Rakennuksen sisäilma ja kosteusvaurio : miten paljon vaaraa terveydelle?

Lääkärin yksi keskeinen tehtävä sisäilmasto-ongelmissa on arvioida sisäilman laadun terveydellistä merkitystä rakennuksen käyttäjien ja joskus myös yksittäisen potilaan kannalta. Sisäilmasto-ongelmia arvioitaessa korostuvat kosteusvauriot, koska niihin liittyy lisääntynyt astmariski. On kuitenkin tärkeää huomioida kaikki altisteet ja muut tilanteeseen vaikuttavat tekijät. Terveysvaaran arvioinnin edellytyksenä on perusteellinen, rakennusteknisiin ja tarvittaessa muihin selvityksiin perustuva altistumisen kartoitus. Kosteusvaurioissa yksittäisillä mikrobimittauksilla ei ole juurikaan käyttöarvoa ilman kokonaistilanteen selvittämistä. Sisäilman terveydellisen merkityksen arviointiin tarvitaan yhteisesti sovittuja pelisääntöjä rationaalisen toiminnan ja rakennuksen käyttäjien tasavertaisen kohtelun takaamiseksi

Letter to the Study by Hyvonen et al. on Moisture Damage and MCS

Due to the significant methodological problems in the empirical part of the paper and the very selective literature review, the conclusions of the paper are mostly unsupported.Non peer reviewe

Subfreezing air as a cough trigger and multiple triggers are strongly associated with the presence of asthma in chronic cough

Background: Management of chronic cough relies on the recognition of cough background disorders. It is not known whether certain cough triggers are associated with specific background disorders. Methods: This was an e-mail study to public service employees of two towns in Finland. The questionnaire included twelve triggers. Current asthma was defined as doctor's diagnosis of asthma and current wheezing. Chronic rhinosinusitis was defined as either nasal blockage or nasal discharge and either facial pain/pressure or reduction/loss of smell for more than three months. Gastroesophageal reflux disease was defined as heartburn and/or regurgitation on at least one day a week during the last three months. Idiopathic cough was defined as absence of any of them. Results: There were 421 subjects with current cough that had lasted at least eight weeks. Subfreezing air as a cough trigger was associated with an adjusted odds ratio (aOR) of 7.27 (4.09-12.9), (p <0.001), for current asthma. The number of cough triggers was largest in asthma, followed by chronic rhinosinusitis, gastro-esophageal reflux, and idiopathic cough (7.05 (6.14-7.96), 4.94 (4.35-5.54), 4.60 (3.77-5.43), and 3.44 (3.02-3.86), respectively, p <0.001). Presence of five or more triggers was associated with an aOR of 7.49 (3.96-14.2), (p <0.001) for current asthma. Absence of any cough triggers increased the probability of idiopathic cough (aOR 2.71 (1.54-4.77), p= 0.001). Conclusions: Subfreezing air as a cough trigger and multiple triggers are strongly associated with the presence of current asthma in chronic cough. Absence of any cough triggers increases the probability of idiopathic cough.Peer reviewe

Persistence of chronic cough in a community-based population

Chronic cough causes significant impairment in the quality of life and is often immune to treatment. Previous studies about its persistence have focused on patients managed in special cough clinics. Little is known about the persistence of chronic cough in unselected populations. In this prospective follow-up study, we investigated factors that predict the persistence of cough at 12-month follow-up in a community-based study of subjects with chronic cough. The first e-mail survey in 2017 included a questionnaire about current cough and its risk factors. The 264 subjects who reported chronic cough were sent a follow-up questionnaire 12 months later. The response rate was 77.7% (205 subjects), of whom 165 subjects (80.5%) still had cough in 2018. In multivariate analysis, the following baseline factors predicted the persistence of cough at 12 months; gastro-oesophageal reflux disease (adjusted OR (aOR) 5.02 (95% CI 1.10-22.83)), presence of a chemical trigger (aOR 2.88 (95% CI (1.20-7.00)), duration of cough more than 1 year (aOR 2.80 (95% CI 1.27-6.22)), frequent somatic symptoms (aOR 1.31 (95% CI 1.07-1.59)), and low number of family members (aOR 0.71 (95% CI 0.52-0.98)). In conclusion, most patients with chronic cough still suffer from cough 1 year later. The presence of gastro-oesophageal reflux disease is the main predictor for the persistence of cough.Peer reviewe

Defining the risk factors for acute, subacute and chronic cough: a cross-sectional study in a Finnish adult employee population

Objectives Chronic cough is linked to various long-standing risk factors like asthma, chronic rhinitis and oesophageal reflux disease. On the contrary, acute and subacute cough are usually considered to be caused by acute respiratory infections. Little is known about the possible long-standing risk factors for acute and subacute cough. In this study, we have identified the long-standing risk factors for acute, subacute and chronic cough in order to identify the risk factors specifically associated with chronic cough.Design A comprehensive 80-item questionnaire was sent via email to the participants.Setting A community-based study to all public service employees of two towns in central Finland.Participants There were 13 980 employees, of them 3697 responded (26.4%). Among the responders, there were 199 subjects with current daily acute cough (duration &lt;3 weeks, prevalence 5.4%), 126 subjects with current daily subacute cough (duration 3–8 weeks, prevalence 3.4%) and 267 subjects with current daily chronic cough (duration &gt;8 weeks, prevalence 7.2%).Primary outcome measures The risk factors that associated with each cough subtype. The subjects without any cough formed the reference group.Results Several risk factors were associated with both short and long cough subtypes namely family history of chronic cough, moisture damage exposure and number of reported somatic symptoms. Furthermore, allergy was associated with acute and subacute cough. Current asthma and chronic rhinitis were associated with subacute and chronic cough. Oesophageal reflux disease and advanced age were associated with chronic cough.Conclusions The specific risk factors for chronic cough were oesophageal reflux disease and advanced age. Acute and subacute cough should not be regarded merely as symptoms of acute respiratory infections but possible manifestations of long-standing risk factors. A new risk factor for all cough types was family history of chronic cough.Peer reviewe

Rakennusten kosteus- ja homevauriot ja terveys

Julkaistaan uudelleen Aikakausikirjan luvall

Terve ihminen terveissä tiloissa : Kansallinen sisäilma ja terveys -ohjelma 2018 - 2028

Puhdas ja raikas sisäilma edistää terveyttä ja hyvinvointia. Sisäilmassa voi esiintyä monia erilaisia epäpuhtauksia, jotka voivat aiheuttaa oireita ja heikentää viihtyvyyttä. Jotkut yksittäiset altisteet lisäävät myös pysyvän sairastumisen riskiä. Sisäilmaan liittyvät ongelmat ovat hyvin laaja kokonaisuus ja kehittämistä tarvitaan useilla eri osa-alueilla. llmiön laajuuden, ihmisten tiedon ja avun tarpeen ja julkistaloudellisten kustannusvaikutusten vuoksi on herännyt tarve etsiä uusia, tutkittuun tietoon perustuvia keinoja, näkökulmia ja ratkaisuja. Kansallisen sisäilma ja terveys -ohjelman päätavoite on vähentää sisäympäristöön liittyviä terveys- ja hyvinvointihaittoja Suomessa. Ohjelma koostuu neljästä osaalueesta, joiden tavoitteena on 1) lisätä ymmärrystä sisäympäristöjen terveys- ja hyvinvointivaikutuksista, 2) kehittää sisäympäristöön liittyvien ongelmien hallintaa, 3) parantaa sisäympäristöissä oireilevien ja sairaiden hoitoa sekä työ- ja toimintakykyä sekä 4) vahvistaa toimijoiden osaamista sisäympäristöasioissa. Raportti on tarkoitettu sisäilmaan liittyvien ongelmien parissa työskenteleville, kuten viranomaisille, järjestöille ja terveydenhuollolle, sekä kaikille, joita sisäilmaongelmat läheisesti koskettavat