Building Related Illness Fred Fung, M.D., M.S. (Tox) Toxicology Consultant, UC San Diego Occupational Medicine, UC Irvine Sharp Rees-Stealy Medical Group

Are They Good or Bad? Diet coke BBQ meat Peanut butter Donepezil Lovastatin We’ll get back to them later

Death & Death Rates, US 1999

Death & Death Rates, 1999 Top 4 causes of death are associated with cigarette smoking Top 4 causes of death account for 65.5% or 1,566,195 deaths in 1999 is US “Sick Building syndrome” is not listed in 113 causes of death Source: Centers for Disease Control National Vital Statistics Reports, Vol 49, June 26, 2001

Hypothesis testing Scientist provides and evaluates findings and evidence Scientist should avoid incriminating something/somebody based on belief Hypothesis must assume no relationship between A and B Must be tested by experiments

Hypotheses on Indoor Air Quality (IAQ) problems 1. VOC emission + inadequate ventilation. 2. Microbial + bioaerosol. 3. Heightened awareness (Limbic system: smell + emotion).

Disease vs comfort JS Billings, a physician, published 1 st American work on building ventilation: Ventilation and Heating (1893) JSB believed that sufficient ventilation can prevent disease transmission (TB) Engineers were more concerned over odor control and comfort ASHRAE standard, first ventilation standard published

Spectrum of Indoor Air Quality (IAQ) symptoms Headaches Fatigue, memory problem Itchy or burning eyes, nose Skin irritations and rash Nasal congestion and dry throat Respiratory distress * Symptoms are not diseases

Sick Building Syndrome(SBS) SBS is a misnomer. Buildings don’t get sick SBS consists of subjective symptoms. It is benign and self-limited Building related illness (BRI) can be serious BRI patient has symptoms and signs verified by diagnostic tests (disease)

Adverse health effects of Building related illness Allergy: rhinitis, asthma, HP Infection: TB, legionnaires disease Irritation: VOC, dust Toxicity: CO, NO 2, pesticides

Toxin and Disease relationship Toxins: CO, pesticides, VOCs, microbial toxins (endotoxins, glucans, mycotoxins) Diseases: irritation syndrome, rhinitis, sinusitis, bronchitis, hypersensitivity pneumonitis, asthma Building related: HVAC, Temp, humidity, filtration, off-gassing, cooking, smoking

Case studies-Chemical? VOC emission + inadequate ventilation. Pathology technician c/o nasal and throat symptoms better over weekends What is the dx? What is the exposure? Solution? Molhave, Menzies

Microbial source? Microbial, bioaerosol. Office worker c/o sneezing, wheezing and chest tightness soon after a flood What is the dx? What is the exposure? Solution? Caveat: No controlled human studies to date

Stachybotrys Spores

Psychogenic illness? Heightened awareness: Psychosomatic, stress, learned illness, conversion. One employee detects a skunky smell, asks if anybody else smells anything, news of toxic gas permeates the entire building, Haz Mat What is the dx? What is the exposure? Solution? Staudenmayer

Professional smellers-Deodorant- $$$

All substances are poisons; there is none which is not a poison. The right dose differentiates a poison from a remedy. Paracelsus ( )

Good or bad? Diet coke: Aspartame BBQ meat: Benzo(a)pyrene Peanut butter: Aflatoxins Donepezil: AChE inhibitor (OP) Lovastatin: mold product

What is Mold all about?

Adverse health effects of mold exposure Allergy Infection Irritation Toxicity (oral ingestion only)

Clinical Issues-MD Exact disease must be determined Exposure must be specified (route, toxin, duration, concentration, data) Smoking, alcohol, drugs (side effects) Beware: Bad lab data, acute vs chronic, generalization, it is my personal experience! Science v Emotion

Basis of medical diagnosis Specific disease (subjective complaints consistent with objective findings) Documented exposure (specific agent and concentration) provided by IH Medical exam, functional test, biologic level if available Differential Diagnosis (r/o other diseases by objective tests)

Basis of Scientific Opinion (MD +IH) Toxin-disease relationship (specific) Exposure assessment (quantitative) Sufficient dose (conc and duration) Difference in opinion (peer review) *Science is usually not sensational (media factor) *Science is usually influenced by politics