Letter to the editor: authors' response to Mr Light's letter to the editor.
Park-J-H; Schleiff-PL; Attfield-MD; Cox-Ganser-JM; Kreiss-K
Indoor Air 2006 Feb; 16(1):83-84
Mr Light raises two important issues that have impeded progress in indoor air quality research: (1) concern for the validity of self-reported symptoms and their temporal occurrence in the built environment and (2) approaches to exposure assessment for the purpose of establishing etiology or hazard. His letter provides an opportunity to clarify our perspective on these two issues. Symptoms are, by definition, subjective. For building- related respiratory disease, symptoms may correlate with 'objective' measurements of physiologic abnormalities. Indeed, we have shown in a subsequent investigation of a damp building population that twothirds of persons meeting a symptom-based case definition of respiratory disease identical to that used in our paper (Park et al., 2004) had either objective abnormalities of reversible airflow obstruction or airways hyper-reactivity or were on prescription medication that can normalize these objective measures (Cox-Ganser et al., 2005). A substantial epidemiologic literature supports the use of a constellation of respiratory symptoms as a health outcome measure because of the correlation between wheezing or physician diagnosis of asthma and abnormal airways hyper-reactivity (Burney et al., 1989; Venables et al., 1993). We did not pursue objective testing in our study because our medical record review substantiated serious respiratory disease among subsets of college employees who had occupied damp campus buildings (Schleiff et al., 2002). Of concern to us was possible misdiagnosis of asthma in six of seven medical records which had abnormalities of interstitial lung disease compatible with hypersensitivity pneumonitis, a rare disease which is a sentinel for building-related respiratory disease among other possible diseases.
Air-quality-monitoring; Air-quality-measurement; Air-quality-control; Air-quality; Exposure-assessment; Environmental-factors; Etiology; Occupational-health; Public-health; Dusts; Dust-particles; Airborne-particles; Airborne-dusts
National Institute for Occupational Safety and Health, Division of Respiratory Disease Studies, 1095 Willowdale Road, Morgantown, WV 26506
Disease and Injury: Asthma and Chronic Obstructive Pulmonary Disease