Skip to main content

Noninvasive Health Assessment Methods in Sick Building Syndrome

  • Chapter
  • First Online:
Sick Building Syndrome

Abstract

One of the major goals in studying sick building syndrome is to demonstrate relationships between building related exposures and health outcomes, especially airways inflammation. Due to the nature of these diseases, accurate, practical, and objective diagnostic measurement techniques are needed in field investigations. Pulmonary function tests, such as spirometry, are important objective techniques. However, they reflect the functional changes of the lung in relatively late and probably irreversible stages. Direct monitoring of airways inflammations in response to building related exposures, are receiving increased attention since they may pick up inflammatory changes before the injury becomes irreversible. Invasive approaches such as bronchoalveolar lavage and bronchial biopsies have been used to assess airways inflammation. These methods however, are not practical for use in field investigations. Thus, much work has been focused on the development of noninvasive methods for monitoring inflammation in building related health problems. The recent most commonly used noninvasive techniques in field investigations are exhaled nitric oxide, nasal nitric oxide, induced sputum, exhaled breath condensate, and nasal lavage. This chapter will discuss the practical application of these methods in sick building syndrome as well as technical details and validity.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abbritti G, Muzi G (2006) Indoor air quality and health in offices and other non-industrial working environments. La Medicina Del Lavoro 97:410–417.

    Google Scholar 

  • Akpinar-Elci M, Siegel PD, Cox-Ganser JM, Stemple KJ, White SK, Hilsbos K, Weissman DN (2008) Respiratory inflammatory responses among occupants of a water-damaged office building. Indoor Air 18:125–130.

    Article  Google Scholar 

  • Akpinar-Elci M, Siegel PD, Enright PL, White SK, Dye A, Park JH, Kreiss K, Cox-Ganser JM (2007a) Symptoms associated with objective indices of upper airway inflammation in occupants of a water-damaged building. Presented at the World Asthma Meeting, June, Istanbul, Turkey.

    Google Scholar 

  • Akpinar-Elci M, Stemple KJ, Enright PL, Fahy JV, Bledsoe TA, Kreiss K, Weissman DN (2005) Induced sputum evaluation in microwave popcorn production workers. Chest 128:991–997.

    Article  Google Scholar 

  • Akpinar-Elci M, Weikart D, Abrokwah M, Elci O (2009) Are we missing an important clue?” United airways disease” among farmers. Am J Respir Crit Care Med 179:A1658.

    Google Scholar 

  • Akpinar-Elci M, Yucesoy B, Elci OC, Weissman DN (2007b) Noninvasive assessment of cytokines in occupational respiratory diseases. Recent Pat Inflamm Allergy Drug Discov 1:100–107.

    Article  Google Scholar 

  • Anderson SD, Brannan JD (2003) Methods for “indirect” challenge tests including exercise, eucapnic voluntary hyperpnea, and hypertonic aerosols. Clin Rev Allergy Immunol 24:27–54.

    Article  Google Scholar 

  • Anon (1998) Respiratory health hazards in agriculture. Am J Respir Crit Care Med 158:S1–S76.

    Google Scholar 

  • Anon (2003) NIOSH Heath hazard evaluation and technical assistance report. Somerset County Assistance Office, Somerset, Pennsylvania. US Department of Health and Human Services, Public Health Service, Center for Disease Control, National Institute for Occupational Safety and Health, NIOSH Report No: HETA 2001-0067–2896

    Google Scholar 

  • Anon (2005) ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 171:912–930.

    Article  Google Scholar 

  • Asada M, Yamaya M, Ebihara S, Yasuda H, Tomita N, Kubo H, Sasaki H (2005) Interleukin-1beta gene polymorphisms associated with COPD. Chest 128:1072–1073.

    Article  Google Scholar 

  • Bakke JV, Wieslander G, Norbäck D, Moen BE (2008) Atopy, symptoms and indoor environmental perceptions, tear film stability, nasal patency and lavage biomarkers in university staff. Int Arch Occup Environ Health 81:861–872.

    Article  Google Scholar 

  • Baraldi E, Ghiro L, Piovan V, Carraro S, Zacchello F, Zanconato S (2003) Safety and success of exhaled breath condensate collection in asthma. Arch Dis Child 88:358–360.

    Article  Google Scholar 

  • Barnes PJ, Chowdhury B, Kharitonov SA, Magnussen H, Page CP, Postma D, Saetta M (2006) Pulmonary biomarkers in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 174:6–14.

    Article  Google Scholar 

  • Barnes PJ, Chung KF, Page CP (1998) Inflammatory mediators of asthma: an update. Pharmacol Rev 50:515–596.

    Google Scholar 

  • Bellanti JA, Wallerstedt DB (2000) Allergic rhinitis update: epidemiology and natural history. Allergy Asthma Proc 21:367–370.

    Article  Google Scholar 

  • Bousquet J, Vignola AM, Demoly P (2003) Links between rhinitis and asthma. Allergy 58:691–706.

    Article  Google Scholar 

  • Bucchioni E, Kharitonov SA, Allegra L, Barnes PJ (2003) High levels of interleukin-6 in the exhaled breath condensate of patients with COPD. Respir Med 97:1299–1302.

    Article  Google Scholar 

  • Deutschle T, Friemel E, Starnecker K, Riechelmann H (2005) Nasal cytologies-impact of sampling method, repeated sampling and interobserver variability. Rhinology 43:215–220.

    Google Scholar 

  • Ebbehøj NE, Meyer HW, Würtz H, Suadicani P, Valbjørn O, Sigsgaard T, Gyntelberg F (2005) Molds in floor dust, building-related symptoms, and lung function among male and female schoolteachers. Indoor Air 15:7–16.

    Article  Google Scholar 

  • Effros RM, Dunning MB, Biller J, Shaker R (2004) The promise and perils of exhaled breath condensates. Am J Physiol Lung Cell Mol Physiol 287:1073–1080.

    Article  Google Scholar 

  • Fireman E, Greif J, Schwarz Y, Man A, Ganor E, Ribak Y, Lerman Y (1999) Assessment of hazardous dust exposure by BAL and induced sputum. Chest 115:1720–1728.

    Article  Google Scholar 

  • Hellgren J, Eriksson C, Karlsson G, Hagberg S, Olin AC, Torén K (2001) Nasal symptoms among workers exposed to soft paper dust. Int Arch Occup Environ Health 74:129–132.

    Article  Google Scholar 

  • Hirvonen MR, Ruotsalainen M, Roponen M, Hyvärinen A, Husman T, Kosma VM, Komulainen H, Savolainen K, Nevalainen A (1999) Nitric oxide and proinflammatory cytokines in nasal lavage fluid associated with symptoms and exposure to moldy building microbes. Am J Respir Crit Care Med 160:1943–1946.

    Google Scholar 

  • Holz O, Richter K, Jörres RA, Speckin P, Mücke M, Magnussen H (1998) Changes in sputum composition between two inductions performed on consecutive days. Thorax 53:83–86.

    Article  Google Scholar 

  • Horváth I, Hunt J, Barnes PJ, Alving K, Antczak A, Baraldi E, Becher G, et al (2005) Exhaled breath condensate: methodological recommendations and unresolved questions. Eur Respir J 26:523–548.

    Article  Google Scholar 

  • Howard TD, Whittaker PA, Zaiman AL, Koppelman GH, Xu J, Hanley MT, Meyers DA, et al (2001) Identification and association of polymorphisms in the interleukin-13 gene with asthma and atopy in a dutch population. Am J Respir Cell Mol Biol 25:377–384.

    Google Scholar 

  • Hunt J (2002) Exhaled breath condensate: an evolving tool for noninvasive evaluation of lung disease. J Allergy and Clin Immunol 110:28–34.

    Article  Google Scholar 

  • Jang AS, Choi IS (1999) Nitric oxide metabolites in patients with asthma: induced sputum versus blood. Respir Med 93:912–918.

    Article  Google Scholar 

  • Joos GF, O’Connor B, Anderson SD, Chung F, Cockcroft DW, Dahlén B, DiMaria G, et al (2003) Indirect airway challenges. Eur Respir J: Official J Eur Soc Clin Respir Physiol 21:1050–1068.

    Google Scholar 

  • Kelly MM, Keatings V, Leigh R, Peterson C, Shute J, Venge P, Djukanović R (2002) Analysis of fluid-phase mediators. Eur Respir J 37:24s–39s.

    Google Scholar 

  • Kolarik B, Lagercrantz L, Sundell J (2009) Nitric oxide in exhaled and aspirated nasal air as an objective measure of human response to indoor air pollution. Indoor Air 19:145–152.

    Article  Google Scholar 

  • Koren HS, Graham DE, Devlin RB (1992) Exposure of humans to a volatile organic mixture. III. Inflammatory response. Arch Environ Health 47:39–44.

    Article  Google Scholar 

  • Laumbach RJ, Kipen HM (2005) Bioaerosols and sick building syndrome: particles, inflammation, and allergy. Curr Opin Allergy and Clin Immunol 5:135–139.

    Article  Google Scholar 

  • Lemiere C (2006) Diagnosing occupational asthma: insight from induced sputum. Can J Physiol Pharmacol 84:1–4.

    Article  Google Scholar 

  • Lemière C (2002) Non-invasive assessment of airway inflammation in occupational lung diseases. Curr Opin Allergy and Clin Immunol 2:109–114.

    Article  Google Scholar 

  • Lemière C, Chaboilliez S, Trudeau C, Taha R, Maghni K, Martin JG, Hamid Q (2000) Characterization of airway inflammation after repeated exposures to occupational agents. J Allergy Clin Immunol 106:1163–1170.

    Article  Google Scholar 

  • Lemière C, Pizzichini MM, Balkissoon R, Clelland L, Efthimiadis A, O’Shaughnessy D, Dolovich J, Hargreave FE (1999) Diagnosing occupational asthma: use of induced sputum. Eur Respir 13:482–488.

    Article  Google Scholar 

  • Li C-Q, Pang B, Kiziltepe T, Trudel LJ, Engelward BP, Dedon PC, Wogan GN (2006) Threshold effects of nitric oxide-induced toxicity and cellular responses in wild-type and p53-null human lymphoblastoid cells. Chem Res Toxicol 19:399–406.

    Article  Google Scholar 

  • Lignell U, Meklin T, Putus T, Vepsäläinen A, Roponen M, Torvinen E, Reeslev M, et al (2005) Microbial exposure, symptoms and inflammatory mediators in nasal lavage fluid of kitchen and clerical personnel in schools. Int J Occup Med Environ Health 18:139–150.

    Google Scholar 

  • Mutlu GM, Garey KW, Robbins RA, Danziger LH, Rubinstein I (2001) Collection and analysis of exhaled breath condensate in humans. Am J Respir Crit Care Med 164:731–737.

    Google Scholar 

  • Nguyen T, Brunson D, Crespi CL, Penman BW, Wishnok JS, Tannenbaum SR (1992) DNA damage and mutation in human cells exposed to nitric oxide in vitro. Proc Natl Acad Sci USA 89:3030–3034.

    Article  Google Scholar 

  • Norbäck D, Wålinder R, Wieslander G, Smedje G, Erwall C, Venge P (2000) Indoor air pollutants in schools: nasal patency and biomarkers in nasal lavage. Allergy 55:163–170.

    Article  Google Scholar 

  • Passalacqua G, Ciprandi G, Pasquali M, Guerra L, Canonica GW (2004) An update on the asthma-rhinitis link. Curr Opin Allergy Clin Immunol 4:177–183.

    Article  Google Scholar 

  • Petrick MM, Slavin RG (2003) Occupational rhinitis. Immunol Allergy Clin North Am 23:193–203.

    Article  Google Scholar 

  • Pizzichini E, Pizzichini MM, Efthimiadis A, Dolovich J, Hargreave FE (1997) Measuring airway inflammation in asthma: eosinophils and eosinophilic cationic protein in induced sputum compared with peripheral blood. J Allergy and Clin Immunol 99:539–544.

    Article  Google Scholar 

  • Purokivi M, Hirvonen M-R, Randell J, Roponen M, Meklin TM, Nevalainen AL, Husman TM, Tukiainen HO (2001) Changes in pro-inflammatory cytokines in association with exposure to moisture-damaged building microbes. Eur Respir J 18:951–958.

    Article  Google Scholar 

  • Purokivi M, Hirvonen M-R, Randell J, Roponen M, Tukiainen H (2002b) Nitric oxide alone is an insufficient biomarker of exposure to microbes in a moisture-damaged building. Inhal Toxicol 14:1279–1290.

    Article  Google Scholar 

  • Purokivi M, Hirvonen M-R, Roponen M, Randell J, Vahteristo M, Tukiainen H (2002a) Comparison of inflammatory elements in nasal lavage and induced sputum following occupational exposure to moldy-building microbes. Inhal Toxicol 14:653–662.

    Article  Google Scholar 

  • Quirce S, Lemière C, de Blay F, del Pozo V, Gerth Van Wijk R, Maestrelli P, Pauli G, et al (2010) Noninvasive methods for assessment of airway inflammation in occupational settings. Allergy 65:445–458.

    Article  Google Scholar 

  • Reed SD, Lee TA, McCrory DC (2004) The economic burden of allergic rhinitis: a critical evaluation of the literature. PharmacoEconomics 22:345–361.

    Article  Google Scholar 

  • Roponen M, Kiviranta J, Seuri M, Tukiainen H, Myllykangas-Luosujärvi R, Hirvonen MR (2001) Inflammatory mediators in nasal lavage, induced sputum and serum of employees with rheumatic and respiratory disorders. Eur Respir J 18:542–548.

    Article  Google Scholar 

  • Roponen M, Toivola M, Alm S, Nevalainen A, Jussila J, Hirvonen M-R (2003) Inflammatory and cytotoxic potential of the airborne particle material assessed by nasal lavage and cell exposure methods. Inhal Toxicol 15:23–38.

    Article  Google Scholar 

  • Rytilä PH, Lindqvist AE, Laitinen LA (2000) Safety of sputum induction in chronic obstructive pulmonary disease. Eur Respir J 15:1116–1119.

    Article  Google Scholar 

  • Sack U, Scheibe R, Wötzel M, Hammerschmidt S, Kuhn H, Emmrich F, Hoheisel G, Wirtz H, Gessner C (2006) Multiplex analysis of cytokines in exhaled breath condensate. Cytometry. Part A: The Journal of the International Society for Analytical Cytology 69:169–172.

    Article  Google Scholar 

  • Siracusa A, Desrosiers M, Marabini A (2000) Epidemiology of occupational rhinitis: prevalence, aetiology and determinants. Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology 30:1519–1534.

    Google Scholar 

  • Smith KR (2002) Indoor air pollution in developing countries: recommendations for research. Indoor Air 12:198–207.

    Article  Google Scholar 

  • Spengler JD, Samet JM, McCarthy JF (Eds.) (2001). Indoor air quality handbook. McGraw-Hill, New York, New York. 54.1–54.24.

    Google Scholar 

  • Stark H, Roponen M, Purokivi M, Randell J, Tukiainen H, Hirvonen M-R (2006) Aspergillus fumigatus challenge increases cytokine levels in nasal lavage fluid. Inhal Toxicol 18:1033–1039.

    Article  Google Scholar 

  • Vlachos-Mayer H, Leigh R, Sharon RF, Hussack P, Hargreave FE (2000) Success and safety of sputum induction in the clinical setting. Eur Respir J 16:997–1000.

    Article  Google Scholar 

  • Wieslander G, Norbäck D, Wålinder R, Erwall C, Venge P (1999) Inflammation markers in nasal lavage, and nasal symptoms in relation to relocation to a newly painted building: a longitudinal study. Int Arch of Occup Environ Health 72:507–515.

    Article  Google Scholar 

  • Wilcosky TC (1993) Biological markers of intermediate outcomes in studies of indoor air and other complex mixtures. Environ Health Perspect 101:193–197.

    Article  Google Scholar 

  • Wålinder R, Norbäck D, Wessen B, Venge P (2001a) Nasal lavage biomarkers: effects of water damage and microbial growth in an office building. Arch Environ Health 56:30–36.

    Article  Google Scholar 

  • Wålinder R, Norbäck D, Wieslander G, Smedje G, Erwall C, Venge P (1999) Nasal patency and lavage biomarkers in relation to settled dust and cleaning routines in schools. Scand J Work, Environ Health 25:137–143.

    Google Scholar 

  • Wålinder R, Norbäck D, Wieslander G, Smedje G, Erwall C, Venge P (2001b) Acoustic rhinometry and lavage biomarkers in relation to some building characteristics in swedish schools. Indoor Air 11:2–9.

    Article  Google Scholar 

  • Zhang J, Smith KR (2003) Indoor air pollution: a global health concern. Br Med Bull 68:209–225.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Muge Akpinar-Elci .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Berlin Heidelberg

About this chapter

Cite this chapter

Akpinar-Elci, M., Elci, O.C. (2011). Noninvasive Health Assessment Methods in Sick Building Syndrome. In: Abdul-Wahab, S. (eds) Sick Building Syndrome. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-17919-8_23

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-17919-8_23

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-17918-1

  • Online ISBN: 978-3-642-17919-8

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics