Few lab tests are specifically relevant, with the exception of tests for exposures that have specific biomarkers: carboxyhemoglobin for CO, blood lead level, and antibody screens for hypersensitivity pneumonitis. As for exposure to tobacco smoke in indoor air, the level of cotinine, a nicotine metabolite, can be measured in saliva, blood, and urine, but this measurement is largely for research purposes.
The Environmental Protection Agency recommends measurement of indoor radon for most homes and in some jurisdictions, it has become required with the sale of a house.
Since air pollution commonly acts by exacerbating existing respiratory diseases, studies to determine the severity and change in physiological abnormality may be helpful. However, pulmonary function studies are generally not helpful for detecting the specific contribution of air pollution to the process except following discrete exposure to high levels of pollutants. Controlling the health effects of indoor and outdoor air pollution requires strategies oriented toward both populations as a whole and individual patients.
At the individual level, efforts should be made to limit personal exposure of susceptible groups during periods of elevated ambient pollution. It is important for the provider to recognize if the patient falls into one of these groups.
Ideally the patient may wish to be aware of pollution levels in the community, using information conveyed from local media or air quality apps. Modifying time-activity patterns to limit time outside during significant pollution represents the most effective strategy to reduce exposure. Those susceptible to air pollution should remain indoors during pollution episodes. During air pollution events, affected individuals should discontinue vigorous outdoor exercise, as exercise increases the dose of pollution delivered to the respiratory tract.
In the setting of very high levels of pollution above EPA standards even healthy individuals should consider exercising indoors. Summertime ozone presents a distinct pattern of exposure, often with low levels in the morning and high levels in the later part of the day, often coinciding with periods of high traffic congestion. Exposure may be reduced by encouraging exercise in the early morning during periods of high daytime ozone. Susceptible individuals, especially those with asthma or COPD, should be reminded about medication adherence during pollution episodes.
Medication use should follow the usual clinical indications, and regimens should not be adjusted because of the occurrence of pollution. Patients should have an action plan in the event of increased symptoms during pollution episodes. Traditionally, the use of masks to reduce individual exposure during pollution episodes has not been recommended and commonly available surgical masks have no benefit. However, there is recent data suggesting that high efficiency masks N95 may reduce particulate exposure and physiologic responses in susceptible individuals walking outside during high level pollution episodes.
More research is required to better define the role for this intervention. Masks have no role in protection against ozone. There has been increasing interest in the use of indoor air filters. High efficiency particulate air HEPA filters can be effective for improving indoor air quality, and have been shown to have health benefits for children with asthma. However, more research is needed to establish effectiveness for other at-risk individuals. Pulmonologists may be faced with community issues that range from building-related issues to the effects of local sources, such as power plants and manufacturing facilities.
Since these inequities are often complex issues that exceed the expertise of the local physician, guidance from public health and environmental agencies should be sought. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Show More. Login Register. Enjoying our content? Thanks for visiting Pulmonology Advisor.
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Jump to Section What every physician needs to know: Classification: Are you sure your patient has had exposure to indoor or outdoor air pollutants? What should you expect to find? Beware: there are other diseases that can mimic exposure to indoor or outdoor air pollutants. Which individuals are at greatest risk of developing a condition related to indoor and outdoor air pollution?
What laboratory studies should you order to help make the diagnosis, and how should you interpret the results?
What imaging studies will be helpful in making or excluding the diagnosis? What non-invasive pulmonary diagnostic studies will be helpful in making or excluding the diagnosis of a condition related to indoor or outdoor air pollution? What diagnostic procedures will be helpful in making or excluding the diagnosis? They do not wait for you to invite them in! Some pollutants, like ozone, even react with materials in our homes to generate a new cocktail of pollutants.
If the indoor space is poorly ventilated, pollution can quickly accumulate, especially in small spaces like inside cars, bathrooms, and garages. However, pollution in confined spaces is usually very specific and, once the source has been identified, can be eliminated. There are multiple sources of indoor pollution and they can be linked to:. These different sources of indoor pollution can generate dozens of chemical substances which are grouped under the name Volatile Organic Compounds or VOCs.
VOCs are emitted in by products such as cleaners or cosmetics, or by combustion smoking, candles, incense, etc. These substances have various health effects, which can cause headaches and eye irritation in the case of short exposure, but can also be linked to respiratory problems and they can even affect the hormonal system in the event of long-term exposure.
According to the working records of the station, it is likely that it was human activities e. The increase of outdoor PM 2. This means when outdoor concentration climbed to certain level, the transport towards indoor microenvironment through infiltration did not increase proportionally as outdoor concentration rose.
A feasible explanation is that a penetration limitation existed. It is likely that the increase of transport slowed down when outdoor concentration climbed to certain level, because of limited space of cracks and leaks for infiltration and some other factors. The method applied in this study is based on a mass-balance equation for pollutants that flow into and out of the indoor microenvironment, including sinks and sources Shair and Heitner, ; Esmen, ; Ishizu, The initial mass-balance equation is from previous study Hayes, ; Chen and Zhao, and simplified based on the research conditions in this study:.
F a represents the indoor-outdoor air exchange rate, mainly through infiltration in the case of this study. F s represents the indoor sink rate of pollutants and P represents the penetration factor. Although the experimental conditions were not strictly unchanged, the simplification is reasonable considering relatively short time of disruption, e.
The penetration factor P should be taken into consideration for PM 2. The rapid surface removal of O 3 by indoor materials was significant, so when conducting simulation on indoor O 3 concentration, two factors F a and F s were both included. However, CO had lower reactivity and longer lifetime indoors, so F s was set to be zero when dealing with the prediction of indoor CO concentration.
The equation was solved by iteration with 5 minutes as the length of one step and the data from first 30 days was used. The combination of parameters F a , F s and P that resulted in smallest RMSE between measured and simulated concentrations was calculated for each pollutant.
Based on the CO data, the F a was calculated to be 0. Considering infiltration as the primary pathway, some other research obtained the value of 0. The value obtained in this study was comparable to them. Considering it is the same indoor environment, it is reasonable to apply this value of F a , which represents indoor-outdoor air exchange of the room, to the simulations of O 3 and PM 2.
Based on O 3 data, the F s of O 3 was calculated, which resulted in 2. The penetration factor P 0. About 5-day indoor data, which was not applied in obtaining the parameters, was used to verify the estimation Fig. It also showed that the method lacked the ability for simulating some short-term fluctuations. Additionally, from the afternoon of October 31 to the afternoon of November 1, , the simulated concentration showed underestimation r and RMSE become 0. A five-fold indoor-outdoor air exchange rate was applied for this period black dashed line in Fig.
Simulation of indoor PM 2. For some periods e. It can be found that from November 28 to December 1, the outdoor PM 2. This means that high outdoor PM 2. Note: the dashed black lines represent the improved simulated indoor concentrations of O 3 and PM 2.
The indoor measurements were conducted in a room with closed windows and relatively regular daily indoor human activity. The statistical results and diurnal variations were analyzed, and the indoor-outdoor relationships were characterized. A simulation method was used to evaluate parameters for predicting the indoor concentrations. Our findings are summarized as follows:. Characterization of indoor particle sources: A study conducted in the metropolitan Boston area. Health Perspect.
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Influence of relative humidity on aerosol deposition by sedimentation. Is there a difference between indoor and outdoor air pollution? New articles What is the U. Featured articles Air quality standards How to clean the air of pollen in spring Smog kills and smoking kills!
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