The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

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European Position Paper on Rhinosinusitis and Nasal Polyps 2020

The science of the total environment

Atmospheric aerosol particles of biological origin are a very diverse group of biological materials and structures, including microorganisms, dispersal units, fragments and excretions of biological organisms. In recent years, the impact of biological aerosol particles on atmospheric processes has been studied with increasing intensity, and a wealth of new information and insights has been gained. This review outlines the current knowledge on major categories of primary biological aerosol particles (PBAP): bacteria and archaea, fungal spores and fragments, pollen, viruses, algae and cyanobacteria, biological crusts and lichens and others like plant or animal fragments and detritus. We give an overview of sampling methods and physical, chemical and biological techniques for PBAP analysis (cultivation, microscopy, DNA/RNA analysis, chemical tracers, optical and mass spectrometry, etc.). Moreover, we address and summarise the current understanding and open questions concerning the influence of PBAP on the atmosphere and climate, i.e. their optical properties and their ability to act as ice nuclei (IN) or cloud condensation nuclei (CCN). We suggest that the following research activities should be pursued in future studies of atmospheric biological aerosol particles: (1) develop efficient and reliable analytical techniques for the identification and quantification of PBAP; (2) apply advanced and standardised techniques to determine the abundance and diversity of PBAP and their seasonal variation at regional and global scales (atmospheric biogeography); (3) determine the emission rates, optical properties, IN and CCN activity of PBAP in field measurements and laboratory experiments; (4) use field and laboratory data to constrain numerical models of atmospheric transport, transformation and climate effects of PBAP. Keywords: primary biological atmospheric aerosol; climate; cloud condensation nuclei; biology; atmospheric ice nuclei (Published: 22 February 2012) Citation: Tellus B 2012, 64 , 15598, DOI: 10.3402/tellusb.v64i0.15598

https://www.tandfonline.com/doi/pdf/10.3402/tellusb.v64i0.15598

Primary biological aerosol particles in the atmosphere: a review

ObjectivesMany studies have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health effects, but causal links remain unclear. Findings on measured m...

Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence

The bacteria that colonize humans and our built environments have the potential to influence our health. Microbial communities associated with seven families and their homes over 6 weeks were assessed, including three families that moved their home. Microbial communities differed substantially among homes, and the home microbiome was largely sourced from humans. The microbiota in each home were identifiable by family. Network analysis identified humans as the primary bacterial vector, and a Bayesian method significantly matched individuals to their dwellings. Draft genomes of potential human pathogens observed on a kitchen counter could be matched to the hands of occupants. After a house move, the microbial community in the new house rapidly converged on the microbial community of the occupants' former house, suggesting rapid colonization by the family's microbiota.

/pdf/longitudinal-analysis-of-microbial-interaction-between-15qn7xmwt7.pdf

Longitudinal analysis of microbial interaction between humans and the indoor environment.

Fungi and actinobacteria in moisture-damaged building materials — concentrations and diversity

Microbial indoor air quality and respiratory symptoms of children were studied in 24 schools with visible moisture and mold problems, and in eight non-damaged schools. School buildings of concrete/brick and wooden construction were included. The indoor environment investigations included technical building inspections for visible moisture signs and microbial sampling using six-stage impactor for viable airborne microbes. Children's health information was collected by questionnaires. The effect of moisture damage on concentrations of fungi was clearly seen in buildings of concrete/brick construction, but not in wooden school buildings. Occurrence of Cladosporium, Aspergillus versicolor, Stachybotrys, and actinobacteria showed some indicator value for moisture damage. Presence of moisture damage in school buildings was a significant risk factor for respiratory symptoms in schoolchildren. Association between moisture damage and respiratory symptoms of children was significant for buildings of concrete/brick construction but not for wooden school buildings. The highest symptom prevalence was found during spring seasons, after a long exposure period in damaged schools. The results emphasize the importance of the building frame as a determinant of exposure and symptoms.

Indoor air microbes and respiratory symptoms of children in moisture damaged and reference schools.

This work was conducted in order to study how the health of adults is affected by the presence of moisture or mould in the home. A random sample of 310 houses in Finland was studied during the years 1993-1994. The houses were investigated for visual signs of moisture by a surveyor, and observations of mould were reported by the occupants. A moisture problem was observed in 52% and a mould problem in 27% of the houses. Health data was collected by means of a postal questionnaire from 699 adults. Exposure to moisture was significantly associated with sinusitis, acute bronchitis, nocturnal cough, nocturnal dyspnoea and sore throat, and the exposed inhabitants had significantly more episodes of common cold and tonsillitis. Exposure to mould was significantly associated with common cold, cough without phlegm, nocturnal cough, sore throat, rhinitis, fatigue and difficulties in concentration. Building-related moisture or mould increased the risk of upper and lower respiratory infections and symptoms as well as of nonrespiratory symptoms.

https://erj.ersjournals.com/content/erj/14/6/1363.full.pdf

The relationship between moisture or mould observations in houses and the state of health of their occupants

UNLABELLED: Effects of renovation on symptom prevalence and microbial status were studied in two moisture-damaged schools and in two non-damaged schools with longitudinal cross-sectional surveys before and after repairs. Over 1300 schoolchildren aged 6-17 returned questionnaires before and after repairs. After full renovation in one of the damaged schools, elevated concentrations and increased frequencies of indoor air fungi normalized and a significant decrease in the prevalence of 10 symptoms of 12 studied was observed among schoolchildren. No change in microbial conditions was seen after partial repairs in the other damaged school, and only slight improvement was observed in symptom prevalence. The change in the prevalence of symptoms in the reference schools was minor. The results suggest that increased symptom prevalence among schoolchildren in moisture-damaged schools can be managed with proper repair of the moisture damage. PRACTICAL IMPLICATIONS: This longitudinal intervention study showed the positive effects of the moisture and mold damage repairs of a school building on children's health. The success necessitates however, a thorough renovation including appropriate ventilation. Monitoring of airborne viable microbes revealed the damage status of the building and thus could be used as a tool in evaluating the quality of repairs.

Effects of moisture‐damage repairs on microbial exposure and symptoms in schoolchildren

The aim of this study was to determine temporal and spatial variation of airborne concentrations of viable fungi in 2 single-family houses during the period of the year that such levels are mostly determined by indoor sources. One of the subject residences had moisture problems (the index residence), the other did not have any moisture problems (the reference residence). The concentrations of viable fungi in indoor air were determined a total of 6 times during the winter with 2 six-stage impactors (Andersen 10-800) in 2 rooms in both of the houses. The total concentrations of viable fungi and concentrations of Penicillium, Aspergillus, and Aspergillus versicolor

Teija Meklin

Papers

Fungi and actinobacteria in moisture-damaged building materials — concentrations and diversity

Indoor air microbes and respiratory symptoms of children in moisture damaged and reference schools.

The relationship between moisture or mould observations in houses and the state of health of their occupants

Effects of moisture‐damage repairs on microbial exposure and symptoms in schoolchildren

Temporal and spatial variation of fungal concentrations in indoor air