Ventilation rates in the bedrooms of 500 Danish children

The ongoing “Indoor Environment and Children’s Health” (IECH) study investigates the environmental risk factors in homes and their association with asthma and allergy among children aged 1–5 years. As part of the study, the homes of 500 children between 3 and 5 years of age were inspected. The selected children included 200 symptomatic children (cases) and 300 randomly selected children (bases). As part of the inspection, the concentration of carbon dioxide in the bedrooms of the children was continuously measured over an average of 2.5 days. The ventilation rates in the rooms during the nights when the children were sleeping in the room were calculated using a single-zone mass balance for the occupant-generated CO₂. The calculated air change rates were log-normally distributed (R² > 0.98). The geometric mean of the air change rates in both the case and the base group was 0.46 air changes per hour (h⁻¹; geom. SD = 2.08 and 2.13, respectively). Approximately 57% of both cases and bases slept at a lower ventilation rate than the minimum required ventilation rate of 0.5 h⁻¹ in new Danish dwellings. Only 32% of the bedrooms had an average CO₂ concentration below 1000 ppm during the measured nights. Twenty-three percent of the rooms experienced at least a 20-minute period during the night when the CO₂ concentration was above 2000 ppm and 6% of the rooms experienced concentrations above 3000 ppm. The average air change rate was higher with more people sleeping in the room. The air change rate did not change with the increasing outdoor temperature over the 10-week experimental period. The calculation method provides an estimate of the total airflow into the bedroom, including airflows both from outdoors and from adjacent spaces. To study the accuracy of the calculated air change rates and their deviation from the true outside air change rates, we calculated CO₂ concentrations at different given air change rates using an indoor air quality and ventilation model (Contam). Subsequently we applied our calculation procedure to the obtained data. The air change rate calculated from the generated CO₂ concentrations was found to be between 0% and 51% lower than the total air change rate defined in the input variables for the model. It was, however, higher than the true outside air change rate. The relative error depended on the position of the room in relation to the adjacent rooms, occupancy in the adjacent room, the nominal air change rate and room-to-room airflows.     

The IVAIRE project – a randomized controlled study of the impact of ventilation on indoor air quality and the respiratory symptoms of asthmatic children in single family homes

A randomized controlled trial was carried out to measure the impact of an intervention on ventilation, indoor air contaminants, and asthma symptoms of children. Eighty‐three asthmatic children living in low‐ventilated homes were followed over 2 years. Several environmental parameters were measured during the summer, fall, and winter. The children were randomized after Year 1 (43 Intervention; 40 Control). The intervention included the installation of either a Heat Recovery Ventilator (HRV) or Energy Recovery Ventilator (ERV). During the fall and winter seasons, there was a significant increase in the mean ventilation rate in the homes of the intervention group. A statistically significant reduction in mean formaldehyde, airborne mold spores, toluene, styrene, limonene, and α‐pinene concentrations was observed in the intervention group. There was no significant group difference in change in the number of days with symptoms per 14 days. However, there was a significant decrease in the proportion of children who experienced any wheezing (≥1 episode) and those with ≥4 episodes in the 12‐month period in the intervention group. This study indicates that improved ventilation reduces air contaminants and may prevent wheezing. Due to lack of power, a bigger study is needed.     

Modeling ventilation rates in bedrooms based on building characteristics and occupant behavior

Air change rate (ACR) data obtained from the bedrooms of 500 Danish children and presented in an earlier paper were analyzed in more detail. Questionnaires distributed to the families, home inspections and interviews with the parents provided information about a broad range of residential characteristics and occupant behavior. These were tested in several linear regression models to identify the degree of effect each selected independent variable has on the total ACR. The measured ACRs are summarized by some of the most significant variables such as room volume (higher ACR in smaller rooms), number of people sleeping in the bedroom (higher ACR with more people), average window and door opening habits (higher ACR with more opening), sharing the bedroom with other family members (higher ACR in shared rooms), location of the measured room (higher ACR above ground floor), year of construction (lowest ACR in buildings from early 1970s), observed condensation on the bedroom window (higher ACR at less condensation), etc. The best-fitting model explained 46% of the variability in the air change rates. Variables related to occupant behavior were stronger predictors of ventilation rate (model R² = 0.30) than those related to building characteristics (model R² = 0.09). Although not perfectly accurate on a room-to-room basis, our best-fitting model may be useful when a rough estimate of the average air change rate for larger study populations is required in future indoor air quality models.     

Association of ventilation rates and CO2 concentrations with health and other responses in commercial and institutional buildings

This paper reviews current literature on the associations of ventilation rates and carbon dioxide concentrations in non-residential and non-industrial buildings (primarily offices) with health and other human outcomes. Twenty studies, with close to 30,000 subjects, investigated the association of ventilation rates with human responses, and 21 studies, with over 30,000 subjects, investigated the association of carbon dioxide concentration with these responses. Almost all studies found that ventilation rates below 10 Ls-1 per person in all building types were associated with statistically significant worsening in one or more health or perceived air quality outcomes. Some studies determined that increases in ventilation rates above 10 Ls-1 per person, up to approximately 20 Ls-1 per person, were associated with further significant decreases in the prevalence of sick building syndrome (SBS) symptoms or with further significant improvements in perceived air quality. The carbon dioxide studies support these findings. About half of the carbon dioxide studies suggest that the risk of sick building syndrome symptoms continued to decrease significantly with decreasing carbon dioxide concentrations below 800 ppm. The ventilation studies reported relative risks of 1.5-2 for respiratory illnesses and 1.1-6 for sick building syndrome symptoms for low compared to high low ventilation rates.     

Association of ventilation system type with SBS symptoms in office workers

This paper provides a synthesis of current knowledge about the associations of ventilation system types in office buildings with sick building syndrome (SBS) symptoms and discusses potential explanations for the associations. Most studies completed to date indicate that relative to natural ventilation, air conditioning, with or without humidification, was consistently associated with a statistically significant increase in the prevalence of one or more SBS symptoms, by approximately 30 to 200%. In two of three analyses from a single study (assessments), symptom prevalences were also significantly higher in air-conditioned buildings than in buildings with simple mechanical ventilation and no humidification. The available data also suggest, with less consistency, an increase in risk of symptoms with simple mechanical ventilation relative to natural ventilation. Insufficient information was available for conclusions about the potential increased risk of SBS symptoms with humidification or recirculation of return air. The statistically significant associations of mechanical ventilation and air conditioning with SBS symptoms are much more frequent than expected from chance and also not likely to be a consequence of confounding by several potential personal, job, or building-related confounders. Multiple deficiencies in HVAC system design, construction, operation, or maintenance, including some which cause pollutant emissions from HVAC systems, may contribute to the increases in symptom prevalences but other possible reasons remain unclear.     

A comparison between occupants’ and inspectors’ reports on home dampness and their association with the health of children: The ALLHOME study

There is some discussion concerning the methodology to be used in order to obtain health-relevant information regarding moisture-related problems in homes (dampness). Occupants’ reports, inspectors’ observations and physical measurements are often used methods. In the current study, data on dwelling dampness and characteristics as reported by parents of 216 pre-school children (the cross-sectional questionnaire study ALLHOME-1) was compared with the information collected by non-professional dwelling inspectors in a nested case–control study (the ALLHOME-2 study). The study took place in the cities of Burgas and Sofia in Bulgaria. The inspectors reported less visible mould, but more damp stains and a mouldy odour than the parents. Exposure to dampness, as reported by parents, was significantly associated with airways, nose and/or skin symptoms (case status) among children, while no association was found between inspectors’ observations on dampness and children's health. Parental reports on housing characteristics such as type of house, residential situation, and type of flooring material matched with those identified by the inspectors and therefore can be used as a reliable source of information in studies on indoor environmental exposure and health. With regard to dampness, parental reports seem to be more health relevant than inspectors reports.     

Indoor air quality,ventilation and health symptoms in schools: an analysis of existing information

We reviewed the literature on Indoor Air Quality (IAQ), ventilation, and building-related health problems in schools and identified commonly reported building-related health symptoms involving schools until 1999. We collected existing data on ventilation rates, carbon dioxide (CO2) concentrations and symptom-relevant indoor air contaminants, and evaluated information on causal relationships between pollutant exposures and health symptoms. Reported ventilation and CO2 data strongly indicate that ventilation is inadequate in many classrooms, possibly leading to health symptoms. Adequate ventilation should be a major focus of design or remediation efforts. Total volatile organic compounds, formaldehyde (HCHO) and microbiological contaminants are reported. Low HCHO concentrations were unlikely to cause acute irritant symptoms (<0.05 ppm), but possibly increased risks for allergen sensitivities, chronic irritation, and cancer. Reported microbiological contaminants included allergens in deposited dust, fungi, and bacteria. Levels of specific allergens were sufficient to cause symptoms in allergic occupants. Measurements of airborne bacteria and airborne and surface fungal spores were reported in schoolrooms. Asthma and 'sick building syndrome' symptoms are commonly reported. The few studies investigating causal relationships between health symptoms and exposures to specific pollutants suggest that such symptoms in schools are related to exposures to volatile organic compounds (VOCs), molds and microbial VOCs, and allergens.     

Breastfeeding modifies the effects of environment tobacco smoke exposure on respiratory diseases and symptoms in Chinese children: the Seven Northeast Cities Study

To evaluate the potential effect of interaction between breastfeeding and environmental tobacco smoke (ETS) exposure on respiratory health, we studied 31 049 children (aged 2–14 years) from 25 districts of seven cities in northeast China. Parents of the children completed standardized questionnaires that characterized the children's histories of respiratory symptoms and illness, feeding methods, ETS exposure, and other associated risk factors. Breastfeeding was defined as having been mainly breastfed for 3 months or more. The results showed that the association of ETS exposure with childhood respiratory conditions/diseases was modified by breastfeeding, and the association for nonbreastfed children was stronger than that for breastfed children. In particular, for nonbreastfed children, the odds ratios (ORs) for the effect of current ETS exposure asthma was 1.71 (95% CI: 1.43–2.05); however, the OR for breastfed children was 1.33 (95% CI: 1.20–1.48), indicating that the interactions between breastfeeding and current ETS exposure on asthma were statistically significant (P = 0.019). When stratified by school (kindergarten vs. elementary school), breastfeeding was more protective for asthma‐related symptoms among children from kindergarten. In conclusion, this study shows that breastfeeding is associated with smaller associations between ETS exposure and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of ETS.     

Effect of cross section and ventilation on heat release rates in tunnel fires

Model scale fire tests were performed in tunnels with varying tunnel widths and heights in order to study the effect of tunnel cross-section and ventilation velocity on the heat release rate (HRR) for both liquid pool fires and solid fuel fires. The results showed that for well ventilated heptane pool fires, the tunnel width nearly has no influence on the HRR whilst a lower tunnel height clearly increases the HRR. For well ventilated solid fuel fires, the HRR increases by approximately 25% relative to a free burn test but the HRR is not sensitive to either tunnel width, tunnel height or ventilation velocity. For solid fuel fires that were not well ventilated, the HRRs could be less than those in free burn laboratory tests. In the case of ventilation controlled fires the HRRs approximately lie at the same level as for cases with natural ventilation.     

Effectiveness of heating, ventilation and air conditioning system with HEPA filter unit on indoor air quality and asthmatic children's health

Poor indoor air quality has been linked to the exacerbation of asthma symptoms in children. Because people spend most of their time indoors, improving indoor air quality may provide some relief to asthma sufferers. A study was conducted to assess whether operating an air cleaning/ventilating unit (HEPAiRx^®) in a child's bedroom can improve his/her respiratory health. Thirty children diagnosed with asthma were randomly split into two groups. For the first six weeks, group A had the air cleaning/ventilating unit (HEPAiRx^®) running in the bedrooms of the participants and group B did not; for the second six weeks, both groups had the cleaners running in the bedrooms; and, for the final six weeks, group A turned the cleaners off and group B kept theirs running. Indoor air quality parameters, including temperature, relative humidity, particulate matter (PM 0.5–10 μm), carbon monoxide, carbon dioxide and total volatile organic compound (TVOC) concentrations, were monitored in each bedroom using an AirAdvice indoor air quality multi-meter. As a measure of pulmonary inflammation, exhaled breath condensate (EBC) was collected every sixth day and analyzed for nitrate and pH. Peak expiratory flow (PEF) was also measured. PM and TVOC concentrations decreased with operation of the HEPAiRx an average of 72% and 59%, respectively. The EBC nitrate concentrations decreased significantly and the EBC pH and PEF values increased significantly with operation of the unit (p < 0.001 when comparing on/off sample means). These results indicate that air cleaning in combination with ventilation can effectively reduce symptoms for asthma sufferers.     

The effect of ventilation strategies of child care centers on indoor air quality and respiratory health of children in Singapore

This paper reports the effects of ventilation strategies on indoor air quality (IAQ) and respiratory health of children within 104 child care centers (CCCs) in a hot and humid climate. The CCCs were categorized by ventilation strategies: natural (NV), air-conditioned and mechanically ventilated (ACMV), air-conditioned using split units (AC), and hybrid (NV and AC operated intermittently). The concentration levels of IAQ parameters in NV CCCs are characterized by the influence of the outdoors and good dilution of indoor pollutants. The lower ventilation rates in air-conditioned CCCs result in higher concentrations of occupant-related pollutants but lower outdoor pollutant ingress. This study also revealed lower prevalence for most asthma and allergy, and respiratory symptoms in children attending NV CCCs. In multivariate analyses controlled for the effects of confounders, the risk of current rhinitis among children is significantly higher if they attend mechanically ventilated CCCs compared to NV CCCs. Air-conditioned CCCs were also associated with higher adjusted prevalence ratio of severe phlegm and cough symptoms and lower respiratory illness. Finally, children attending CCCs with hybrid ventilation are at high risk for almost all the respiratory symptoms studied. PRACTICAL IMPLICATIONS: This large field study indicates that different ventilation strategies employed by child care centers can cause significant variations in the indoor air quality and prevalence of asthma, allergies and respiratory symptoms of attending children. The higher prevalence rates of allergic and respiratory symptoms among young children, whose immune system is still under-developed, in child care centers, whether fully or partially air-conditioned, suggest that ventilation and plausible growth and propagation mechanisms of allergens and infectious agents be further investigated.     

Are cats and dogs the major source of endotoxin in homes?

Previous studies have suggested that exposure to cats and dogs during early childhood reduces the risk of allergic disease, possibly by increasing home endotoxin exposure. This study asked the question of whether cats and dogs are the dominant influence on dust endotoxin concentrations in homes after considering other variables reportedly associated with endotoxin. The presence of cats or dogs in homes, household and home characteristics, and dust endotoxin concentrations from 5 locations were assessed in 966 urban and suburban homes. Whether considered together as pets or as cats and dogs separately, the presence of cats and dogs significantly contributed to living room and bedroom floor endotoxin concentrations, but not to bed endotoxin concentrations. However, the two variables consistently related to endotoxin in all home sites were the home occupant density (occupants/room) and cleanliness of the home. Our data suggest that reducing occupant density and improving home cleanliness would reduce home endotoxin concentrations more than removing pet cats or dogs from the home.     

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.     

Effects of ventilation rate per person and per floor area on perceived air quality,sick building syndrome symptoms,and decision‐making

Ventilation rates (VRs) in buildings must adequately control indoor levels of pollutants; however, VRs are constrained by the energy costs. Experiments in a simulated office assessed the effects of VR per occupant on perceived air quality (PAQ), Sick Building Syndrome (SBS) symptoms, and decision‐making performance. A parallel set of experiments assessed the effects of VR per unit floor area on the same outcomes. Sixteen blinded healthy young adult subjects participated in each study. Each exposure lasted four hours and each subject experienced two conditions in a within‐subject study design. The order of presentation of test conditions, day of testing, and gender were balanced. Temperature, relative humidity, VRs, and concentrations of pollutants were monitored. Online surveys assessed PAQ and SBS symptoms and a validated computer‐based tool measured decision‐making performance. Neither changing the VR per person nor changing the VR per floor area, had consistent statistically significant effects on PAQ or SBS symptoms. However, reductions in either occupant‐based VR or floor‐area‐based VR had a significant and independent negative impact on most decision‐making measures. These results indicate that the changes in VR employed in the study influence performance of healthy young adults even when PAQ and SBS symptoms are unaffected.     

Molds in floor dust and building-related symptoms in adolescent school children

This stratified cross-sectional epidemiological study included 1053 school children aged 13-17 years. All pupils filled in a questionnaire on building-related symptoms and other relevant health aspects. The following exposure measurements were carried out: room temperature, CO2 level, and relative humidity; building characteristics including mold infestation were assessed, and dust was collected from floors, air, and ventilation ducts during a working day. Dust was examined for endotoxin level, and cultivated for viable molds. We did not find a positive association between building-related symptoms and extent of moisture and mold growth in the school buildings. Five of eight building-related symptoms were significantly and positively associated with the concentration of colony forming units of molds in floor dust: eye irritation, throat irritation, headache, concentration problems, and dizziness. After adjusting for different potentially confounding factors in separate analyses of each symptom, the above-mentioned associations between molds in dust and symptoms were still present, except for concentration problems. However, in none of the analyses was mold exposure the strongest covariate, being secondary to either asthma, hay fever, recent airway infection, or psychosocial factors.     

Association between substandard classroom ventilation rates and students' academic achievement

This study focuses on the relationship between classroom ventilation rates and academic achievement. One hundred elementary schools of two school districts in the southwest United States were included in the study. Ventilation rates were estimated from fifth-grade classrooms (one per school) using CO(2) concentrations measured during occupied school days. In addition, standardized test scores and background data related to students in the classrooms studied were obtained from the districts. Of 100 classrooms, 87 had ventilation rates below recommended guidelines based on ASHRAE Standard 62 as of 2004. There is a linear association between classroom ventilation rates and students' academic achievement within the range of 0.9-7.1 l/s per person. For every unit (1 l/s per person) increase in the ventilation rate within that range, the proportion of students passing standardized test (i.e., scoring satisfactory or above) is expected to increase by 2.9% (95%CI 0.9-4.8%) for math and 2.7% (0.5-4.9%) for reading. The linear relationship observed may level off or change direction with higher ventilation rates, but given the limited number of observations, we were unable to test this hypothesis. A larger sample size is needed for estimating the effect of classroom ventilation rates higher than 7.1 l/s per person on academic achievement. PRACTICAL IMPLICATIONS: The results of this study suggest that increasing the ventilation rates toward recommended guideline ventilation rates in classrooms should translate into improved academic achievement of students. More studies are needed to fully understand the relationships between ventilation rate, other indoor environmental quality parameters, and their effects on students' health and achievement. Achieving the recommended guidelines and pursuing better understanding of the underlying relationships would ultimately support both sustainable and productive school environments for students and personnel.