Polluted air--outdoors and indoors.

Many air pollutants which are considered important in ambient (outdoor) air are also found, sometimes at higher levels, in indoor air. With demanding standards having been set for many of these pollutants, both in the workplace and ambient air, consideration of the problems posed by indoor pollution is gaining pace. Studies on exposure to pollutants found in the indoor domestic environment are increasing and are contributing to an already significant compilation of datasets. Improvement in monitoring techniques has helped this process. Documented reports of fatalities from carbon monoxide poisonings are still worrying. However, studies on health effects of non-fatal, long term, low dose, indoor exposure to carbon monoxide and other pollutants, are still inconclusive and too infrequently documented. Of particular concern are the levels of air pollutants found in the domestic indoor environment in developing countries, despite simple interventions such as vented stoves having shown their value. Exposure to biomass smoke is still a level that would be considered unacceptable on health grounds in developed countries. As in the occupational environment, steps need to be taken to control the risks from exposure to the harmful constituents of indoor air in the home. However, the difficulty regarding regulation of the domestic indoor environment is its inherent privacy. Monitoring levels of pollutants in the home and ensuring regulations are adhered to, would likely prove difficult, especially when individual behaviour patterns and activities have the greatest influence on pollutant levels in indoor air. To this end, the Department of Health is developing guidance on indoor air pollution to encourage the reduction of pollutant levels in indoor domestic air. The importance of the effects of domestic indoor air on health and its contribution to the health of the worker are increasingly appreciated. Occupational physicians, by training and interest, are well placed to extend their interests into the environmental field and to focus on this important area.