria, fungi, temperature, and relative humidity were conducted. A questionnaire survey of 1600 children of ages 8–9 years was undertaken and a lung function test, exhaled nitric oxide (eNO), and tear film stability testing were performed. The questionnaire focused on children’s health and on the environment in their school and homes. One thousand and ninety-nine questionnaires were returned. In the second phase, a subsample of 68 children was enrolled for further studies, including a walk-through inspection and checklist and an extensive set of IAQ measurements in their homes. The acquired data are relevant to assess children’s environmental exposures and health status.