Experimental PVC material challenge in subjects with occupational PVC exposure.

BACKGROUND: Polyvinyl chloride (PVC) materials have been linked to asthma in several epidemiologic studies, but the possible causal factors remain unknown. PARTICIPANTS: We challenged 10 subjects experimentally to degraded PVC products under controlled conditions. All of the subjects had previously experienced respiratory symptoms suspected to be caused by this kind of exposure in their work place. Five subjects had doctor-diagnosed asthma. METHODS: The subjects were exposed to degraded PVC material in an exposure chamber ; a challenge with ceramic tile was used as the control test. We followed exhaled nitric oxide, nasal NO, lung functions, cytokines [tumor necrosis factor-alpha (TNF-alpha) , interleukin-4 (IL-4) , IL-6, and IL-12] and NO in nasal lavage fluid (NAL) during and after the exposures. We also measured 2-ethylhexanol in exhaled breath samples and NAL. RESULTS: On the morning after the PVC exposure, subjects reported respiratory tract symptoms significantly more often than they did after the control test (50% vs. 0%, respectively ; p = 0.029 ; n = 10) . We did not detect any changes in lung functions or levels of exhaled NO, nasal NO, or NO in NAL after PVC challenge compared with the control test. Cytokine levels increased after both exposures, with no statistically significant difference between situations. All of the exhaled breath samples collected during the PVC exposure contained 2-ethylhexanol. CONCLUSIONS: PVC flooring challenge can evoke respiratory tract symptoms in exposed subjects. Our results do not support the hypothesis that PVC materials themselves evoke immediate asthmatic reactions. The chamber test used is well suited to this type of exposure study.

Indoor air quality and health problems associated with damp floor coverings.

OBJECTIVES: To study the relationship between a high incidence of bronchial asthma among employees working in an office building and an indoor air problem related to the degradation of polyvinyl chloride (PVC) floor coverings in the building. The indoor air measurements and results of renovations are also described. METHODS: Employees' symptoms were surveyed by a questionnaire, and the incidence of asthma was calculated from the medical records for 1997-2000. The quality of indoor air was assessed by microbial sampling and by investigation of the building for possible moisture damage. Indoor air was sampled for volatile organic compounds (VOCs) through Tenax adsorbent tubes. In situ volatile emission measurements from the concrete floor were performed via the field and laboratory emission cell (FLEC) method. RESULTS: In an office with approximately 150 employees, eight new cases of asthma were found in 4 years. In addition, the workers complained of respiratory, conjunctival and nasal symptoms. Emissions indicating the degradation of plastic floor coverings (e.g. 2-ethyl-1-hexanol, 1-butanol) were found in the indoor air and floor material samples. The plastic floor coverings, adhesives and the levelling layers were carefully removed from 12 rooms. The VOCs had diffused into the underlying concrete slabs. The concrete was warmed to remove the diffused VOCs from these areas. After the repairs the concentrations of the VOCs indicating the degradation of PVC, decreased, as did the prevalence of the employees' symptoms and several asthma patients' need for medication. CONCLUSIONS: The workers in the office building complained of several respiratory, conjunctival and dermal symptoms. The incidence of adult-onset asthma was approximately nine-times higher than that among Finns employed in similar work. The most probable single cause of the indoor air problem was the degradation of the plastic floor coverings.