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Table of Contents

Suming up

Report from the Convention

Indoor Air Quality - Environmental Ambulances

Indoor Air Quality:  Elaboration of a European standard

Ralph BADEN
Service de la Médecine de l’Environnement
Direction de la Santé Health Ministry of Luxemburg

Health problems have substantially changed over the last decades throughout Europe. Illnesses dues to bacteria and viruses are more and more replaced by new symptologies like allergies and asthma which are constantly increasing, troubles of fertility and certain forms of cancer. "Multiple chemical sensitivity", "Chronic fatigue syndrome" and "sick building syndrome" try to describe those new symptologies. The origins of these illnesses are very often related to the pollution of ambient air and particularly of the indoor air inside the habitations where people spend the main time of their life (more then 90 percent of the time). Many studies have clearly shown that the indoor air is a primary source for many symptoms as the long list of excellent lectures during the Environment & Health conference of Luxemburg in June 2005 have testimonied.

The first step of therapying people suffering from these kinds of health trouble is to stop or at least reduce substantially the exposition to the causing pollutants. The best therapy cannot fructify without reducing the cause of problem.

Thus the importance of the indoor air quality and the mission of the biologists, chemists, "Baubiologists" and other experts working to identify the pollutants in order to avoid further exposition.

Over the last years, many efforts have been realised in "indoor air quality": the programs SCALE, THADE, EHAP of the European Union, the WHO-directives as well as numerous national initiatives by different member states like the inventory of data concerning the indoor air quality inside buildings realised by the French "Observatoire de la Qualité de l’Air Intérieur en France" (inventaire des données françaises sur la qualité de l’air intérieur des bâtiments), the directives of the vdb (Verein Deutscher Baubiologen) and those of the AGÖF (Arbeitsgemeinschaft ökologischer Forschung), the directives about moulds of the LGA Baden-Würtemberg (Landesgesundheitsamt) and the report "amelioration of the indoor air quality" by the BMU (Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit), all these in Germany or the efforts realised throughout Belgium, like the conference of Habay (Arlon) in 2004: Environmental Illnesses: a task for the professionals of health care.

In most of the member states, structures are actually being organized to investigate habitations in order to identify the pollutant charges. The organisation and structure of these services commonly called "environmental ambulances" differ from one member state to the other. Thus the analysed parameters, the methodologies, the samplings, the analysing procedures by the chemical or mycological laboratories, the interpretation of the results , the guiding values and limits make it difficult to compare the pollutant charges and their effects on health between member states. On the other side, the circumstances under which patients or habitants can benefit from the services offered are quit different from one country or region to another.

This makes it obvious that a harmonisation of the national services involved in the investigation of indoor pollution is needed especially since numerous projects are being realized through the European Union. Such a coordination would allow to take advantage of the experience and the practise of the existing services and so contribute to the development of further indoor air investigation services throughout Europe. The comparison of the "indoor air situation" between member states would considerably accelerate the knowledge about different "indoor pollutants" and thus enhance the acquisition of data indispensable to prevent the use of hazardous products inside habitation.

Why a European standard?

  • To guarantee a most complete service which allows to identify a maximum of pollutants known actually

  • To gather the experience and the acquired knowledge in order to benefit at a maximum from the existing competences of the different member states

  • To be able to respond quickly to new exigencies (new pollutants, synergistic effects of different pollutants)

  • To compare the analytical methodologies and the measuring techniques used actually

  • To strengthen the cooperation with other services implicated like environmental medicine in order to establish a link or causal effect between pollutants and certain kinds of symptoms and thus to optimize the therapeutic treatment of patients

  • To compare and coordinate the data acquired in the different member states in order to contribute to increase the state of knowledge about pollutants allowing thus a regulation and prevention of the pollutants

  • To participate to European programmes trough the contribution of field experience necessary to the further orientation of the European programmes concerning the interface environment and health

    •
    The standardization and harmonisation of the habitation investigation on behalf of indoor air quality should concern the following points:

    1. the investigation of the habitation

    2. parameters to be analyzed

    3. techniques of measuring

    4. conditions of sampling

    5. laboratory analyses

    6. guidelines & orientation values

    7. recommendations, measures to reduce the exposition, materials to avoid

    8. controls to be done

    9. Centralisation of data

    10. formation and continuous formation

    The conference of june and particularly the workshop about Indoor Air Quality gathered experts on behalf of "indoor air quality" and especially experts having acknowledged experience in investigating habitations in different member states.

    Proposition of standardization
    1. the investigation of the habitation
      The structures of the services involved in the investigation of habitats vary through the different member states (national service in Luxemburg, regional services in Belgium, private services in Germany, Austria, Netherlands, Switzerland or Portugal. In some member states a tight cooperation with environmental medicine or with medical doctors is standard whereas such a coordination does not exist in other member states. In some member states a medical prescription is needed. A harmonisation of the conditions is substantial to compare the "indoor air quality" measuring between member states in order to draw the conclusions relevant to the different parameters measured in an appropriate time.
    2. parameters to be analyzed
      The different parameters to be investigated can be subdivided into three categories: physical parameters, chemical substances and mycological pollutants:

    The sampling is taken either in the air for volatile organic compounds or in the dust for non- or semi organic compounds. Due to the immediate exposition and the duration of the exposition, sampling of suspicious matresses should be realised as well.

    1. techniques of measuring
      The comparison of sampling results is not possible without a harmonisation of the sampling and analytic techniques (including the culture media for mould-sampling).
    2. conditions of sampling
      TheThe results of an analyse are dependant on the conditions under which the sampling is realised. So for the interpretation of the results and the comparison of the data a standardisation of these conditions including aeration (for example no aeration 12 houres before the sampling), ventilation, ambient temperature and relative humidity are required. The sampling conditions actually are integrating part of the reports.
    3. laboratory analyses
    4. guidelines & orientation values
      The conclusions of the Dutch conference of Egmont-am-Zee in december 2004 mentioned the necessity of guidelines values (citation: … guidelines values may be a helpful tool to guarantee good indoor air quality…)

      The orientation values or guidelines issue from toxicological or epidemiological data or from statistic data. Toxicological data resulting from laboratory (id est animal) testing or from epidemiologic studies despite their importance when available often reveal to be insufficient to the purpose of "indoor air quality" because of several reasons: long term effects (at the rate of life long effects, especially with children), synergistic effects of several pollutants or "behavioural symptoms" (headaches or nausea cannot be considered in animal testing or appear to be subjective in epidemiological studies) are rarely taken in account. The examples of asbestos, dental amalgams, tobacco smoke or formaldehyde (which has been declared carcinogen in 2004) reveal the large delays in time between the use and the acknowledge of toxicological data.

      Statistical data constitute the acquisition of "normal values" resulting from a large effective of investigated habitations and thus allow to identify the level of a contamination which is superior to a normal "indoor"-concentration of a defined chemical, physical or microbiological parameter (for example a 95-percentile or a 50-percentile). This is the proceeding way for the interpretation of many clinical parameters considering a "normal" population (blood levels of cholesterol, of selenium, …)

      The "Environmental Ambulances" operating in different European countries and represented at the congress in Luxemburg (Austria, Germany, Netherlands, Switzerland, Portugal, Luxemburg, …) are actually using orientation values basing on statistical evaluation of the data resulting from several thousand investigations. However these orientation values are "updated" with the information resulting from toxicological or epidemiological data if available, so that these guidelines constitute a dynamic model.
    5. recommendations, measures to reduce the exposition, materials to avoid
    6. controls to be done
      The control of the measures realised to reduce the contamination are necessary for two reasons: first, for the verification of the diagnosis and the measures proposed by the expert and second the control of the contamination level permits the follow up of the patients symptoms and thus the link between the pollutants on the one side and the symptoms of the patients on the other side.

      Thus for example a standardized control measure twelve month after the execution of the recommendations to reduce the pollution would allow the sampling under the same conditions than the initial measures (heating period or summer, ..) Since these control measures are primordial to improve the quality of work of the investigating experts and the medical doctors taking care of the patients more than for the patients themselves, a way to finance these analyses and measures must be elaborated.
    7. Centralisation of data
      The necessary structures to centralize the data generated by the multidisciplinary work must be defined and created in every member state in order to favorize the accumulation of data and by that a continuous exchange and a common evaluation of the acquired experience in the different member states. Finally a communication platform gathering all the structures and services involved in "indoor air quality" and in "environmental medicine" in required.
    8. formation and continuous formation
      A specific education and a continuous training of the investigation experts are required to guarantee the scientific approach of the indoor air investigations. Therefore, the congresses, conferences and meetings that are already organised and held in different member states should be open and accessible to all the experts of the different member states (problem of language barrier).
    9. Quality of chemical and mycological analyses
      The mycological and chemical laboratories should be included into regular comparison tests (Ring tests) in order to assure the comparability of their results (such comparison tests are already being realised in different member states).

      This standardization proposal has been worked out during the Luxemburg conference by "indoor air quality" investigation experts who dispose of a certain experience from the "field". The aim of the standard is to take into account a maximum of potential pollutants susceptibles to induce health problems to the inhabitants. It is evident that a standardisation of the indoor air investigation is very complex and takes a long time to be realised. For that reason such a standard is to be considered as an orientation tool.

      On the other side, the knowledge and the use about different pollutants and the replacement of some pollutants by other pollutants are constantly evolving. The standard should therefore be constantly adapted and reviewed constituting a dynamic instrument designated to help the indoor air investigation experts in their daily work and to enrich the knowledge in environmental health.

      In order to finalize the objectives resulting from the conference in Luxemburg, the implementation of a "European Expert Group for Indoor Air Investigation for chemical, physical and microbiological agents has been decided.
    10. The main objective will be the improvement of the indoor air quality in Europe by:
      the dsescription of the indoor air quality in Europe

      a cooperation with medical doctors
      a harmonisation and standardization of investigation methods

    11. The first steps towards these objectives will be:

      the collection and comparison of acquired data and guidelines
      the translation of existing guidelines
      the organisation of an international conference "European Database Indoor Air Quality"