During the last two decades there has been increasing concern within the scientific community over the effects of indoor air quality on health. Changes in building design devised to improve energy efficiency have meant that modern homes and offices are frequently more airtight than older structures. Furthermore, advances in construction technology have caused a much greater use of synthetic building materials. Whilst these improvements have led to more comfortable buildings with lower running costs, they also provide indoor environments in which contaminants are readily produced and may build up to much higher concentrations than are found outside. This article reviews our current understanding of the relationship between indoor air pollution and health. Indoor pollutants can emanate from a range of sources. The health impacts from indoor exposure to combustion products from heating, cooking, and the smoking of tobacco are examined. Also discussed are the symptoms associated with pollutants emitted from building materials. Of particular importance might be substances known as volatile organic compounds (VOCs), which arise from sources including paints, varnishes, solvents, and preservatives. Furthermore, if the structure of a building begins to deteriorate, exposure to asbestos may be an important risk factor for the chronic respiratory disease mesothelioma. The health effects of inhaled biological particles can be significant, as a large variety of biological materials are present in indoor environments. Their role in inducing illness through immune mechanisms, infectious processes, and direct toxicity is considered. Outdoor sources can be the main contributors to indoor concentrations of some contaminants. Of particular significance is Radon, the radioactive gas that arises from outside, yet only presents a serious health risk when found inside buildings. Radon and its decay products are now recognised as important indoor pollutants, and their effects are explored. This review also considers the phenomenon that has become known as Sick Building Syndrome (SBS), where the occupants of certain affected buildings repeatedly describe a complex range of vague and often subjective health complaints. These are often attributed to poor air quality. However, many cases of SBS provide a valuable insight into the problems faced by investigators attempting to establish causality. We know much less about the health risks from indoor air pollution than we do about those attributable to the contamination of outdoor air. This imbalance must be redressed by the provision of adequate funding, and the development of a strong commitment to action within both the public and private sectors. It is clear that meeting the challenges and resolving the uncertainties associated with air quality problems in the indoor environment will be a considerable undertaking. (C) 1999 Elsevier Science Ltd. All rights reserved.
