Robert Wålinder

Indoor air pollutants in schools: nasal patency and biomarkers in nasal lavage

Background: There is growing concern about the respiratory health aspects of the indoor air quality in schools.

Nasal Lavage Biomarkers: Effects of Water Damage and Microbial Growth in an Office Building

Abstract Selected nasal symptoms were studied in personnel who worked in a damp office building that had microbial growth (including Stachybotrys sp.) in mineral fiber insulation and gypsum board. There were also signs of dampness in the floor. Clinical examinations included nasal lavage and peak expiratory flow measurements in 12 subjects in the damp building; an additional 8 subjects in a control building (i.e., no signs of dampness or microbial growth) were also examined. Hygienic air measurements of microorganisms and volatile organic compounds were performed in both buildings. The concentrations of eosinophil cationic protein, myeloperoxidase, and albumin, and the number of subjects with eosinophils in lavage fluid, were higher among office workers in the damp building than among controls. The damp building had greater amounts of total molds and bacteria in its construction than the building materials in nondamp buildings. In addition, an increase of 2-ethyl-1 -hexanol in the indoor air was detected in the damp building—a sign of dampness-related alkaline degradation of diethyl-hexyl phthalate in polyvinyl chloride floor coatings. In conclusion, the results of this study indicate that exposures in a damp office building may cause an inflammatory nasal mucosal response. The results also support conclusions of earlier studies, indicating that building dampness is related to respiratory inflammation.

Acute Effects of a Fungal Volatile Compound

Objective: 3-Methylfuran (3-MF) is a common fungal volatile product with active biologic properties, and previous studies have indicated a contribution to airway disease. The aim of the present study was to assess the acute health effects of this compound in humans. Design: Acute effects were assessed via chamber exposure to (1 mg/m3) 3-MF. Participants and measurements: Twenty-nine volunteers provided symptom reports, ocular electromyograms, measurement of eye tear film break-up time, vital staining of the eye, nasal lavage, acoustic rhinometry, transfer tests, and dynamic spirometry. Results: No subjective ratings were significantly increased during exposure. Blinking frequency and the lavage biomarkers myeloperoxidase and lysozyme were significantly increased, and forced vital capacity was significantly decreased during exposure to 3-MF compared with air control. Conclusions and relevance to clinical practice: Acute effects in the eyes, nose, and airways were detected and might be the result of the biologically active properties of 3-MF. Thus, 3-MF may contribute to building-related illness.

Acute effects of 1-octen-3-ol, a microbial volatile organic compound (MVOC)--an experimental study

Acute effects were assessed from exposure to a common volatile compound of microbial origin, the aliphatic alcohol 1-octen 3-ol (octenol). Twenty-nine volunteers performed symptom reports, measurement of blink frequency by electromyography, measurement of the eye break-up time, vital staining of the eye, nasal lavage, acoustic rhinometry, transfer tests and dynamic spirometry. Subjects were during 2h in random order exposed to either 10mg/m(3) of octenol or clean air as control. During octenol exposure subjective ratings of smell and nasal irritation were increased together with higher nasal lavage biomarker levels of eosinophil cationic protein, myeloperoxidase and lysozyme. Also eye irritation and blinking frequency were increased together with throat irritation, mild dyspnoea after 1-h but not after 2-h, and a small decrease in vital capacity. Ratings of headache and nausea were also increased. Atopics did not have more reactions due to exposure, whereas females experienced more smell and mucosal irritation. Thus, there were both subjective and objective signs of mild mucosal irritation of eyes and airways together with symptoms of headache and nausea.

Influence of horse stable environment on human airways

BackgroundMany people spend considerable amount of time each day in equine stable environments either as employees in the care and training of horses or in leisure activity. However, there are few studies available on how the stable environment affects human airways. This study examined in one horse stable qualitative differences in indoor air during winter and late summer conditions and assessed whether air quality was associated with clinically detectable respiratory signs or alterations to selected biomarkers of inflammation and lung function in stable personnel.MethodsThe horse stable environment and stable-workers (n = 13) in one stable were investigated three times; first in the winter, second in the interjacent late summer and the third time in the following winter stabling period. The stable measurements included levels of ammonia, hydrogen sulphide, total and respirable dust, airborne horse allergen, microorganisms, endotoxin and glucan. The stable-workers completed a questionnaire on respiratory symptoms, underwent nasal lavage with subsequent analysis of inflammation markers, and performed repeated measurements of pulmonary function.ResultsMeasurements in the horse stable showed low organic dust levels and high horse allergen levels. Increased viable level of fungi in the air indicated a growing source in the stable. Air particle load as well as 1,3-β-glucan was higher at the two winter time-points, whereas endotoxin levels were higher at the summer time-point. Two stable-workers showed signs of bronchial obstruction with increased PEF-variability, increased inflammation biomarkers relating to reported allergy, cold or smoking and reported partly work-related symptoms. Furthermore, two other stable-workers reported work-related airway symptoms, of which one had doctors diagnosed asthma which was well treated.ConclusionBiomarkers involved in the development of airway diseases have been studied in relation to environmental exposure levels in equine stables. Respirable dust and 1,3-β-glucan levels were increased at winter stabling conditions. Some employees (3/13) had signs of bronchial obstruction, which may be aggravated by working in the stable environment. This study contributes to the identification of suitable biomarkers to monitor the indoor horse stable environment and the personnel. An improved management of the stable climate will be beneficial for the health of both stable workers and horses.

Peritonectomy with high voltage electrocautery generates higher levels of ultrafine smoke particles

BACKGROUND To adequately perform peritonectomy, the use of an electrocautery device at a high voltage is recommended. The aim of this study was to analyse the amount of airborne and ultrafine particles (UFP) generated during peritonectomy and to compare this with standard colon and rectal cancer surgery (CRC). METHOD UFP was measured approximately 2-3 cm from the breathing area of the surgeon (personal sampling) and 3 m from where the electrocautery smoke was generated (stationary sampling) from 14 consecutive peritonectomy procedures and 11 standard CRC resections. The sampling was by P-Trak UFP counter that has the capacity to detect particle size ranging from 0.02 to 1 microm. RESULTS The cumulative level of UFP of personal sampling in the peritonectomy group was higher (9.3 x 10(6) particle/ml/h (pt/ml/h)) than in the control group (4.8 x 10(5) pt/ml/h). A higher cumulative level of UFP in stationary sampling was observed in the PC group (2.6 x 10(6) pt/ml/h) than in the control group (3.9 x 10(4)pt/ml/h). CONCLUSION Peritonectomy procedure with high voltage electrocautery generates elevated levels of UFP than standard CRC surgery does. The level of UFP produced by a peritonectomy is comparable to cigarette smoking. More efficient smoke evacuator systems are needed in order to reduce the levels of UFP generated during electrocautery surgery.

The Effect of Air Humidification on Symptoms and Nasal Patency, Tear Film Stability, and Biomarkers in Nasal Lavage: A 6 Weeks' Longitudinal Study

Air humidification is sometimes used to reduce dryness symptoms in temperate climates, but the biological mechanism behind this effect is not well understood. We have investigated the effect of air humidification on physiological signs from the eyes and nose, other medical symptoms and on perceived air quality. An experimental study was performed in two units of a well-ventilated geriatric hospital in southern Sweden. Blinded central steam air humidification in one of the units during 6 weeks raised the relative air humidity to 43% RH (January–March 1997), while the other unit with 35% RH served as control. All staff (N = 32) working the day shift were invited to undergo a medical investigation performed in the hospital units. It included measurement of tear film stability, acoustic rhinometry, nasal lavage and completing a medical questionnaire. The investigation was repeated at both units after 6 weeks and 26 subjects participated on both occasions (81%). The technical measurements were room temperature, relative air humidity and the levels of nitrogen dioxide (NO2), moulds, bacteria, formaldehyde, and total as well as specific volatile organic compounds in the air. The mean room temperature (22.5°C), and indoor concentrations of pollutants were similar in both units, before and after humidification. Air humidification decreased the sensation of air dryness and reduced the number of dermal symptoms. No effect on other symptoms, i.e. tear film stability (breakup time), nasal patency, or biomarkers in nasal lavage, was observed. In conclusion, increasing air humidity from 35 to 43% RH with central steam humidification was found to reduce dermal symptoms and perception of air dryness, but there was no evidence of an effect on tear film stability, nasal patency, or nasal mucosal inflammation or secretion.

Nasal Congestion in Relation to Low Air Exchange Rate in Schools: Evaluation by Acoustic Rhinometry

Upper airway symptoms are common, but there is little information available on clinical findings in relation to indoor air pollution. This pilot study was conducted to test whether increased levels of indoor air pollutants in schools may correlate to a swelling of the nasal mucosa. The assumption was made that the degree of swelling could be related to the degree of decongestive effect of xylometazoline, and measured by acoustic rhinometry. The study was performed among 15 subjects in a school with low air exchange rate (0.6 air changes/h) and 12 subjects in a school with high air exchange rate (5.2 air changes/h). Hygienic measurements were performed in both schools. Acoustic rhinometry was performed for each individual under standardized forms. Cross-sectional areas and volumes of the nasal cavity were measured before and after decongestion with xylometazoline hydrochloride. Absolute values of the minimal cross-sectional area were lower in the school with poor ventilation. The decongestive effect of xylometazoline was significantly higher in the school with low air exchange, when correction for the influence of age was made. A diminished decongestive effect was seen with increasing age. The exposure measurements showed that indoor concentrations of volatile organic compounds, bacteria and moulds were higher in the school with low ventilation. In conclusion, raised levels of indoor air pollutants due to inadequate ventilation in schools may affect the upper airways and cause a swelling of the nasal mucosa, and acoustic rhinometry could be a useful objective method to measure human nasal reactions to the indoor environment.

Acute effects of exposure to 1 mg/m(3) of vaporized 2-ethyl-1-hexanol in humans

The objective was to assess acute effects from controlled exposure of volunteers to 2-ethyl-1-hexanol, a volatile organic compound that is often found in indoor air. Sixteen males and fourteen females were in random order exposed to 1 mg/m(3) of vapors of 2-ethyl-1-hexanol or to clean air (control exposure) in an exposure chamber during 2 h at rest. The subjects performed symptom ratings on Visual Analog Scales. During exposure to 2-ethyl-1-hexanol subjective ratings of smell and eye discomfort were minimally but significantly increased. Ratings of nasal irritation, throat irritation, headache, dyspnoea, fatigue, dizziness, nausea, and intoxication were not significantly affected. No exposure-related effects on measurement of blinking frequency by electromyography, measurement of the eye break-up time, vital staining of the eye, nasal lavage biomarkers, transfer tests, spirometric and rhinometric measures were seen. No differences in response were seen between sexes or between atopics and non-atopics. Practical Implications It is important to assess acute effects in volatile organic compounds like 2-ethyl-1-hexanol. 2-ethyl-1-hexanol is often found in indoor air generated by degradation of plastic building materials or in new buildings. There are associations between 2-ethyl-1-hexanol in indoor air and respiratory effects, eye irritation, headache, and blurred vision. A controlled chamber exposure study in acute effects was performed. In conclusion, this study showed weak subjective symptom of irritation in the eyes.

The effect of building dampness and type of building on eye, nose and throat symptoms in Swedish hospitals

The effect of building dampness and type of building on eye, nose and throat symptoms in Swedish hospitals