Nonspecific Building Related Illnesses / 대한산업의학회지

Nonspecific building related illnesses (NBRI) are an array of diverse symptoms related to working in particular buildings. There are numerous contributing factors, including basic factors (temperature, humidity and ventilation) as well as chemicals, dust, microorganisms, and psychosocial factors. At the individual level, taking a careful history is the essential first step. After ruling out other diseases, clinicians can start the symptomatic treatment for NBRI. If a relationship to the building is suspected, a walk through evaluation is very helpful. At the group level, standardized questionnaires and investigations of the building environment can be applied simultaneously. If the prevalence of symptoms are greater than that of general population, appropriate interventions have to be provided for prevention and group health care. In both approaches, it is essential to periodically follow up with symptomatic patients and work environments after an intervention. For the management of NBRI, taking care of the patient's symptoms and maintaining a good indoor environment are important. To achieve this goal, cooperation among workers, building managers, employers and occupational health staff is crucial.

Sick building syndrome.

Sick building syndrome describes a number of mostly unspesific complaints of some occupants of the building. The exact pathophysiological mechanism remains elusive. It is a multi factorial event which may include physical, chemical, biological as well as psycological factors. In many cases it is due to insufficient maintenance of the HVAC (heating, ventilation, air conditioning) system in the building. Sign and symptoms can be uncomfortable and even disabling, which may include mucus membrane irritation, neurotoxic symptoms, asthma like symptoms, skin complaints, gastrointestinal symptoms and other related symptoms. There are various investigation methods to diagnose sick building syndrome, and on site assessment of the building is extremely useful. Prevention through a proactive air quality monitoring program is far more desirable than dealing with an actual sick building. Indoor air and the sick building symdrome serves as a paradigm of modern occupational and environmental medicine.

Building-related Illnesses

Building-related illness is an increasingly common problem. The disease fall into two categories : those that have an identifiable cause-such as legionellosis, humidifier fever, and conditions resulting from exposure to known substances such as asbestos, lead in paint, formaldehyde, etc-and those that have no readily identifiable cause but can be described only by a group of symptoms known as sick building syndrome (SBS). Although objective physiologic abnormalities are generally not found and permanent sequelae are rare, the symptoms of SBS can be uncomfortable, even disabling, and whole workplaces may be rendered non-functional. In assessment of patients with SBS complaints, specific building-related illnesses should be ruled out by history or physical examination. On-site assessment of buildings is extremely useful. Symptoms of non-specific building-related illnesses are common ; their heterogeneity suggests that they do not represent a single disorder. Although there is little convincing, direct evidence to implicate specific causative agents, there is sufficient indirect evidence to support a number of recommendations. For example, it seems prudent to maintain an outdoor-air supply of more than 10 liters per second per person ; to select the building materials, furnishings, and equipments that are least likely to release pollutants such as formaldehyde or volatile organic compounds ; to ensure proper maintenance and cleaning ; and to avoid materials that may act as substrates for the proliferation of microbes or dust mites.