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Vol. 29. Issue 1.
Pages 97-98 (January - February 2023)
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Vol. 29. Issue 1.
Pages 97-98 (January - February 2023)
Open Access
Indoor environmental quality—Take me where the air is clean
M. Polastria,
Corresponding author
, E. Pehlivanb
a Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St Orsola University Hospital, Bologna, Italy
b Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, University of Health Sciences Turkey, Istanbul, Turkey
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Dear Editor,

We read the editorial piece by Winck et al. who solicited a call for a Portuguese national strategy addressing indoor air quality.1 The topic explored by the authors is an emerging area of interest worthy of further consideration. We found the proposed plans put forward in the Winck et al. article1 of great interest. Among these, air recirculation is undoubtedly one of the more feasible and straightforward methods of ameliorating indoor air quality, as already pointed out by other authors.2 The rapid and global spread of COVID-19 seems to be associated with indoor and outdoor air pollution. Studies show that in some parts of the world, where air pollution rates are high, COVID-19 is spreading faster.3 In this sense, depending on air quality, the diffusion trends for COVID-19 could be positively or negatively affected. It should be noted that indoor air pollution could also be generated by outdoor pollutants that are brought indoors in the processes of ventilation through the building envelope.4 Furthermore, people living in polluted air conditions are more prone to getting sick, and viral contamination becomes easier in such environments.5 These findings have been confirmed in a recent study, whose authors found an association between exposure to air pollution and the onset of respiratory symptoms and diseases such as allergic rhinitis, cough, asthma, and COPD.6

At the time of writing –April 2022– despite a reduction in new COVID-19 cases and the consequent easing of the restrictive measures, the infection risk persists in schools, hospitals, and other indoor contexts. Therefore, improving indoor air quality is crucial to overcoming the pandemic and alleviating the related health and economic consequences.

After reading the piece by Winck et al., it emerges that an increasing number of guidelines has been released in the last two years by international agencies to promote appropriate ventilation inside buildings.4,7–9 Such measures should be extended as much as possible within medical facilities, commercial buildings, and workplaces. As highlighted in the editorial by Winck et al.,1 Recovery and Resilience Plan supported by the European Union, is an occasion to direct financial resources towards implementing safe and healthy indoor environments in the eurozone. The European Recovery Plan10 is a € 2.018 trillion package created to respond to the COVID-19 pandemic; this unprecedented financial support should be used to facilitate local indoor air quality policies across countries. In this sense, rehabilitative pulmonary settings should be considered privileged as they would benefit from enhanced indoor air circulation. In fact, in such settings patients and professionals are greatly exposed to droplets and air contamination.2

We then applaud the analysis made by Winck et al.1 because it contributed to expanding awareness of the importance of addressing indoor air quality during the COVID-19 pandemic and beyond. Furthermore, we hope that readers will be encouraged to be proactive –within the context of their institutions and workplaces– directed at enhancing indoor air quality.

As professionals, consumers, and citizens, we can all actively contribute to obtaining a better environment to live and work in.

JC Winck, SM Almeida, G Correia, MF Gabriel, G Marques, MG. Silva.
A call for a national strategy for indoor air quality.
Pulmonology, 28 (2022), pp. 245-251
M Polastri, E. Pehlivan.
Preventing indoor contamination in private physiotherapy practice.
Int J Ther Rehabil, 28 (2021), pp. 1-3
T Balboa-Castillo, O Andrade-Mayorga, GN Marzuca-Nassr, G Morales Illanes, M Ortiz, I Schiferlli, et al.
Pre-existing conditions in Latin America and factors associated with adverse outcomes of COVID-19: a review.
World Health Organization.2021 WHO global air quality guidelines: particulate matter (PM2.5 and PM10). Ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. (Accessed 7 April 2022)
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Air pollution and COVID-19: the role of particulate matter in the spread and increase of COVID-19′s morbidity and mortality.
Int J Environ Res Public Health, 17 (2020), pp. 4487
S De Matteis, F Forastiere, S Baldacci, S Maio, S Tagliaferro, S Fasola, et al.
Issue 1 - “Update on adverse respiratory effects of outdoor air pollution”. Part 1): outdoor air pollution and respiratory diseases: a general update and an Italian perspective.
Pulmonology, 28 (2022), pp. 284-296
REHVA. COVID-19 guidance document version 4.0. how to operate HVAC and other building service systems to prevent the spread of the coronavirus (SARS-CoV-2) disease (COVID-19) in workplaces. 2020. (Accessed 7 April 2022)
ASHRAE. Epidemic Task Force. Core recommendations for reducing airborne infectious aerosol exposure. 2021. (Accessed 7 April 2022)
M Guo, P Xu, T Xiao, R He, M Dai, SL. Miller.
Review and comparison of HVAC operation guidelines in different countries during the COVID-19 pandemic.
European Union. Recovery plan for Europe. 2021. (Accessed 7 April 2022)
Copyright © 2022. Sociedade Portuguesa de Pneumologia
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