Book Review

Indoor Air Pollution: Problems and Priorities

N Engl J Med 1993; 328:895March 25, 1993

Article

Indoor Air Pollution: Problems and Priorities
Edited by G.B. Leslie and F.W. Lunau. 329 pp., illustrated. New York, Cambridge University Press, 1992. $79.95. ISBN: 0-521-38510-5

According to the introduction, this book is aimed at the informed nonspecialist who has to deal with questions of indoor air pollution. We certainly qualify as nonspecialists in the field, and we have judged the book by its clarity in explaining this complex area.

In Europe and the United States, more than 70 percent of people's time is spent indoors, where they can be exposed to a variety of potentially harmful substances. Some such substances enter from the outdoor environment (as in the case of grass pollen). As outdoor air in most “advanced” countries has become less polluted, however, indoor sources of air contamination have become more important. This is particularly true because room-air exchange rates have tended to decline with the need to conserve energy.

The increasing use of recycled, air-conditioned air in the workplace has led to problems of contamination of indoor air with microorganisms. Representative examples are legionnaires' disease and Pontiac fever, discussed with admirable clarity in chapter 3. However, the biocides often used to control legionella in water pipes and tanks can themselves be sources of irritation if they accumulate in indoor air. Potentially toxic agents that can be present in indoor air include fungal spores, organic chemicals (from paints, lacquers, wood preservatives, or insulating foam, for example), oxides of nitrogen (from the combustion of organic materials, including cigarettes), dust fibers, and mineral fibers.

The first and last chapters of the book deal with the question of what is an acceptable atmosphere. Despite the development of complex assays and mathematical equations to try to arrive at standards, it seems that subjective assessment (Does a significant percentage of people find the atmosphere unpleasant?) is still the best measure.

The other chapters deal in detail with potential pollutants; the extent of their coverage is variable, but it is generally complete. What seemed to vary more among chapters was the degree of critical analysis applied to findings reported in the literature. Thus, chapter 4 gives an excellent account of extrinsic allergic alveolitis, humidifier fever, asthma, allergic rhinitis, and sick building syndrome but is characterized by a lack of skepticism about the many and varied health effects that have been attributed to sick building syndrome. By contrast, chapter 12 on environmental tobacco smoke attempts the formidable task of formulating a health-risk evaluation for environmental tocacco smoke on the basis of dosimetry, a goal probably not attainable given the lack of hard data. This chapter was intensely critical of many of the studies claiming to show harmful health effects of exposure to environmental tobacco smoke.

Overall, we found the book a useful compilation of information. In addition to chapter 3, we particularly enjoyed chapter 5 (on oxides of nitrogen), chapter 6 (on asbestos, containing an interesting discussion of the relative merits of removing asbestos from buildings and leaving it in place), chapter 7 (on radon, with an excellent account of the potential health risks of radon and radon daughters), and chapter 8 (on formaldehyde).

As with all multiauthored works, there were problems of overlap between chapters, unevenness in the depth of treatment, and lack of citation of very recent literature, as well as illogical ordering of chapters. For example, chapter 13 discusses general principles for the control of air quality in the industrial environment, but it comes well after chapter 9, which is a collection of data on a multitude of different organic solvents and pesticides. In chapter 14, the author gives a good explanation of the production of extremely-low-frequency electromagnetic radiation by electrical power sources but provides few good data to review concerning the health effects of such electromagnetic fields.

Another criticism regards the appearance of the book. The cover looks good, but the text and diagrams are uninspiringly presented. The index is scanty. All except one of the authors is from the United Kingdom, and most of the references to legislation refer only to the United Kingdom.

Despite these criticisms, the book is a useful summary of current knowledge about almost all aspects of indoor air pollution, and we recommend it.

Barry Halliwell, D.Sc.
Carroll E. Cross, M.D.
University of California, Davis, Medical Center, Sacramento, CA 95817