[Indoor air quality and occupational health, past and present]

The expression "indoor pollution" of residential, office and public buildings appeared for the first time in western societies toward the end of the '60s to indicate a complex phenomenon as important to public health as that of the "outdoor air pollution" or even more so. The demonstration of the toxic effects of passive smoking, radon, and other chemical and biological pollutants present in office and residential environments has prompted a wide spectrum of research into health risks, has led to position-taking by national and international authorities, and has given rise to a new scientific multi-disciplinary field of research, with respective international associations, scientific journals, and international conferences attended by thousands of participants. In Italy, since 1988, several scientific conferences have been organised and these have led to institutional initiatives such as the Commission set up in 1990 by the Italian Environment Ministry and the Commission set up in 1998 by the Italian Ministry of Health. The latter produced a Prevention Plan for Health Protection and Promotion in Indoor Environments which, for the first time, tackles indoor air pollution in a systematic way and provides an overall picture of the health and economic impact of the main illnesses related to indoor pollution on society. Decree 626/94 has also been affected, in some way, by these new scientific findings and in art. 33 has produced an update of the old art. 9 of the Decree 303/56. The attention to the subject of indoor air quality, in addition to that of offices and commercial buildings, has turned in more recent years to special environments such as schools and hospitals, resulting in the production of important publications. The modern frontier of research on indoor and outdoor air hazards is represented by fine air particulate matter. A large number of worldwide epidemiological studies have revealed that the daily variation in fine and ultra-fine particle air concentration in urban areas is associated with the simultaneous daily variation in the morbidity and mortality of the general population. The particle-linked increase in mortality has been attributed to respiratory and cardiovascular toxic effects, but the mechanisms by which urban air particles (indoor and outdoor) induce worsening of respiratory and cardio-vascular diseases are so far unknown and are the subject of intense investigation. Workers employed in the tertiary sector (offices, trade, banking, hospitals, schools, etc.) now account for 80% of the Italian labour force and the occupational physician is increasingly requested to assess the risk and monitor the health status of tertiary sector workers. These working environments are believed to be healthy and lacking in specific health risk factors, but such a belief is often only the result of the limited knowledge that employers, workers and the physicians themselves have about these environments and the results of international research studies over the last forty years. This issue is surely at the centre of the interest of our discipline and of public health throughout the developed western world and represents an ongoing challenge for the occupational physician, with new research topics and new problems to deal with. Recent issues include SARS and the defence of buildings and the air of working environments against terrorism attacks, such as the use of anthrax dust.