Students' school-level symptoms mediate the relationship between a school's observed moisture problems and students’ subjective perceptions of indoor air quality

Moisture damage can influence the subjective assessment of indoor air quality (subjective IAQ) in various ways. We studied whether the frequency of symptoms reported across students at school level mediates the relationship between observed mold and dampness in a school building and students’ subjective IAQ. To answer this research question, we tested a multilevel path model. The analyzed data were created by merging two nationwide data sets: (a) survey data from students, including information on subjective IAQ (N = 24,786 students); (b) data from schools, including information on mold and dampness in a school building (N = 222). After the background variables were adjusted, schools’ observed mold and dampness were directly and significantly related to poor subjective IAQ (standardized beta (β)= 0.22, P = .002). In addition, in schools with mold and dampness, students reported significantly more symptoms (β = 0.22, P = .023) than in schools without; the higher the prevalence of symptoms at school level, the worse the students’ subjective IAQ (β = 0.60, P < .001). This indirect path was significant (P = .023). In total, schools’ observed mold and dampness and student-reported symptoms explained 52% of the between-school variance in subjective IAQ.     

Parental worry about indoor air quality and student symptom reporting in primary schools with or without indoor air quality problems

Poor indoor air quality (IAQ) in schools is related to increased symptom reporting in students. We investigated whether parental worry about school IAQ influences this association. Data came from survey collected from five Finnish primary schools with observed IAQ problems and five control schools. Parents (n = 1868) of primary school students reported worry about IAQ in schools and symptoms of their children. Associations between observed IAQ problems, worry, and five symptom scores (ie, respiratory, lower respiratory, eye, skin, and general symptoms) were analyzed using multivariate logistic regression and mediation analysis. Parents were on average more worried in schools with observed IAQ problems. Observed IAQ problems were strongly associated with increased worry and all symptoms under study (unadjusted ORs ranged between 1.48 [95% CI 1.48‐2.16] and 2.70 [95% CI 1.52‐5.17]). Parental worry was associated with all symptoms (unadjusted ORs ranged between 2.49 [95% CI 1.75‐3.60] and 4.92 [95% CI 2.77‐9.40]). Mediation analyses suggested that parental worry might partially explain the association between observed IAQ problems and symptom reporting (proportion mediated ranged between 67% and 84% for the different symptoms). However, prospective studies are needed to assess causal relationships between observed IAQ problems, worry, and symptom reporting in schools.     

A preliminary study on the association between ventilation rates in classrooms and student performance

Poor conditions leading to substandard indoor air quality (IAQ) in classrooms have been frequently cited in the literature over the past two decades. However, there is limited data linking poor IAQ in the classrooms to student performance. Whereas, it is assumed that poor IAQ results in reduced attendance and learning potential, and subsequent poor student performance, validating this hypothesis presents a challenge in today's school environment. This study explores the association between student performance on standardized aptitude tests that are administered to students on a yearly basis, to classroom carbon dioxide (CO2) concentrations, which provide a surrogate of ventilation being provided to each room. Data on classroom CO2 concentrations (over a 4-5 h time span within a typical school day) were recorded in fifth grade classrooms in 54 elementary schools within a school district in the USA. Results from this preliminary study yield a significant (P < 0.10) association between classroom-level ventilation rate and test results in math. They also indicate that non-linear effects may need to be considered for better representation of the association. A larger sample size is required in order to draw more definitive conclusions. Practical Implications Future studies could focus on (1) gathering more evidence on the possible association between classroom ventilation rates and students' academic performance; (2) the linear/non-linear nature of the association; and (3) whether it is possible to detect 'no observed adverse effect level' for adequate ventilation with respect to academic performance in schools. All of this information could be used to improve guidance and take regulatory actions to ensure adequate ventilation in schools. The high prevalence of low ventilation rates, combined with the growing evidence of the positive impact that sufficient ventilation has on human performance, suggests an opportunity for improving design and management of school facilities.     

Subjective Indoor Air Quality in Schools – The Influence of High Room Temperature,Carpeting, Fleecy Wall Materials and Volatile Organic Compounds (VOC)

There is a growing concern about indoor air quality (IAQ) in schools. We have studied relations between subjective indoor air quality (SIAQ) and measured IAQ among school personnel (N = 97) in six mid-Swedish primary schools. Information on SIAQ and the psychosocial work environment was measured by a self-administered questionnaire, using analogue rating scales. Indoor exposures were quantified by hygienic measurements. Perception of high room temperature was related to a poor climate of cooperation, fleecy wall materials, and the concentration of volatile organic compounds (VOC), including xylene, limonene, and butanols. Perception of air dry-ness was related to atopy, work stress, poor climate of cooperation, high room temperature, low air humidity, and high VOC concentration, including, limonene, and n-alkanes. Perception of dusty air was related to work stress, the role of schoolteacher, and exposure to 2-ethyl-1-hexanol. No relations were found between SIAQ and CO2, building age, or respirable dust. To achieve a good SIAQ, room temperature should be kept at a maximum of 22°C, and exposure to VOCs and fleecy materials should be minimized. Finally, a sound psychosocial work climate is essential for the perception of a good physical indoor climate.     

Building‐related health symptoms and classroom indoor air quality: a survey of school teachers in New York State

Most previous research on indoor environments and health has studied school children or occupants in non‐school settings. This investigation assessed building‐related health symptoms and classroom characteristics via telephone survey of New York State school teachers. Participants were asked about 14 building‐related symptoms and 23 classroom characteristics potentially related to poor indoor air quality (IAQ). Poisson regression analysis was used to assess the relationship between these symptoms and each classroom characteristic, controlling for potential confounders. About 500 teachers completed the survey. The most frequently reported classroom characteristics included open shelving (70.7%), food eaten in class (65.5%), dust (59.1%), and carpeting (46.9%). The most commonly reported symptoms included sinus problems (16.8%), headache (15.0%), allergies/congestion (14.8%), and throat irritation (14.6%). Experiencing one or more symptoms was associated most strongly with reported dust (relative risk (RR) = 3.67; 95% confidence interval (CI): 2.62–5.13), dust reservoirs (RR = 2.13; 95% CI: 1.72–2.65), paint odors (RR = 1.73; 95% CI: 1.40–2.13), mold (RR = 1.71; 95% CI: 1.39–2.11), and moldy odors (RR = 1.65 95% CI: 1.30–2.10). Stronger associations were found with increasing numbers of reported IAQ‐related classroom characteristics. Similar results were found with having any building‐related allergic/respiratory symptom. This research adds to the body of evidence underscoring the importance to occupant health of school IAQ.     

Classroom conditions and CO2 concentrations and teacher health symptom reporting in 10 New York State Schools

This study assessed the relationship between teacher‐reported symptoms and classroom carbon dioxide (CO₂) concentrations. Previous studies have suggested that poor indoor ventilation can result in higher levels of indoor pollutants, which may affect student and teacher health. Ten schools (9 elementary, 1 combined middle/high school) in eight New York State school districts were visited over a 4‐month period in 2010. Carbon dioxide concentrations were measured in classrooms over 48‐h, and teachers completed surveys assessing demographic information and self‐reported symptoms experienced during the current school year. Data from 64 classrooms (ranging from 1 to 9 per school) were linked with 68 teacher surveys (for four classrooms, two surveys were returned). Overall, approximately 20% of the measured classroom CO₂ concentrations were above 1000 parts per million (ppm), ranging from 352 to 1591 ppm. In multivariate analyses, the odds of reporting neuro‐physiologic (i.e., headache, fatigue, difficulty concentrating) symptoms among teachers significantly increased (OR = 1.30, 95% CI = 1.02–1.64) for every 100 ppm increase in maximum classroom CO₂ concentrations and were non‐significantly increased in classrooms with above‐median proportions of CO₂ concentrations greater than 1000 ppm (OR = 2.26, 95% CI = 0.72–7.12).     

Assessment of ventilation and indoor air pollutants in nursery and elementary schools in France

The aim of this study was to characterize the relationship between Indoor Air Quality (IAQ) and ventilation in French classrooms. Various parameters were measured over one school week, including volatile organic compounds, aldehydes, particulate matter (PM_2.5 mass concentration and number concentration), carbon dioxide (CO₂), air temperature, and relative humidity in 51 classrooms at 17 schools. The ventilation was characterized by several indicators, such as the air exchange rate, ventilation rate (VR), and air stuffiness index (ICONE), that are linked to indoor CO₂ concentration. The influences of the season (heating or non‐heating), type of school (nursery or elementary), and ventilation on the IAQ were studied. Based on the minimum value of 4.2 l/s per person required by the French legislation for mechanically ventilated classrooms, 91% of the classrooms had insufficient ventilation. The VR was significantly higher in mechanically ventilated classrooms compared with naturally ventilated rooms. The correlations between IAQ and ventilation vary according to the location of the primary source of each pollutant (outdoor vs. indoor), and for an indoor source, whether it is associated with occupant activity or continuous emission.     

Allergy and respiratory health effects of dampness and dampness‐related agents in schools and homes: a cross‐sectional study in Danish pupils

Little is known about the health effects of school‐related indoor dampness and microbial exposures. In this study, we investigated dampness and dampness‐related agents in both homes and schools and their association with allergy and respiratory health effects in 330 Danish pupils. Classroom dampness was identified based on technical inspection and bedroom dampness on parents' self‐report. Classroom and bedroom dust was analyzed for seven microbial components. Skin prick testing determined atopic sensitization. Lung function was expressed as z‐scores for forced expiratory volume in one‐second (zFEV₁), forced vital capacity (zFVC) and the ratio zFEV₁/zFVC using GLI‐2012 prediction equations. The parents reported children's allergies, airway symptoms, and doctor‐diagnosed asthma. High classroom dampness, but not bedroom dampness, was negatively associated with zFEV₁ (β‐coef. ?0.71; 95% CI ?1.17 to ?0.23) and zFVC (β‐coef. ?0.52; 95% CI ?0.98 to ?0.06) and positively with wheezing (OR 8.09; 95% CI 1.49 to 43.97). No consistent findings were found between any individual microbial components or combination of microbial components and health outcomes. Among other indoor risk factors, environmental tobacco smoke (ETS) decreased zFEV₁ (β‐coef. ?0.22; 95% CI ?0.42 to ?0.02) and zFEV₁/zFVCratio (β‐coef. ?0.26; 95% CI ?0.44 to ?0.07) and increased upper airway symptoms (OR 1.66; 95% CI 1.03–2.66). In conclusion, dampness in classrooms may have adverse respiratory health effects in pupils, but microbial agents responsible for this effect remain unknown.     

The relationship between indoor and outdoor temperature,apparent temperature,relative humidity,and absolute humidity

Many studies report an association between outdoor ambient weather and health. Outdoor conditions may be a poor indicator of personal exposure because people spend most of their time indoors. Few studies have examined how indoor conditions relate to outdoor ambient weather. The average indoor temperature, apparent temperature, relative humidity (RH), and absolute humidity (AH) measured in 16 homes in Greater Boston, Massachusetts, from May 2011 to April 2012 was compared to measurements taken at Boston Logan airport. The relationship between indoor and outdoor temperatures is nonlinear. At warmer outdoor temperatures, there is a strong correlation between indoor and outdoor temperature (Pearson correlation coefficient, r = 0.91, slope, β = 0.41), but at cooler temperatures, the association is weak (r = 0.40, β = 0.04). Results were similar for outdoor apparent temperature. The relationships were linear for RH and AH. The correlation for RH was modest (r = 0.55, β = 0.39). Absolute humidity exhibited the strongest indoor‐to‐outdoor correlation (r = 0.96, β = 0.69). Indoor and outdoor temperatures correlate well only at warmer outdoor temperatures. Outdoor RH is a poor indicator of indoor RH, while indoor AH has a strong correlation with outdoor AH year‐round.     

Ventilation rates in recently constructed U.S. school classrooms

Low ventilation rates (VRs) in schools have been associated with absenteeism, poorer academic performance, and teacher dissatisfaction. We measured VRs in 37 recently constructed or renovated and mechanically ventilated U.S. schools, including LEED and EnergyStar‐certified buildings, using CO₂ and the steady‐state, build‐up, decay, and transient mass balance methods. The transient mass balance method better matched conditions (specifically, changes in occupancy) and minimized biases seen in the other methods. During the school day, air change rates (ACRs) averaged 2.0±1.3 hour^?1, and only 22% of classrooms met recommended minimum ventilation rates. HVAC systems were shut off at the school day close, and ACRs dropped to 0.21±0.19 hour^?1. VRs did not differ by building type, although cost‐cutting and comfort measures resulted in low VRs and potentially impaired IAQ. VRs were lower in schools that used unit ventilators or radiant heating, in smaller schools and in larger classrooms. The steady‐state, build‐up, and decay methods had significant limitations and biases, showing the need to confirm that these methods are appropriate. Findings highlight the need to increase VRs and to ensure that energy saving and comfort measures do not compromise ventilation and IAQ.     

Indoor air quality in Michigan schools

Indoor air quality (IAQ) parameters in 64 elementary and middle school classrooms in Michigan were examined for the purposes of assessing ventilation rates, levels of volatile organic compounds (VOCs) and bioaerosols, air quality differences within and between schools, and emission sources. In each classroom, bioaerosols, VOCs, CO(2), relative humidity, and temperature were monitored over one workweek, and a comprehensive walkthough survey was completed. Ventilation rates were derived from CO(2) and occupancy data. Ventilation was poor in many of the tested classrooms, e.g., CO(2) concentrations often exceeded 1000 ppm and sometimes 3000 ppm. Most VOCs had low concentrations (mean of individual species <4.5 microg/m(3)); bioaerosol concentrations were moderate (<6500 count per m(3) indoors, <41,000 count per m(3) outdoors). The variability of CO(2), VOC, and bioaerosol concentrations within schools exceeded the variability between schools. These findings suggest that none of the sampled rooms were contaminated and that no building-wide contamination sources were present. However, localized IAQ problems might remain in spaces where contaminant sources are concentrated and that are poorly ventilated. PRACTICAL IMPLICATIONS: Indoor air quality (IAQ) is a continuing concern for students, parents, teachers, and school staff, leading to many complaints regarding poor IAQ. Investigations of these complaints often include air sampling, which must be carefully conducted if representative data are to be collected. To better understand sampling results, investigators need to account for the variability of contaminants both within and between schools.     

Indoor air quality in Portuguese schools: levels and sources of pollutants

Indoor air quality (IAQ) parameters in 73 primary classrooms in Porto were examined for the purpose of assessing levels of volatile organic compounds (VOCs), aldehydes, particulate matter, ventilation rates and bioaerosols within and between schools, and potential sources. Levels of VOCs, aldehydes, PM_2.5, PM₁₀, bacteria and fungi, carbon dioxide (CO₂), carbon monoxide, temperature and relative humidity were measured indoors and outdoors and a walkthrough survey was performed concurrently. Ventilation rates were derived from CO₂ and occupancy data. Concentrations of CO₂ exceeding 1000 ppm were often encountered, indicating poor ventilation. Most VOCs had low concentrations (median of individual species <5 μg/m³) and were below the respective WHO guidelines. Concentrations of particulate matter and culturable bacteria were frequently higher than guidelines/reference values. The variability of VOCs, aldehydes, bioaerosol concentrations, and CO₂ levels between schools exceeded the variability within schools. These findings indicate that IAQ problems may persist in classrooms where pollutant sources exist and classrooms are poorly ventilated; source control strategies (related to building location, occupant behavior, maintenance/cleaning activities) are deemed to be the most reliable for the prevention of adverse health consequences in children in schools.     

The effects of building‐related factors on classroom relative humidity among North Carolina schools participating in the ‘Free to Breathe,Free to Teach’ study

Both high and low indoor relative humidity (RH) directly impact Indoor Air Quality (IAQ), an important school health concern. Prior school studies reported a high prevalence of mold, roaches, and water damage; however, few examined associations between modifiable classroom factors and RH, a quantitative indicator of dampness. We recorded RH longitudinally in 134 North Carolina classrooms (n = 9066 classroom‐days) to quantify the relationships between modifiable classroom factors and average daily RH below, within, or above levels recommended to improve school IAQ (30–50% or 30–60% RH). The odds of having high RH (>60%) were 5.8 [95% Confidence Interval (CI): 2.9, 11.3] times higher in classrooms with annual compared to quarterly heating, ventilating, and air‐conditioning (HVAC) system maintenance and 2.5 (95% CI: 1.5, 4.2) times higher in classrooms with HVAC economizers compared to those without economizers. Classrooms with direct‐expansion split systems compared to chilled water systems had 2.7 (95% CI: 1.7, 4.4) times higher odds of low RH (<30%). When unoccupied, classrooms with thermostat setbacks had 3.7 (95% CI: 1.7, 8.3) times the odds of high RH (>60%) of those without setbacks. This research suggests actionable decision points for school design and maintenance to prevent high or low classroom RH.     

Unexpected increase in indoor pollutants after the introduction of a smoke‐free policy in a correctional center

Correctional centers (prisons) are one of the few non‐residential indoor environments where smoking is still permitted. However, few studies have investigated indoor air quality (IAQ) in these locations. We quantified the level of inmate and staff exposure to secondhand smoke, including particle number (PN) count, and we assessed the impact of the smoking ban on IAQ. We performed measurements of indoor and outdoor PM_2.5 and PN concentrations, personal PN exposure levels, volatile organic compounds (VOCs), and nicotine both before and after a complete indoor smoking ban in an Australian maximum security prison. Results show that the indoor 24‐h average PM_2.5 concentrations ranged from 6 (±1) μg/m³ to 17 (±3) μg/m³ pre‐ban. The post‐ban levels ranged from 7 (±2) μg/m³ to 71 (±43) μg/m³. While PM_2.5 concentrations decreased in one unit post‐ban, they increased in the other two units. Similar post‐ban increases were also observed in levels of PN and VOCs. We describe an unexpected increase of indoor pollutants following a total indoor smoking ban in a prison that was reflected across multiple pollutants that are markers of smoking. We hypothesise that clandestine post‐ban smoking among inmates may have been the predominant cause.     

Can changing the timing of outdoor air intake reduce indoor concentrations of traffic‐related pollutants in schools?

Traffic emissions have been associated with a wide range of adverse health effects. Many schools are situated close to major roads, and as children spend much of their day in school, methods to reduce traffic‐related air pollutant concentrations in the school environment are warranted. One promising method to reduce pollutant concentrations in schools is to alter the timing of the ventilation so that high ventilation time periods do not correspond to rush hour traffic. Health Canada, in collaboration with the Ottawa‐Carleton District School Board, tested the effect of this action by collecting traffic‐related air pollution data from four schools in Ottawa, Canada, during October and November 2013. A baseline and intervention period was assessed in each school. There were statistically significant (P < 0.05) reductions in concentrations of most of the pollutants measured at the two late‐start (9 AM start) schools, after adjusting for outdoor concentrations and the absolute indoor–outdoor temperature difference. The intervention at the early‐start (8 AM start) schools did not have significant reductions in pollutant concentrations. Based on these findings, changing the timing of the ventilation may be a cost‐effective mechanism of reducing traffic‐related pollutants in late‐start schools located near major roads.     

Persistent allergic rhinitis and indoor air quality perception--an experimental approach

In order to compare patterns of indoor air perception, including perceptions of temperature, air movement, indoor air quality (IAQ), mental concentration, and comfort, 33 subjects either with persistent allergic rhinitis or controls were exposed to different temperatures and constant relative humidity in an experimental office environment. Results were obtained by means of a self-administered visual analogue scale, analyzed using mean score comparisons and principal component analysis. At 14 degrees C, the rhinitis group reported higher scores for sensations of air dryness than controls. At 18 degrees C, in the rhinitis group, there was a correlation between dry, stagnant air, and difficult mental concentration. This group also correlated heat, dry air, and poor IAQ, in contrast to the control group, which correlated comfort, easy mental concentration, and freshness. At 22 degrees C, the rhinitis group correlated heat, dryness, stagnant air, and overall discomfort. This group also correlated non-dry air, freshness, and comfort, whereas the control group correlated heat, humidity, good indoor air, freshness, and comfort. This study suggests that the rhinitis group perceives indoor temperatures of 14 degrees C as dryer than controls do, and that at 18 and 22 degrees C this group positively correlates different adverse perceptions of IAQ. By means of a self-administered questionnaire in an experimental condition, the present study compares subjective patterns of indoor air perception from individuals with respiratory allergy (allergic rhinitis) to control individuals. It reports different patterns of perception of indoor air quality (IAQ) between the two groups, suggesting that allergic individuals could have different IAQ perception.     

Do classroom ventilation rates in California elementary schools influence standardized test scores? Results from a prospective study

Limited evidence has associated lower ventilation rates (VRs) in schools with reduced student learning or achievement. We analyzed longitudinal data collected over two school years from 150 classrooms in 28 schools within three California school districts. We estimated daily classroom VRs from real‐time indoor carbon dioxide measured by web‐connected sensors. School districts provided individual‐level scores on standard tests in Math and English, and classroom‐level demographic data. Analyses assessing learning effects used two VR metrics: average VRs for 30 days prior to tests, and proportion of prior daily VRs above specified thresholds during the year. We estimated relationships between scores and VR metrics in multivariate models with generalized estimating equations. All school districts had median school‐year VRs below the California VR standard. Most models showed some positive associations of VRs with test scores; however, estimates varied in magnitude and few 95% confidence intervals excluded the null. Combined‐district models estimated statistically significant increases of 0.6 points (P = 0.01) on English tests for each 10% increase in prior 30‐day VRs. Estimated increases in Math were of similar magnitude but not statistically significant. Findings suggest potential small positive associations between classroom VRs and learning.     

Sick building syndrome—A case study in a multistory centrally air-conditioned building in the Delhi City

Recently, airtight envelope system has become popular in the design of office buildings to reduce heating and cooling loads. Maintaining allowable indoor air quality (IAQ) for such airtight buildings totally depends on mechanical ventilation systems. Subsequently, poor operation of the ventilation system in such office buildings causes ineffective removal of polluted indoor air, and displays a sign of “sick building syndrome” (SBS). User's perception is an important parameter for evaluating IAQ. A questionnaire study was carried out to investigate the prevalence of the SBS at a multistory centrally air-conditioned Airport Authority of India (AAI) building in the New Delhi city. Quantification of the perceptions of the users regarding IAQ was done by converting their responses to a SBS score. The quantified answers were then subjected to statistical analysis. Qualitative analysis of the questionnaire was carried out to evaluate relationships between SBS score and carbon dioxide (CO₂) and other parameters related to building and work environment. Quantitative analysis of IAQ was also conducted by monitoring indoor concentrations of four pollutants, namely, nitrogen dioxide (NO₂), sulphur dioxide (SO₂), suspended particulate matter (SPM) and carbon monoxide (CO). Concentrations of pollutants were complying with IAQ standards as given by ASHRAE and WHO. The SBS was higher on the third floor as compared to other floors and the control tower. The main symptoms prevailing were headache (51%), lethargy (50%), and dryness in body mucous (33%). The third floor and the control tower were affected by infiltration, mainly from entrance doors. A direct relation between the average SBS score and CO₂ concentration was found, i.e., the average SBS score increased with CO₂ concentration and vice versa, clearly signifying the usefulness of SBS score in IAQ.     

Ventilation rates in schools

Research shows that poor indoor air quality (IAQ) in school buildings can cause a reduction in the students’ performance assessed by short-term computer-based tests; whereas good air quality in classrooms can enhance children's concentration and also teachers’ productivity. Investigation of air quality in classrooms helps us to characterise pollutant levels and implement corrective measures. Outdoor pollution, ventilation equipment, furnishings, and human activities affect IAQ. In school classrooms, the occupancy density is high (1.8–2.4 m²/person) compared to offices (10 m²/person). Ventilation systems expend energy and there is a trend to save energy by reducing ventilation rates. We need to establish the minimum acceptable level of fresh air required for the health of the occupants. This paper describes a project, which will aim to investigate the effect of IAQ and ventilation rates on pupils’ performance and health using psychological tests. The aim is to recommend suitable ventilation rates for classrooms and examine the suitability of the air quality guidelines for classrooms. The air quality, ventilation rates and pupils’ performance in classrooms will be evaluated in parallel measurements. In addition, Visual Analogue Scales will be used to assess subjective perception of the classroom environment and SBS symptoms. Pupil performance will be measured with Computerised Assessment Tests (CAT), and Pen and Paper Performance Tasks while physical parameters of the classroom environment will be recorded using an advanced data logging system. A total number of 20 primary schools in the Reading area are expected to participate in the present investigation, and the pupils participating in this study will be within the age group of 9–11 years. On completion of the project, based on the overall data recommendations for suitable ventilation rates for schools will be formulated.     

What is IAQ?

In spaces for human occupancy indoor air quality (IAQ) is often defined as the extent to which human requirements are met. But what requirements do people have in relation to indoor air? The desire is that the air be perceived as fresh and pleasant, that it has no negative impact on their health, and that the air is stimulating and promotes their work, i.e. it increases their productivity and the learning of their children in the classroom at school. Present ventilation standards and guidelines do not care about productivity and learning and have the very modest requirement that the indoor air shall be 'acceptable,' meaning that the most sensitive group of persons (usually 20%) perceive the air as unacceptable while the remaining less sensitive persons may find the air barely acceptable. With such a modest aim it is not surprising that comprehensive field studies in many countries in buildings in which ventilation standards are met show high percentages of dissatisfied persons and of those suffering from sick building syndrome symptoms. Recent studies show that improvement of IAQ by a factor of 2-7 compared with existing standards increases office productivity and school learning significantly, while decreasing the risk of allergic symptoms and asthma in homes. To make indoor air acceptable, even for the most sensitive persons, an improvement of 1-2 orders of magnitude may be required. The paper will discuss the development of new methods that can provide such substantial improvements of IAQ while maintaining or even decreasing ventilation and energy usage. A paradigm shift is required and further future shifts are foreseen where we learn how to make indoor air equally fresh and pleasant as outdoors when it is best. Or even better, i.e. 'out of this world.' PRACTICAL IMPLICATIONS: The paper estimates an enormous potential for improving IAQ in practice utilizing new emerging technologies. This will enable us to provide IAQ which is acceptable even for the most sensitive persons. Already modest improvements compared to present minimum standards and typical conditions in practice can significantly decrease the risk of asthma/allergy in homes, improve learning in schools and increase productivity.