<b>Bijsluiter</b>. De hyperlink naar het originele document werkt niet meer. Daarom laat Woogle de tekst zien die in dat document stond. Deze tekst kan vreemde foutieve woorden of zinnen bevatten en de opmaak kan verdwenen of veranderd zijn. Dit komt door het zwartlakken van vertrouwelijke informatie of doordat de tekst niet digitaal beschikbaar was en dus ingescand en vervolgens via OCR weer ingelezen is. Voor het originele document, neem contact op met de Woo-contactpersoon van het bestuursorgaan.<br><br>====================================================================== Pagina 1 ======================================================================

<pre>Overzicht van studies naar
blootstelling en studies
naar gezondheidsklachten
na woningisolatie met
gespoten PUR-schuim
Nr. 2020/24A/02, Den Haag, 1 december 2020
Achtergronddocument bij: Gespoten PUR-schuimisolatie en gezondheid.
2020/24, Den Haag, 1 december 2020
                                                                    2 2
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<pre> Inhoud           Overzicht van studies naar blootstelling en naar gezondheidsklachten na woningisolatie met gespoten PUR-schuim | pagina 2 van 8
 inhoud
 Table 3. Studies reporting exposure during and 		
 after spray polyurethane foam insulation                          3
 Table 4. Case studies                                             6
1      Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                    2                               3
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<pre>                             Overzicht van studies naar blootstelling en naar gezondheidsklachten na woningisolatie met gespoten PUR-schuim | pagina 3 van 8
 Table 3. Studies reporting exposure during and after spray polyurethane foam insulation
  Author (year of publ)    Setting                                  SPF type              Conditions (ventilation, etc) Measurement site               Sampling time        Exposure measures
  Sponsor
  Measurements during and immediately after SPF isolation
  Bello (2019), Center for Spray polyurethane foam insulation       Open and closed cell  Variable depending on site    Inhalation and dermal samples During spraying 2h    Isocyanates in air and (MDA)
  Construction Research    at 14 sites in New England, of which                                                         of sprayers, helpers, inside,  on average           urine biomonitoring
  and Training through     7 existing homes; 3 new homes, 3                                                             and outside area.
  NIOSH Cooperative        training centers, 1 apartment in USA                                                         Biomonitoring.
  Agreement
  Bello (2018)             Four SPF insulation sites and one        Open and closed cell  Spraying and shaving of the   Personal inhalation exposure   During SPF           flame retardants in air, and
                           foam removal site in USA                                       foam. Foam removal.           and dermal exposure            insulation           biomarkers of flame
                                                                                                                                                                            retardants in urine.
  Bilan (1989)             Spray polyurethane foam application      Rigid foam (closed?)  Passive air flow (assumed)    Sprayer, helper, fixed         During spraying; 60  MDI
                           in three roofs, two barns, walk-in                                                           distances from spray operation to 190 minutes
                           cooler, Quonset hut, horse stalls,
                           Canada
  Brennan (2013)           Two new residential constructions,       Open cell             No mechanical ventilation     Application area and adjacent  2h and 9h post-      MDI and amine catalyst
                           USA                                                            present during measurements   hallways                       application area
                                                                                                                                                       samples
  Crespo (1999)            Indoor (semi-open) and outdoor spray Unknown                   Passive air flow (assumed)    Sprayer, helper                During spraying;     Airborne MDI
                           polyurethane foam insulation at 17                                                                                          3-7h
                           construction sites, Spain
  Estill (2019)            SPF at various commercial and            Open and closed cell  Preparation of spray area,    Air sampling (outside          During entire work   TCPP in air and hand wipes
                           residential sites by 6 businesses                              spraying and cutting of the   respirators) on two            shift.
                                                                                          foam, cleaning spray area     consecutive days. Hand wipe
                                                                                                                        samples before and after shift
                                                                                                                        on day two.
  Havermans (2014)         Sprayed polyurethane foam insulation Closed cell (assumed)     Forced ventilation during and Air samples in crawl space,    During and after     (Di)isocyanates; Amine
                           of 1 crawl space under concrete floor,                         up to 30 in after isolation   living room, outdoor           spraying; Up to 144h catalysts; Blowing agents
                           the Netherlands                                                                                                             after insulation
  Hosein (1981)            Sprayed polyurethane foam at 7 sites     Unk                   Varying room sizes            Air sampling in proximity of   During spraying;     TDI
                           representative of work by insulation                                                         sprayer, 2m and 3m of          105-442 min
  Construction Safety      companies (two new barns,                                                                    sprayer.
  Association Ontario      retrofitting barn, truck, crawl space,
                           new residential building), Canada
  Lesage (2007)            SPF application on basement walls or Closed cell. Not          Passive air flow (assumed)    Applicators and assistants,    During spraying up   Airborne MDI monomer and
                           inside exterior walls in 5 single-family reported but based on                               various distances from         to 24h after         and blowing agent
                           homes in US and Canada                   blowing agent and                                   application (1-3; 3-6; 6-12m)  completion
                                                                    density
2           Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                                                             2                                          4
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<pre>                          Overzicht van studies naar blootstelling en naar gezondheidsklachten na woningisolatie met gespoten PUR-schuim | pagina 4 van 8
 Author (year of publ)  Setting                                SPF type                 Conditions (ventilation, etc)   Measurement site                Sampling time          Exposure measures
 Sponsor
 Robert (2012)          SPF application to first floor kitchen Medium-density closed    With and without mechanical     In application area and         During and 1h          MDI, amine catalysts, flame
                        addition, attic, basement, garage of   cell                     ventilation at 20-60 Air        adjacent areas                  post-application       retardants, blowing agents,
                        three existing homes, USA                                       Changes per Hour                                                                       and VOC’s.
 Robert (2014)          SPF application on wall and roof in    Open cell                SPF application and trimming.   Worker exposure                 During and after SPF MDI, flame retardant, total
                        two homes under construction and a                              Natural ventilation via door                                    application.           volatile organic hydrocarbons,
 BASF                   laboratory spray booth, USA                                     and windows                                                     Trimming immediate amine catalysts
                                                                                                                                                        after application, one
                                                                                                                                                        day and one week
                                                                                                                                                        after application.
 RPS Advies en          SPF-isolation in 7 crawl spaces of     Closed cell              One or two layers of SPF of     Area air sampling in crawl      Spray time             Isocyanates (MDI and
 ingenieursburo (2014)  homes with concrete or wooden floor,                            different thickness, humidity,  space, at access to crawl       30-180min.             breakdown products), blowing
                        the Netherlands                                                 crawl space volume, forced      space and nearest living area   Sampling during and    agents, (amine)catalysts,
 Kennisplatform                                                                         post-ventilation 30-60min.                                      up to 74h after        flame retardant
 Gespoten PUR-schuim                                                                    Mechanical ventilation with air                                 spraying
                                                                                        exchange rates from 50-200,
                                                                                        but poorly executed in three
                                                                                        homes.
 Tian (2018)            SPF application on interior and        Unk                      Not reported                    Sampling locations in 3         During and up to 24h   Airborne MDI, VOC’s, flame
                        exterior façade of a three-story                                                                bedrooms and in the center of   after spraying (MDI).  retardants, blowing agents
                        single-family house in West Virginia,                                                           the attic                       Other chemicals up     and airborne particles. Flame
                        USA                                                                                                                             to 3 months after      retardant accumulation in
                                                                                                                                                        spraying. Spraying     materials (carpet and drywall)
                                                                                                                                                        took 4 days.
 TNO-rapport R11049     SPF application in crawlspace in 3     Closed cell (assumed     Condition A: 1.0/0.9 MDI/       Living room, crawl space (after Before, during and     Isocyanates, blowing agents,
 (2013)                 test homes. Forced ventilation during  based on blowing         polyol proportion. B: closed    144 only), outside air.         after spraying; up to catalysts
                        and up to 30min after isolation. The   agent)                   crawl space. C: normal                                          144h after insulation.
 Nuon Isolatie B.V.     Netherlands                                                     procedure.                                                      Spray time
                                                                                        Forced ventilation.                                             45-60min.
 Wood (2017)            Industrial hygiene study in a 11.2 m3  Low-density high-        Ventilation rates 10.4, 233,    Air samplers in breathing zone 15 min of spraying;     VOC’s, MDI, flame retardants,
                        chamber with 3 different commercial    pressure open-cell       598 Air changes per hour. NB:   of the spray applicator, and    Sampling during and amine catalysts, blowing
 Center for the         SPF formulations. USA                  formulation; medium-     10.4 Air changes per hour is    0.6m behind applicator          30 min after spraying agents, aldehydes
 Polyurethanes industry                                        density high-pressure    seen as representative for
                                                               closed-cell formulation; residential setting
                                                               low-pressure closed-cell
                                                               kit formulation
3         Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                                                                2                                              5
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<pre>                            Overzicht van studies naar blootstelling en naar gezondheidsklachten na woningisolatie met gespoten PUR-schuim | pagina 5 van 8
  Author (year of publ)   Setting                                  SPF type                 Conditions (ventilation, etc)    Measurement site                 Sampling time        Exposure measures
  Sponsor
  Measurements long after SPF isolation
 Huang (2014)             Spray polyurethane foam insulation in Closed cell but             Faulty application; subjects     Attic and family room            10 months after      VOC’s in indoor air samples
                          homes at east coast US. Attic only or potentially also open.      stayed home during                                                spraying attic; 3    and in vitro SPF samples
                          attic, side walls and crawl space.                                application, returned too early,                                  months after
                                                                                            no ventilation was applied, or                                    spraying entire
                                                                                            improper mixing technique.                                        house
 LBP sight rapport        SPF isolation of crawl space. The        Closed cell                                               Living room, crawl space,        ~30y after isolation VOC, formaldehyde, MDI,
 (2019)                   Netherlands                                                                                        sample of SPF.                                        biological agents
 Kennisplatform
 Gespoten PUR-schuim
 Poppendieck (2017)       Furniture-free residential test facility Open cell in residential Unfurnished house without        Samples taken in basement        2y after application Flame retardant: TCPP
 National Institute of    with 15m2 SPF in basement.               setting.                 carpet (TCPP source is SPF       (n=12) and on first floor (n=9),
 standards and            Microchamber tests. USA                  Open and closed cell in  only)                            and outdoor
 technologies                                                      microchambers
 TNO-rapport R10642       SPF isolation of crawl space. The        Closed cell                                               Living room, crawl space         4 to 28 months after Isocyanates, blowing agents,
 (2013)                   Netherlands                                                                                                                         isolation. Median:   catalysts
                                                                                                                                                              8/9 months.
 Nuon Isolatie BV
 MDA: 4,4’-methylenedianiline; MDI: methylene diphenyl diisocyanate; SPF: Sprayed polyurethane foam; TCPP: Tris-(1-chloro-2-propyl) phosphate; TDI: toluene diisocyanate; VOC: Volatile Organic Compounds.
4         Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                                                                      2                                          6
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<pre>                             Overzicht van studies naar blootstelling en naar gezondheidsklachten na woningisolatie met gespoten PUR-schuim | pagina 6 van 8
 Table 4. Case studies
  Author (year    Setting                         Exposed person (incl.   Time of symptoms, Symptoms                                    Medical diagnosis                 Exposure measurement
  of publication)                                 medical history)        location
  Dietemann-      Domestic use of commercial      38-year old men,        Acute during          Asthmatic reaction while insulating     Four months later, high levels of none
  Molard (1991)   polyurethane foam for           bronchospasm after      insulation and        window, facial swelling while drilling  blood eosinophilia and specific
                  insulating a window and,        burning polyurethane    drilling.                                                     IgE against isocyanates. Skin-
                  24h later, drilling of dry foam packs, symptoms                                                                       prick tests negative, patch tests
                                                  disappeared after                                                                     with foam and MDI positive.
                                                  changing jobs                                                                         Bronchial provocation test with
                                                                                                                                        TDI negative. Realistic test with
                                                                                                                                        foam containing MDI induced
                                                                                                                                        acute bronchospasm.
  Huang (2014)    Spray polyurethane foam         13 adults from 10       Acute, and long       Fishy odors, watery and burning eyes,   Metacholine test after >6 months  Increased concentrations of
                  insulation in home at east      households              after application. At burning nose, sinus congestion, throat  in 7 subjects of which one was    SPF-derived and indoor VOC’s in
                  coast US. Faulty application;                           home only, all        irritation, cough, dyspnea, chest       positive. This subject had a      indoor air samples (5 houses, at
                  subjects stayed home during                             subjects eventually   tightness (n=13). Neuropsychiatric      history of mild intermittent      least 6 months after application)
                  application, returned too                               vacated their         symptoms including headache,            asthma. IgE for isocyanates was   and in vitro SPF samples (from 3
                  early, no ventilation was                               homes.                dizziness, forgetfulness, difficulty in negative for 4 subjects who had   houses). Indoor air VOC
                  applied, or improper mixing                                                   concentration, insomnia (n=12).         the test done after >5 months.    decreased after SPF removal (2
                  technique.                                                                    Nausea, vomiting abdominal cramps                                         houses)
                                                                                                (n=3), skin rash (n=3)
  Lacroix (1984)  Polyurethane insulation and     Two girls, aged 1,5 and Some after            Child 1.5 year old: Breathing problems                                    Water and mold on walls.
                  room humidification (on         3,5 years               insulation, most      and pneumonia. Asthma after                                               Characterization of molds
                  doctor’s advice) after first                            after room            humidification.
                  symptoms                                                humidification was    Child 3.5 year: breathing problems and
                                                                          started.              pneumonia after humidification. Both
                                                                                                girls have anorexia, headache, nausea
                                                                                                and vomiting after humidification.
                                                                                                Symptoms disappear after
                                                                                                humidification stopped.
  Redlich (2013)  Polyurethane foam               Subjects and family     After application,    Upper airway, mucosal and central       No new onset asthma or            Qualitative reporting of high total
                  application in homes of 4       members                 home-related          nervous system symptoms, distinct odor sensitization to MDI               VOC (above recommended
                  families                                                                                                                                                levels), detection of amine
                                                                                                                                                                          catalysts, siloxanes, blowing
                                                                                                                                                                          agents, fire retardants, aldehydes,
                                                                                                                                                                          polyols up to 20 months. No MDI
                                                                                                                                                                          detected.
5          Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                                                               2                                              7
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<pre>                            Overzicht van studies naar blootstelling en naar gezondheidsklachten na woningisolatie met gespoten PUR-schuim | pagina 7 van 8
  Author (year    Setting                       Exposed person (incl.        Time of symptoms, Symptoms                                   Medical diagnosis                  Exposure measurement
  of publication)                               medical history)             location
 Tsuang (2012)    SPF insulation of a           36-y old men and 38-y old    Acute at returning    Acute and persistent: noxious odor,    Positive methacholine challenge none
                  residential home, USA         women of the same            home after SPF        cough, dyspnea, dizziness, nausea,     test. Asthma or reactive airway
                                                household without            application (4 hours  headache, watery eyes.                 dysfunction syndrome diagnosis
                                                significant medical history, after completion of                                          induced by exposure to
                                                non-smoking, office-         application). And                                            isocyanates. Bronchodilators and
                                                based professions.           chronic.                                                     inhaled steroids treatment
 Verschoor        SPF insulation of crawl       11 persons from 7            Acute or chronic (?)  (reported more than once)                                                 None
 (2013)           space in residential homes,   households                   in home. Symptoms     Dyspnea: 6
                  the Netherlands                                            disappeared when      Eye complaints: 5
                                                                             leaving home.         Cough: 4
                                                                                                   Sore throat: 4
                                                                                                   Concentration problems: 2
                                                                                                   Swallowing complaints: 2
                                                                                                   Feel miserable: 3
                                                                                                   Stomach/gut complaints: 2
                                                                                                   Skin rash: 3
                                                                                                   Irritation mouth/tongue/throat: 3
                                                                                                   Headache: 3
                                                                                                   Muscle pain: 2
                                                                                                   Tired: 2
 Verschoor L      SPF insulation of cavity wall 62-y old men                 Day 2 after isolation Acute: odor                            Diagnosed as allergic or           Measurements done but results
 (2013)                                                                                            Day 2: tired, dyspnea.                 anaphylactic reaction. Bronchial   not reported.
                                                                                                   Chronic: stuffy nose, skin complaints, hyperreactivity. Allergic astma or
                                                                                                   allergic reaction to other compounds.  COPD.
 MDI: methylene diphenyl diisocyanate; SPF: Sprayed polyurethane foam; VOC: Volatile Organic Compounds
6         Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                                                                  2                                         8
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<pre> De Gezondheidsraad, ingesteld in 1902, is een adviesorgaan met als taak de regering en het parlement ‘voor te lichten over de stand der wetenschap
 ten aanzien van vraagstukken op het gebied van de volksgezondheid en het gezondheids(zorg)onderzoek’ (art. 22 Gezondheidswet).
 De Gezondheidsraad ontvangt de meeste adviesvragen van de bewindslieden van Volksgezondheid, Welzijn en Sport; Infrastructuur en Waterstaat;
 Sociale Zaken en Werkgelegenheid en Landbouw, Natuur en Voedselkwaliteit. De raad kan ook op eigen initiatief adviezen uitbrengen,
 en ontwikkelingen of trends signaleren die van belang zijn voor het overheidsbeleid.
 De adviezen van de Gezondheidsraad zijn openbaar en worden als regel opgesteld door multidisciplinaire commissies van – op persoonlijke titel
 benoemde – Nederlandse en soms buitenlandse deskundigen.
 U kunt dit document downloaden van www.gezondheidsraad.nl.
 Deze publicatie kan als volgt worden aangehaald:
 Gezondheidsraad. Overzicht van studies naar blootstelling en naar gezondheidsklachten na
 woningisolatie met gespoten PUR-schuim.
 Achtergronddocument bij Gespoten PUR-schuimisolatie en gezondheid.
 Den Haag: Gezondheidsraad, 2020; publicatienr. 2020/24A/02.
 Auteursrecht voorbehouden
7        Gezondheidsraad | Achtergronddocument Nr. 2020/24A/02                                                      2
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