Health symptoms and perception of cabin air quality (CAQ) among commercial cabin crew were studied as a function of personal risk factors, occupation, and work on intercontinental flights with exposure to environmental tobacco smoke (ETS). A standardized questionnaire (MM 040 NA) was mailed in February to March 1997 to all Stockholm airline crew on duty in a Scandinavian airline (n=1857), and to office workers from the same airline (n=218). During this time, smoking was allowed only on intercontinental flights. The participation rate was 81% (n=1513) by the airline crew, and 77% (n=168) by the office group. Statistical analysis was performed by multiple logistic regression analysis, controlling for age, gender, atopy, current smoking habits, and occupation. The most common symptoms among airline crew were: fatigue (21%), nasal symptoms (15%), eye irritation (11%), dry or flushed facial skin (12%), and dry/itchy skin on hands (12%). The most common complaint about CAQ was dry air (53%). Airline crew had more nasal, throat, and hand skin symptoms, than office workers did. Airline crew with a history of atopy had more nasal, throat, and dermal face and hand symptoms than other crew members did. Older airline crew members had more complaints of difficulty concentrating, but fewer complaints of dermal symptoms on the face and hands than younger crew members did. Female crew members reported more headaches than male crew members reported. Smoking was not associated with frequency of symptoms. Pilots had fewer complaints of most symptoms than other crew had. Airline crew that had been on an intercontinental flight in the week before the survey had more complaints of fatigue, heavy-headedness, and difficulty concentrating. Complaints of stuffy air and dry air were more common among airline crew than among office workers from the same airline. Female crew had more complaints of stuffy and dry air than male crew had. Older cabin crew had fewer complaints of dry air than younger crew had, and cabin crew with atopy had more complaints of dry air than other crew had. Current smokers had fewer complaints of stuffy air than non-smokers had. Airline crew that had been on a flight on which smoking was allowed in the week before the survey, had more complaints of stuffy air, dry air and passive smoking, than crew that had not been on such a flight in the preceding week had.
Practical implications: Complaints on cabin air quality and health symptoms were common among commercial airline crew, and related to age, gender, atopy and type of work onboard. The hygienic measurements showed that the relative air humidity is very low on intercontinental flights, and particle levels are high on flights with passive smoking. This illustrates the need to improve the cabin air quality in commercial airlines. Such improvements could include better control of cabin temperature, air humidification, efficient air filtration with high efficiency particulate air filter (HEPA) filtration on all types of aircraft and sufficient air exchange rate in order to fulfil current ventilation standards.