Building-related lung diseases

Building-related diseases are a heterogeneous group of diseases whose causes are related to the environment of modern airtight buildings. Such buildings are characterized by sealed windows and a reliance on heating, ventilation, and air conditioning systems for air exchange. Most cases occur in non-industrial office buildings, but can occur in multi-family residential buildings, single-family homes, schools, museums, and libraries.

Building-related lung diseases can be specific and non-specific.

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Building-related specific diseases

Specific building-related diseases are those for which a relationship between exposure factors in the home and the disease has been demonstrated. Examples include Legionella infection, occupational asthma, hypersensitivity pneumonitis and inhalation fever.

Inhalational fever is a febrile reaction caused by exposure to organic aerosols or dusts. Names used to describe this type of illness include humidifier fever, grain fever, and mycotoxicosis. Metal dusts and polymer fumes can also cause febrile illness. The term "toxic organic dust syndrome" (TODS) has been used to describe the reaction to any organic dust, although the term "toxic pneumonitis" is also in common use.

In nonindustrial buildings, an illness called humidifier fever occurs as a consequence of humidifiers or other types of ventilation that serve as a reservoir for the growth of microorganisms (bacteria, fungi) and a means of aerosolizing these pollutants. The illness usually presents with low-grade fever, malaise, cough, and shortness of breath. Improvement with limitation of exposure (eg, a weekend away from the building) is often one of the first indications of the etiology. The condition has an acute onset and lasts for a certain period of time (usually 2-3 days). Physical manifestations may be absent or mild. Clusters of illness are common. Unlike immune-mediated conditions such as hypersensitivity pneumonitis and building-associated asthma, inhalational fevers have no sensitization period. The illness may occur upon first exposure. Acute episodes usually require no treatment other than removal from the contaminated environment and antipyretics. If symptoms persist, further investigation should be directed at ruling out infection, hypersensitivity pneumonitis, or other conditions. Identification of the causative agent (detection of airborne microbes in the environment) can be expensive and time-consuming, but is necessary in some cases to identify the source of contaminated air. Inhalational fevers of all types are usually prevented by good maintenance of ventilation systems.

Non-specific building-related diseases

Non-specific building-related illnesses are those for which the association between the illness and exposure to building conditions is more difficult to prove. The term sick building syndrome has been used to describe illnesses that occur in clusters within a building, the symptoms of which are often vague, including itching, irritation, dryness, or watery eyes; runny nose or nasal congestion; sore throat or tightness; dry itchy skin or unexplained skin rashes; and headache, drowsiness, and difficulty concentrating.

In some cases, certain building-related factors seem to explain the symptoms; these include higher building temperatures, higher humidity, and poor ventilation, usually with an inability to provide sufficient fresh air. But patient characteristics, including female gender, a history of atopy, hyperattention to sensations, preoccupation with existing sensations, anxiety, depression, and sometimes mass hysteria, may also underlie the disorder.