Role of occupational physician in the assessment and management of indoor air quality problems

Introduction
The occupational physician is increasingly requested in non-industrial sectors (offices, banks, schools, etc.). Workers employed in such environments account for the main part of the labor force in many countries. Effects on health, well-being, and productivity have been increasingly reported during the last decades. The indoor air quality (IAQ) in non-industrial buildings is an issue of increasing concern and there is a growing interest in exploring potential synergies with psychosocial stress.

Methods
The role of the occupational physician in the assessment and management of IAQ problems has been discussed by experts of the Scientific Committee on Indoor Air Quality and Health of the ICOH and has been proposed as shown below.

Results
1. Collaboration in risk assessment – risk management. An integration of building assessment, environmental measurements and questionnaire survey is the recommended approach for periodical risk assessment and specific indoor problem solving. The questionnaire should cover questions about the indoor climate as well as psycho-social working aspects. The results can be used for mapping the perceived indoor climate and to prioritize the order in which the problems should be tackled. 
2. Health surveillance. Individual health surveillance in relation to IAQ is proposed only when periodical health surveillance is already performed for other risks (e.g. Video Display Units) or when specific clinical examination of workers is required due to the occurrence of diseases that can be linked to IAQ (e.g. Legionnaire’s disease), recurrent inflammation, infections of eyes, respiratory airways effects, and sensorial disturbances.
3. Health promotion. The workplace is one of the priority settings for health promotion. Workplace health promotion programs include smoking cessation and stress management; programs for a better IAQ management may also be considered.

Discussion
A team approach with cooperation between medical and technical experts, including experts in toxicology, is recommended in the assessment and management of indoor air quality problems.