Recognizing and managing of health effects related to mold exposure and indoor moisture--guidance for clinicians.

From sinusitis to asthma and pneumonitis, serious illness as a result of poor indoor air quality has been well documented in recent years. Less clearly established are the specific causes of building-related illness and the measures required to prevent or ameliorate them.

For physicians and other health care providers faced with a rapidly growing number of patients troubled by indoor contaminants, there is a new primer to guide them: Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors. This resource was published by the Center for Indoor Environments and Health at the University of Connecticut Health Center with a grant from the U.S. Environmental Protection Agency.

"It's a manual for primary care physicians," said Eileen Storey, M.D., M.P.H., chief of the Division of Occupational and Environmental Medicine and one of the authors of the book. "We give them an approach to use with their patients. We help them identify patients and the illnesses or complaints that may be related to mold or other indoor contaminants. We give them assessment tools for those patients. We tell them how to counsel their worried-well patients and guide them to resources their patients can use to reduce moisture and mold in their homes."

For example, the book contains a questionnaire physicians can use to evaluate a patient when an environmental problem is suspected. It can be filled out by a patient in a few minutes and contains questions that help explore moisture and mold in the patient's home, school, or work environment. Any positive response may indicate uncontrolled moisture with a potential for biological growth and begins a helpful dialogue between patient and health care provider. The book provides a list of references to specific books or pamphlets that patients can use to eliminate problem moisture.

"We know that exposure to mold and other contaminants in indoor environments may adversely affect a person's health," said Paula Schenck, M.P.H., a co-author of the book. "We spend nearly 90 percent of our time indoors. Asthma has increased substantially in recent years, so we suspect the indoor environment plays a role. But not everyone is sensitized to indoor contaminants, and different people become sensitized in different ways." The book provides approaches for assessing indoor environments and gives physicians strategies to recognize environment-related clinical problems, said Schenck.

"Something is going on in our indoor environment that is making us sick," said Storey. "We see it in office workers. We see it in schoolteachers. Their illnesses range from chronic runny nose to sinusitis or more serious conditions like asthma and hypersensitivity pneumonitis. Their symptoms often diminish when they leave the workplace for the weekend or the summer, but we don't know what is actually causing their illness." In recent years, according to Storey, a tremendous amount of attention has focused on architecture, construction materials, and ventilation systems. "We use wallboard instead of plaster. We don't build with wood and bricks as much; instead we use steel and concrete. Modern materials don't shed water as well. When water comes into contact with wallboard and wall-to-wall carpeting, it can create a beautiful environment for growing mold."

Primary-care physicians are the point of contact. If a patient presents with persistent respiratory symptoms, physicians should inquire about the presence of chronic moisture in the home, workplace, or school. Storey said, "It's like tobacco. Thirty years ago, doctors did not think of tobacco as an issue for them in their practice. Now it's standard health care practice for physicians to ask their patients about tobacco use and provide counseling for it. We hope this book will do the same thing for indoor air quality. We want them to ask their patients about environmental issues that might be related to their illnesses and be able to provide counseling about them."

Besides Storey and Schenck, the authors of the book are Kenneth H. Dangman, M.D., Ph.D., M.P.H.; Robert L. De Bernardo, M.D., M.P.H.; Chin S. Yang, Ph.D.; Anne Bracker, C.I.H., M.P.H.; and Michael J. Hodgson, M.D., M.P.H.

The book presents illustrative case reports, briefly discusses fungal ecology, reviews current literature on health effects from mold and moisture, and outlines principles that underlie a professional environmental assessment. It is available free at the Web site of the University of Connecticut Center for Indoor Environments and Health, at www.oehc.uchc.edu/clinser/indoor.htm.