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Occupational and Environmental Lung Disease |

The Spectrum of Building-Related Airway Disorders*: Difficulty in Retrospectively Diagnosing Building-Related Asthma

Stuart M. Brooks, MD; Wil Spaul, PhD; James D. McCluskey, MD
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*From the Department of Environmental and Occupational Health (Drs. Spaul and Brooks), College of Public Health, and Department of Internal Medicine (Drs. Brooks and McCluskey), College Of Medicine, University of South Florida, Tampa, FL.

Correspondence to: Stuart M. Brooks, MD, University of South Florida, College of Public Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612; e-mail: sbrooks@hsc.usf.edu



Chest. 2005;128(3):1720-1727. doi:10.1378/chest.128.3.1720
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Introduction: The specific causes and mechanism(s) for asthma occurring among occupants of nonresidential buildings with poor indoor air quality are not known, but allergic and nonallergic processes are possible explanations

Methods: Repeated indoor air quality measurements were made while employees were working in a building where cigarette smoking was allowed. Seven of 19 employees who sought medical care from their private physicians because of respiratory complaints received a diagnosis of asthma. Subsequently, 19 symptomatic employees were examined at the University of South Florida (USF) 2 ± 0.8 months (mean ± SD) after removal from the building.

Results: The first floor of the building, where employee complaints were prevalent, was characterized by markedly reduced outdoor fresh air supply, diminished air circulation to the occupant spaces, and elevated airborne concentrations of formaldehyde. Nineteen workers examined at the USF 2 ± 0.8 months after leaving the building reported ear, nose, and throat irritation and asthma-like symptoms while working in the building. There was resolution of symptoms in most of the seven employees (37%) with asthma previously diagnosed by their private physician. In fact, 16 of 19 subjects (84%) reported resolution or significant improvement of symptoms. Among 11 persons with symptoms suggesting asthma while working in the building, 4 persons (21%) showed a negative provocative concentration of methacholine producing a 20% fall in FEV1, including two subjects with doctor-diagnosed asthma.

Conclusions: Confirmation of building-related asthma is influenced by time factors and the clinical criteria used for diagnosis. A nonallergic mechanism seems operative in our cases. While considered an example of occupational asthma, building-related asthma is a challenge for the practicing physician to confirm retrospectively.

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