Pollutant exposures and health symptoms in aircrew and office workers: Is there a link?

Biomonitoring of volatile organic compounds and organophosphorus flame retardands in commercial aircrews after "fume and smell events"

Health risks to humans after "fume and smell events", short-term incidents on aircrafts that are accompanied by unpleasant odour or visible smoke, remain a subject of controversy. We assessed exposure to volatile organic compounds (VOC) and organophosphorus compounds (OPC) by biomonitoring in 375 aircrew members after self-reported "fume and smell events" and in 88 persons of the general population. A total of 20 parameters were analysed in blood and urine by gas chromatography and mass spectrometry. Median levels of acetone in blood and urine and 2-propanol in blood were elevated in aircrews compared to controls (p < 0.0001). Additionally, elevated peak exposures, best estimated by the 95th percentiles, were observed in aircrews for n-heptane and n-octane in blood, and acetone, 2,5-hexanedione and o-cresol in urine. Only the maximum observed levels of 2,5-hexandione in urine (768 μg/L) and toluene in blood (77 μg/L) in aircrew members were higher than the current biological exposure indices (BEI® levels) (500 and 20 μg/L, respectively) of the American Conference of Governmental Industrial Hygienists (US-ACGIH) for workers occupationally exposed to n-hexane and toluene, two well-accepted human neurotoxicants. Low-level exposures to n-hexane and toluene could be also observed in controls. The majority of OPC parameters in urine, including those of neurotoxic ortho-isomers of tricresylphosphate, were below the limit of quantitation in both aircrews and controls. Our comparative VOC and OPC analyses in biological samples of a large number of aircrew members and controls suggest that exposures are similar in both groups and generally low.

Health consequences of exposure to aircraft contaminated air and fume events: a narrative review and medical protocol for the investigation of exposed aircrew and passengers

Thermally degraded engine oil and hydraulic fluid fumes contaminating aircraft cabin air conditioning systems have been well documented since the 1950s. Whilst organophosphates have been the main subject of interest, oil and hydraulic fumes in the air supply also contain ultrafine particles, numerous volatile organic hydrocarbons and thermally degraded products. We review the literature on the effects of fume events on aircrew health. Inhalation of these potentially toxic fumes is increasingly recognised to cause acute and long-term neurological, respiratory, cardiological and other symptoms. Cumulative exposure to regular small doses of toxic fumes is potentially damaging to health and may be exacerbated by a single higher-level exposure. Assessment is complex because of the limitations of considering the toxicity of individual substances in complex heated mixtures.There is a need for a systematic and consistent approach to diagnosis and treatment of persons who have been exposed to toxic fumes in aircraft cabins. The medical protocol presented in this paper has been written by internationally recognised experts and presents a consensus approach to the recognition, investigation and management of persons suffering from the toxic effects of inhaling thermally degraded engine oil and other fluids contaminating the air conditioning systems in aircraft, and includes actions and investigations for in-flight, immediately post-flight and late subsequent follow up.

In vitro neurotoxicity screening of engine oil- and hydraulic fluid-derived aircraft cabin bleed-air contamination

In most airplanes, cabin air is extracted from the turbine compressors, so-called bleed air. Bleed air can become contaminated by leakage of engine oil or hydraulic fluid and possible neurotoxic constituents, like triphenyl phosphate (TPhP) and tributyl phosphate (TBP). The aim of this study was to characterize the neurotoxic hazard of TBP and TPhP, and to compare this with the possible hazard of fumes originating from engine oils and hydraulic fluids in vitro. Effects on spontaneous neuronal activity were recorded in rat primary cortical cultures grown on microelectrode arrays following exposure for 0.5h (acute), and 24h and 48h (prolonged) to TBP and TPhP (0.01 - 100µM) or fume extracts (1 - 100µg/mL) prepared from four selected engine oils and two hydraulic fluids by a laboratory bleed air simulator. TPhP and TBP concentration-dependently reduced neuronal activity with equal potency, particularly during acute exposure (TPhP IC₅₀: 10 - 12µM; TBP IC₅₀: 15 - 18µM). Engine oil-derived fume extracts persistently reduced neuronal activity. Hydraulic fluid-derived fume extracts showed a stronger inhibition during 0.5h exposure, but the degree of inhibition attenuates during 48h. Overall, fume extracts from hydraulic fluids were more potent than those from engine oils, in particular during 0.5h exposure, although the higher toxicity is unlikely to be due only to higher levels of TBP and TPhP in hydraulic fluids. Our combined data show that bleed air contaminants originating from selected engine oils or hydraulic fluids exhibit neurotoxic hazard in vitro, with fumes derived from the selected hydraulic fluids being most potent.

Recent progress on studies of airborne infectious disease transmission, air quality, and thermal comfort in the airliner cabin air environment

Airborne transmission of infectious diseases through air travel has become a major concern, especially during the COVID-19 pandemic. The flying public and crew members have long demanded better air quality and thermal comfort in commercial airliner cabins. This paper reviewed studies related to the airliner cabin air environment that have been published in scientific journals since 2000, to understand the state-of-the-art in cabin air environment design and the efforts made to improve this environment. In this critical review, this paper discusses the challenges and opportunities in studying the cabin air environment. The literature review concluded that current environmental control systems for airliner cabins have done little to stop the airborne transmission of infectious diseases. There were no reports of significant air quality problems in cabins, although passengers and crew members have complained of some health-related issues. The air temperature in cabins needs to be better controlled, and therefore, better thermal comfort models for airliners should be developed. Low humidity is a major complaint from passengers and crew members. Gaspers are used by passengers to adjust thermal comfort, but they do not improve air quality. Various personalized and displacement ventilation systems have been developed to improve air quality and thermal comfort. Air cleaning technologies need to be further developed. Good tools are available for designing a better cabin air environment.

Occupational risk of organophosphates and other chemical and radiative exposure in the aircraft cabin: A systematic review

Occupational exposure to oil fumes, organophosphates, halogenated flame retardants, and other volatile and semi-volatile contaminants is a concern within the aviation industry. There is no current consensus on the risk attributed to exposure to these chemical classes within the aircraft cabin. Contaminant concentrations rarely exceed conventional air quality guidelines, but concerns have been raised about these guidelines' applicability within the aircraft environment. This systematic review, the largest and most comprehensive completed to date on the subject matter, aims to synthesize the existing research related to chemical and other exposures inside the aircraft cabin to determine the occupational risk that may be attributed said exposure, as well as, determine knowledge gaps in source, pathway, and receptor that may exist. The Science Direct, Scopus, and Web of Science databases were queried with five search terms generating 138 manuscripts that met acceptance criteria and screening. Several potential areas requiring future examination were identified: Potable water on aircraft should be examined as a potential source of pollutant exposure, as should air conditioning expansion turbines. Historical exposure should also be more fully explored, and non-targeted analysis could provide valuable information to comprehend the aircraft cabin exposome. Occupational risk under typical flight scenarios appears to be limited for most healthy individuals. Contaminants of concern were demonstrated to be extant within the cabin, however the concentrations under normal circumstances do not appear to be individually responsible for the symptomologies that are present in impacted individuals. Questions remain regarding those that are more vulnerable or susceptible to exposure. Additionally, establishing the effects of chronic low dose exposure and exposure to contaminant mixtures has not been satisfied. The risk of acute exposure in mitigable fume events is substantial, and technological solutions or the replacement of compounds of concern for safer alternatives should be a priority.

Cabin air quality on non-smoking commercial flights: A review of published data on airborne pollutants

We reviewed 47 documents published 1967-2019 that reported measurements of volatile organic compounds (VOCs) on commercial aircraft. We compared the measurements with the air quality standards and guidelines for aircraft cabins and in some cases buildings. Average levels of VOCs for which limits exist were lower than the permissible levels except for benzene with average concentration at 5.9 ± 5.5 μg/m3 . Toluene, benzene, ethylbenzene, formaldehyde, acetaldehyde, limonene, nonanal, hexanal, decanal, octanal, acetic acid, acetone, ethanol, butanal, acrolein, isoprene and menthol were the most frequently measured compounds. The concentrations of semi-volatile organic compounds (SVOCs) and other contaminants did not exceed standards and guidelines in buildings except for the average NO2 concentration at 12 ppb. Although the focus was on VOCs, we also retrieved the data on other parameters characterizing cabin environment. Ozone concentration averaged 38 ppb below the upper limit recommended for aircraft. The outdoor air supply rate ranged from 1.7 to 39.5 L/s per person and averaged 6.0 ± 0.8 L/s/p (median 5.8 L/s/p), higher than the minimum level recommended for commercial aircraft. Carbon dioxide concentration averaged 1315 ± 232 ppm, lower than what is permitted in aircraft and close to what is permitted in buildings. Measured temperatures averaged 23.5 ± 0.8°C and were generally within the ranges recommended for avoiding thermal discomfort. Relative humidity averaged 16% ± 5%, lower than what is recommended in buildings.

Melatonin Protects Neural Stem Cells Against Tri-Ortho-Cresyl Phosphate-Induced Autophagy

Tri-ortho-cresyl phosphate (TOCP) is an extensively used organophosphate in industry. It has been proven to lead to toxicity in different organ systems, especially in the nervous system. Neural stem cells (NSCs) play important roles in both embryonic and adult nervous systems. However, whether TOCP induces cytotoxicity in embryonic NSCs remains unclear. In this study, mouse NSCs were exposed to different concentrations of TOCP for 24 h. The results showed that TOCP led to impaired proliferation of NSCs and induced the autophagy of NSCs by increasing the generation of intracellular reactive oxygen species (ROS) and decreasing the phosphorylation of extracellular regulated protein kinase (ERK1/2). Melatonin has been reported to exert neuroprotective effects via various mechanisms. Therefore, we further investigate whether melatonin has potential protective effects against TOCP-induced cytotoxicity on NSCs. Our data showed that melatonin pretreatment attenuated TOCP-induced autophagy by suppressing oxidative stress and restoring ERK1/2 phosphorylation consistently. Taken together, the results indicated that TOCP induced the autophagy in mouse NSCs, and melatonin may effectively protect NSCs against TOCP-induced autophagy.

Indoor air chemistry: Terpene reaction products and airway effects

Reactive chemistry is ubiquitous indoors with a wealth of complex oxidation reactions; some of these are initiated by both homogeneous and heterogeneous reaction of ozone with unsaturated organic compounds and subsequent the hydroxyl radical, either in the gas-phase or on reactive surfaces. One major focus has been the reaction of common and abundant terpene-based fragrances in indoor air emitted from many wood-based materials, a variety of consumer products, and citrus fruits and flowers. Inhalation of the terpenes themselves are generally not considered a health concern (both acute and long-term) due to their low indoor air concentrations; however, their gas- and surface reactions with ozone and the hydroxyl radical produce a host of products, both gaseous, i. a. formaldehyde, and ultrafine particles formed by condensation/nucleation processes. These reaction products may be of health concern. Human cell bioassays with key reaction products from ozone-initiated terpene reactions have shown some inflammatory reactions, but results are difficult to interpret for human exposure and risk assessment. Acute effects like sensory irritation in eyes and airways are unlikely or present at very low intensity in real life conditions based on rodent and human exposure studies and known thresholds for sensory irritation in eyes and airways and derived human reference values for airflow limitation and pulmonary irritation. Some fragrances and their ozone-initiated reaction products may possess anti-inflammatory properties. However, long-term effects of the reaction products as ultrafine particles are poorly explored. Material and product surfaces with high ozone deposition velocities may significantly impact the perceived air quality by altered emissions from both homogeneous and heterogeneous surface reactions.

Investigating the potential for transisomerisation of trycresyl phosphate with a palladium catalyst and its implications for aircraft cabin air quality

The quality of aircraft cabin air has been an area of concern for several decades. Many investigations have linked the presence of organophosphates in air to Aerotoxic Syndrome with adverse symptoms reported by thousands of aircraft crew across the globe. Currently the source of organophosphates has been under debate, with studies pointing towards tricresylphosphates (TCP) in aircraft oil as the main source due to leaks in engine seals resulting in fumes entering the cabin. However, comparisons of oil and cabin samples have shown that the cabin samples contain a much higher proportion of ortho-substituted TCP than is commonly detected in oil. The aim of this experiment was to investigate the potential for palladium catalysts (present in aircraft air conditioning systems) to convert meta- and para-substituted TCP to produce ortho-substituted TCP through transisomerisation. This experiment was performed in a controlled laboratory setting aimed to represent the conditions likely to be experienced in aircraft. Samples were introduced to a stainless steel micro reactor tube containing the pelletized palladium catalyst using a HPLC pump with a 0.2 ml/min feed flow rate. The temperature maintained at 400 °C over a period of 1 h and samples collected using a condensing vesicle. These were then diluted and transferred to a 2 mL vial for analysis by gas chromatography mass spectrometry. No evidence supporting the transisomerisation of tricresylphosphate was obtained. This indicates that more emphasis should be placed on identifying other potential sources of ortho substituted TCP.

The impact of occupational exposure to traffic-related air pollution among professional motorcyclists from Porto Alegre, Brazil, and its association with genetic and oxidative damage

Vehicles play an important role in modern life; however, they also generate hazards. Occupational exposed subjects are in long-term contact with harmful products, which sets these professionals in a susceptible group to air pollutant damage. The aims of this study were to quantify individual exposure to pollutant gases and chemical elements and to evaluate oxidative and genetic damage in professional motorcyclists and office workers. We recruited professional motorcyclists and office workers from Porto Alegre, Brazil, between January and December 2016. Individual exposure to air pollutants was assessed by passive monitoring. Fingernail trace elements were determined by using inductively coupled plasma mass spectrometry. Oxidative stress biomarkers were quantified spectrophotometrically, and genotoxicity was evaluated by micronuclei assay. Individual exposure to NO₂ and O₃, trace element content (Sb, Pt, As, Cd, V, Mn, and Co), oxidative stress factors, and genetic damage were statistically higher in professional motorcyclists (p < 0.05). Moreover, NO₂ and O₃ levels showed very strong positive correlation with plasmatic lipid peroxidation (p < 0.001 and r = 0.8849 and 0.8995) and strong positive correlation with micronuclei frequency (p < 0.001 and r = 0.7683 and 0.7280). Results suggest that professional motorcyclists are at high risk due to long-term air pollution exposure, which implies in the onset of several harmful effects and worsening of pre-existent diseases.

Human symptom responses to bioeffluents, short-chain carbonyls/acids, and long-chain carbonyls in a simulated aircraft cabin environment

Occupants of aircraft have reported an array of symptoms related to general discomfort and irritation. Volatile organic compounds (VOCs) have been suggested to contribute to the reported symptoms. VOCs are from products used, bioeffluents from people and oxidation reaction products. Thirty-six healthy, young female subjects rated symptoms and environmental quality during an eight-hour exposure to groups of compounds often present in aircraft: (i) long-chain carbonyls, (ii) simulated bioeffluents, and (iii) short-chain carbonyls/organic acids. Statistically more symptoms were identified for the simulated bioeffluents and, to a lesser extent, short-chain carbonyls/organic acids compared to a control condition, although they remained in the acceptable range. There were three temporal patterns in the environmental quality and symptom reports: (i) an adaptive response (immediate increases followed by a decline); (ii) an apparent physiological effect (increases one to three hours into the exposure that remained elevated); and (iii) no statistical differences in reported environmental quality or symptom severity compared to the control air conditions. Typical concentrations found in aircraft can cause transitory symptoms in healthy individuals questioning the adequacy of current standards. Understanding the effects on individuals sensitive to air pollutants and methods to remove the compounds causing the greatest symptom responses are needed.

Chemical Characterization of the Indoor Air Quality of a University Hospital: Penetration of Outdoor Air Pollutants

For healthcare centers, local outdoor sources of air pollution represent a potential threat to indoor air quality (IAQ). The aim of this study was to study the impact of local outdoor sources of air pollution on the IAQ of a university hospital. IAQ was characterized at thirteen indoor and two outdoor locations and source samples were collected from a helicopter and an emergency power supply. Volatile organic compounds (VOC), acrolein, formaldehyde, nitrogen dioxide (NO₂), respirable particulate matter (PM-4.0 and PM-2.5) and their respective benz(a)pyrene contents were determined over a period of two weeks. Time-weighted average concentrations of NO₂ (4.9–17.4 μg/m³) and formaldehyde (2.5–6.4 μg/m³) were similar on all indoor and outdoor locations. The median concentration VOC in indoor air was 119 μg/m³ (range: 33.1–2450 μg/m³) and was fivefold higher in laboratories (316 μg/m³) compared to offices (57.0 μg/m³). PM-4.0 and benzo(a)pyrene concentration were lower in buildings serviced by a >99.95% efficiency particle filter, compared to buildings using a standard 80–90% efficiency filter (p < 0.01). No indications were found that support a significant contribution of known local sources such as fuels or combustion engines to any of the IAQ parameters measured in this study. Chemical IAQ was primarily driven by known indoor sources and activities.

Effects by inhalation of abundant fragrances in indoor air - An overview

Odorous compounds (odors) like fragrances may cause adverse health effects. To assess their importance by inhalation, we have reviewed how the four major abundant and common airborne fragrances (α-pinene (APN), limonene (LIM), linalool (LIL), and eugenol (EUG)) impact the perceived indoor air quality as odor annoyance, sensory irritation and sensitization in the airways. Breathing and cardiovascular effects, and work performance, and the impact in the airways of ozone-initiated gas- and particle phase reactions products have also been assessed. Measured maximum indoor concentrations for APN, LIM and LIL are close to or above their odor thresholds, but far below their thresholds for sensory irritation in the eyes and upper airways; no information could be traced for EUG. Likewise, reported risk values for long-term effects are far above reported indoor concentrations. Human exposure studies with mixtures of APN and LIM and supported by animal inhalation models do not support sensitization of the airways at indoor levels by inhalation that include other selected fragrances. Human exposure studies, in general, indicate that reported lung function effects are likely due to the perception rather than toxic effects of the fragrances. In general, effects on the breathing rate and mood by exposure to the fragrances are inconclusive. The fragrances may increase the high-frequency heart rate variability, but aerosol exposure during cleaning activities may result in a reduction. Distractive effects influencing the work performance by fragrance/odor exposure are consistently reported, but their persistence over time is unknown. Mice inhalation studies indicate that LIM or its reaction mixture may possess anti-inflammatory properties. There is insufficient information that ozone-initiated reactions with APN or LIM at typical indoor levels cause airway effects in humans. Limited experimental information is available on long-term effects of ozone-initiated reaction products of APN and LIM at typical indoor levels.

Photocatalytic degradation of formaldehyde by PAN nonwoven supported Fe(iii) catalysts under visible light irradiation

Amidoximated PAN nonwoven fabrics coordinated with Fe(iii) as a photocatalyst for formaldehyde degradation by activating O₂ under visible irradiation.

A comparison of fresh and used aircraft oil for the identification of toxic substances linked to aerotoxic syndrome

Fresh and used aircraft engine lubricants (Mobil Jet Oil II) were analysed using a Fourier Transform Ion Cyclotron Resonance Mass Spectrometer (FTICRMS) and comprehensive two dimensional gas chromatography with high resolution time of flight mass spectrometry (GCxGC-HRTOFMS). The composition of the fresh oil was established, with special focus to its tricresyl phosphate (TCP) content as this has formed the focus for most investigations into aerotoxic syndrome. The results showed that only four TCP isomers were present at detectable levels in the fresh oil: mmm-TCP, mmp-TCP, ppm-TCP and ppp-TCP. The results indicate that the formulation of Mobile Jet Oil II does not contain the more toxic ortho substituted TCP isomers at concentrations above 0.0005%. The temperatures of jet engines during operation are greater than 200 °C which creates the potential to alter the composition of the original oil and create other toxic compounds. The results show there may be a significant risk from alkylated cresyl phosphates, which were identified in the used oils at concentrations calculated in the range of 0.13-0.69%. w/w. Several xylenyl and ethylphenyl phosphates have been shown to exhibit a similar toxicity to ortho substituted TCP isomers which makes there discovery in used oil significant. These compounds should be included in future aircraft air quality studies and when assessing the risks and causes of aerotoxic syndrome.

Assessment of neurotoxic effects of tri-cresyl phosphates (TCPs) and cresyl saligenin phosphate (CBDP) using a combination of in vitro techniques

Environmental exposures to tri-cresyl phosphates (TCPs) and the possible formation of toxic metabolites (e.g. cresyl saligenin phosphate; CBDP) may cause a variety of neurotoxic effects in humans. As reported for other organophosphorus compounds (OPs), the inhibition of acetylcholine esterase (AChE) has also been proposed as the underlying mechanism for TCP neurotoxicity. The ortho-isomer, ToCP and its metabolite CBDP are also known to affect neuropathy target esterase (NTE) leading to organophosphate-induced delayed neuropathy (OPIDN). Recently, in vitro testing has led to the identification of other molecular targets and alternative mechanisms of ToCP toxicity. The metabolite CBDP and other isomers, as well as commercial mixtures have not been tested for such additional modes of actions. Accordingly, the present study investigates alterations of neurobiological correlates of central nervous processes using different in vitro techniques. The three symmetric TCP isomers - ToCP, TpCP, and TmCP - that contain a methyl group at the ortho-, para-, or meta-position of the aromatic ring system, respectively, together with a commercial TCP mixture, and CBDP were all tested using concentrations not exceeding their cytotoxic concentrations. Isolated cortical neurons were kept in culture for 6days followed by 24h incubation with different concentrations of the test compounds. Thus, all endpoints were assessed after 7days in vitro (DIV 7), at which time cell viability, neurite microstructure, and the function of glutamate receptors and voltage-gated calcium cannels (VGCC) were measured. While the cytotoxic potential of the TCP isomers and their mixture were comparable (IC₅₀≥80μM), CBDP was more cytotoxic (IC₅₀: 15μM) to primary cortical neurons. In contrast, CBDP (up to 10μM) did not compromise the microstructure of neurites. Ten μM of ToCP significantly reduced the size and complexity of neurite networks, but neither TmCP and TpCP nor the mixture affected this second endpoint of neurotoxicity assessment. TCPs and their mixture significantly reduced the Ca²⁺ influx in response to glutamate and KCl stimulation in concentrations of 10μM. Only ToCP showed a specific effect on glutamate receptors with 100nM reducing the evoked Ca²⁺ influx. The effects of CBDP on the provoked Ca²⁺ influx were much weaker than those observed for TCPs. These results confirmed that ToCP has a unique mode of action on glutamate receptors that are not observed with the metabolite CBDP and the other symmetric TCP isomers. In addition, the TmCP isomer seems to have the lowest potency with respect to inducing neurotoxic effects. CBDP did not affect the neurospecific endpoints investigated in this study. Therefore, the specific affinity of CBDP for NTE and the reported general cytotoxicity might be the most relevant modes of action of this toxic metabolite in the context of ToCP-induced neurotoxicity, including OPIDN.