Estimated effect of ventilation and filtration on chronic health risks in U.S. offices,schools, and retail stores

We assessed the chronic health risks from inhalation exposure to volatile organic compounds (VOCs) and particulate matter (PM2.5) in U.S. offices, schools, grocery, and other retail stores and evaluated how chronic health risks were affected by changes in ventilation rates and air filtration efficiency. Representative concentrations of VOCs and PM2.5 were obtained from available data. Using a mass balance model, changes in exposure to VOCs and PM2.5 were predicted if ventilation rate were to increase or decrease by a factor of two, and if higher efficiency air filters were used. Indoor concentrations were compared to health guidelines to estimate percentage exceedances. The estimated chronic health risks associated with VOC and PM2.5 exposures in these buildings were low relative to the risks from exposures in homes. Chronic health risks were driven primarily by exposures to PM2.5 that were evaluated using disease incidence of mortality, chronic bronchitis, and non‐fatal stroke. The leading cancer risk factor was exposure to formaldehyde. Using disability‐adjusted life years (DALYs) to account for both cancer and non‐cancer effects, results suggest that increasing ventilation alone is ineffective at reducing chronic health burdens. Other strategies, such as pollutant source control and the use of particle filtration, should also be considered.     

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.     

Association of subjective health symptoms with indoor air quality in European office buildings: The OFFICAIR project

The aim of this study was to explore the association between the building-related occupants’ reported health symptoms and the indoor pollutant concentrations in a sample of 148 office rooms, within the framework of the European OFFICAIR research project. A large field campaign was performed in 37 office buildings among eight countries, which included (a) 5-day air sampling of volatile organic compounds (VOCs), aldehydes, ozone, and NO₂ (b) collection of information from 1299 participants regarding their personal characteristics and health perception at workplace using online questionnaires. Stepwise and multilevel logistic regressions were applied to investigate associations between health symptoms and pollutant concentrations considering personal characteristics as confounders. Occupants of offices with higher pollutant concentrations were more likely to report health symptoms. Among the studied VOCs, xylenes were associated with general (such as headache and tiredness) and skin symptoms, ethylbenzene with eye irritation and respiratory symptoms, a-pinene with respiratory and heart symptoms, d-limonene with general symptoms, and styrene with skin symptoms. Among aldehydes, formaldehyde was associated with respiratory and general symptoms, acrolein with respiratory symptoms, propionaldehyde with respiratory, general, and heart symptoms, and hexanal with general SBS. Ozone was associated with almost all symptom groups.     

Respiratory symptoms, asthma and allergen levels in schools--comparison between Korea and Sweden

We studied reports on respiratory symptoms, asthma and atopic sensitisation in relation to allergen contamination in Korean schools and compared with data from a previous Swedish study performed in eight primary schools. Korean pupils (n = 2365) in 12 primary schools first completed a questionnaire. Then airborne and settled dust were collected from 34 classrooms and analyzed for allergens by ELISA. In both countries, boys reported more symptoms. The prevalence of wheeze was similar, while daytime [odds ratio (OR) = 14.0, 95% confidence interval (CI) = 9.0-21.9] and nocturnal breathlessness (OR = 3.1, 95% CI = 1.5-6.4) were much higher among Korean students. In Korean schools, dog allergen (Can f 1) was the most common followed by mite allergen (Der f 1), while cat (Fel d 1), dog, and horse allergen (Equ cx) were abundant in Sweden. Moreover, CO(2) levels were high in most Korean schools (range 907-4113 ppm). There was an association between allergen levels in dust and air samples, and number of pet-keepers in the classrooms. In conclusion, allergen contamination in Korean schools may be an important public issue. PRACTICAL IMPLICATIONS: This study showed that furry pet allergen contamination was common in both Korean and Swedish schools. In addition, house dust-mite (Der f 1) allergen contamination was common in Korean schools, probably because of transport of allergen from other environments. Transfer should therefore be minimized. Korean schools had high CO(2) levels and the concept of mechanical ventilation should be introduced. Measurement of airborne allergen levels is quite new and seems to be a more convenient and correct way to monitor allergen exposure in classrooms.     

Multivariate evaluation of VOCs in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not

Volatile organic compounds (VOCs) were sampled in buildings where people with non-specific building-related symptoms perceive health problems and in buildings where they do not. In total, nine persons and 34 buildings were included in the study. The obtained VOC data was evaluated using multivariate methods, to investigate possible systematic differences in air quality of 'problem' and 'non-problem' buildings. All individual compounds were included as variables in a multivariate partial least squares (PLS) data analysis. 'Problem' and 'non-problem' buildings separated into two distinct groups, showing that air samples of the two groups of building were chemically different. PRACTICAL IMPLICATIONS: The study showed that there was an identifiable systematic difference in the collected VOC data between buildings causing and not causing problems for people with non-specific building-related symptoms (also called sick building syndrome, SBS). This is an important indication that even such volatile organic compounds that can be sampled by commonly used adsorbents are of importance for the presence of such symptoms. By coordination of procedures for sampling and analysis of VOCs in buildings between laboratories, to get large datasets and more general models, the method can become a useful diagnostic measure in evaluating indoor air and to identify chemical compounds and sources that contribute to SBS problems.     

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.     

Comparing mixing and displacement ventilation in classrooms: pupils' perception and health

Several studies have found that indoor air quality (IAQ) in schools is often poor and may affect the health of the pupils. Building ventilation is a means to reduce pollutants indoors, but different designs should be evaluated for their effectiveness in different environments. In a field experiment performed at four classrooms in one school building, air was supplied either in the mixing or in the displacement mode, and we collected information on exposures, pupils' perception of IAQ and climate, and health symptoms and performed clinical examinations. The room temperature, relative humidity, concentration of CO?, and cat allergen were measured at the breathing height and were similar during each ventilation mode. The children perceived IAQ were similar in the two ventilation regimes, and there were few differences in symptom reports or clinical parameters. However, the pupils reported more eye symptoms during displacement ventilation. PRACTICAL IMPLICATIONS: Both mixing and displacement ventilation may be appropriate in school classrooms as long as the overall design, ventilation rates, and maintenance of systems are satisfactory.     

Sensory And Physiological Effects On Humans Of Combined Exposures To Air Temperatures And Volatile Organic Compounds

Ten healthy humans were exposed to combinations of volatile organic compounds (VOCs) and air temperature (0 mg/m³ and 10 mg/m³ of a mixture of 22 volatile organic compounds and 18, 22 and 26° C). Previously demonstrated effects of VOCs and thermal exposures were replicated. For the first time nasal cross-sectional areas and nasal volumes, as measured by acoustic rhinometry, were shown to decrease with decreasing temperature and increasing VOC exposure. Temperature and pollutant exposures affected air quality, the need for more ventilation, skin humidity on the forehead, sweating, acute sensory irritation and possibly watering eyes in an additive way. Interactions were found for odor intensity (p = 0.1), perceived facial skin temperature and dryness, general well-being, tear film stability, and nasal cavity dimension. The presence of interactions implies that in the future guidelines for acceptable indoor air concentrations of VOCs should depend on room air temperature.     

The prevalence and incidence of sick building syndrome in Chinese pupils in relation to the school environment: a two-year follow-up study

There are few incidence studies on sick building syndrome (SBS). We studied two-year change of SBS in Chinese pupils in relation to parental asthma/allergy (heredity), own atopy, classroom temperature, relative humidity (RH), absolute humidity (AH), crowdedness, CO?, NO?, and SO?. A total of 1993 participated at baseline, and 1143 stayed in the same classrooms after two years. The prevalence of mucosal and general symptoms was 33% and 28% at baseline and increased during follow-up (P < 0.001). Twenty-seven percent reported at least one symptom improved when away from school. Heredity and own atopy were predictors of SBS at baseline and incidence of SBS. At baseline, SO? was associated with general symptoms (OR=1.10 per 100 μg/m3), mucosal symptoms (OR=1.12 per 100 μg/m3), and skin symptoms (OR=1.16 per 100 μg/m3). NO? was associated with mucosal symptoms (OR=1.13 per 10 μg/m3), and symptoms improved when away from school (OR=1.13 per 10 μg/m3). Temperature, RH, AH, and CO? were negatively associated with prevalence of SBS. Incidence or remission of SBS was not related to any exposure, except a negative association between SO? and new skin symptoms. In conclusion, heredity and atopy are related to incidence and prevalence of SBS, but the role of the measured exposures for SBS is more unclear. PRACTICAL IMPLICATIONS: We found high levels of CO? indicating inadequate ventilation and high levels of SO? and NO?, both indoors and outdoors. All schools had natural ventilation, only. Relying on window opening as a tool for ventilation in China is difficult because increased ventilation will decrease the level of CO? but increase the level of NO? and SO? indoors. Prevalence studies of sick building syndrome (SBS) might not be conclusive for causal relationships, and more longitudinal studies on SBS are needed both in China and other parts of the world. The concept of mechanical ventilation and air filtration should be introduced in the schools, and when planning new schools, locations close to heavily trafficked roads should be avoided.     

Subjective Indoor Air Quality in Schools in Relation to Exposure

Abstract This paper presents data on indoor air quality in schools as perceived by those working in them and relates these data to exposure measurements. Data on subjective air quality, domestic exposures and health aspects were gathered by means of a questionnaire which was sent to all personnel in 38 schools; it was completed by 1410 persons (85’4 of the total). Data on exposure were gathered by exposure measurements in classrooms. The results indicate that 53% of the personnel perceived the indoor air quality as bad or very bad. It was perceived as worse by those who were younger, those who were dissatisfied with their psychosocial work climate and those who were not exposed to tobacco smoke at home. In older school buildings and buildings with displacement ventilation there was less dissatisfaction with the air quality. There were no significant relations between complaints and air exchange rate or concentration of carbon dioxide. The air quality was perceived as worse at higher levels of exposure to a number of airborne compounds including volatile organic compounds, moulds, bacteria and respirable dust. It was concluded that exposure to indoor pollutants affects perception even at the low concentrations normally found indoors in nonindustrial buildings.     

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.     

A comparative study of asthma, pollen, cat and dog allergy among pupils and allergen levels in schools in Taiyuan city, China, and Uppsala, Sweden

We compared the school environment, asthma and allergy in 10 schools in Taiyuan, China, with eight schools in Uppsala, Sweden. In total 2193 pupils (mean age 13 years) participated. Chinese pupils had more respiratory symptoms, particularly daytime breathlessness after exercise (29.8% vs. 7.1%; P < 0.001), while cat allergy (1.2% vs. 6.6%; P < 0.001) and dog allergy (1.3% vs. 4.0%; P < 0.01) was less common. Cumulative incidence of asthma (1.8% vs. 9.5%; P < 0.001) and doctor's diagnosed asthma (1.2% vs. 9.0%; P < 0.001) were less common in China, indicating an under-diagnosis of asthma. Chinese classrooms were colder (mean 14.7 vs. 21.4 degrees C), more humid (mean 42% vs. 31% RH) and had higher CO2-levels (mean 2211 vs. 761 ppm). Levels of cat (Fel d1), dog (Can f1) allergens were low in settled dust from China (< 200 ng/g dust), but high in airborne dust on Petri-dishes (GM 16.8 ng/m2/day for Fel d1 and 17.7 for Can f1). The Swedish settled dust contained cat, dog and horse allergens in high levels (median 1300 ng/g, 1650 ng/g, 1250 U/g dust, respectively). In conclusion, there were large differences in the school environment, and in respiratory symptom and allergy. Allergen measurements in settled dust only may largely underestimate the classroom exposure. Practical Implications There is a need to improve the school environment, both in China and Sweden. The Swedish schools contained high levels of cat, dog and horse allergens and more amounts of open shelves and textiles that can accumulate dust and allergens. The air measurements indicated that Chinese schools may contain significant amounts of cat and dog allergen, and analysis of settled dust only may not reflect the true allergen exposure. Since the Chinese schools had no mechanical ventilation, they could not fulfill the ventilation standard in winter, and hence there is a need for improving the ventilation. The great discrepancy between respiratory symptoms and reports on asthma, and the high prevalence of attacks of breathlessness without wheeze, may have implication for future questionnaire studies on asthma in China.     

Relationships Between Ventilation and Indoor Air Quality: A Review

Abstract Adjustment of ventilation rates in buildings is widely practised, both to provide good air quality on a proactive basis and to mitigate air quality problems associated with occupant complaints. However, both cross-sectional and experimental epidemiological studies have reported mixed results and have for the most part failed to establish definitive relationships between ventilation rates and symptom prevalence or dissatisfaction with air quality. The difficulties involved in establishing such relationships may be due to a variety of confounding factors which include limitations in study design and interaction effects; difficulties in controlling ventilation rates in experimental studies; inadequate mixing of supply air in occupied spaces; high source strengths for some contaminants; dynamic interactions between sources and ventilation rates that result in increased contaminant emissions; contaminant dose-response sensory effects which are log-linear; potential contaminant generation within ventilation systems themselves; and multifactorial genesis of sick building symptoms. There is limited evidence to suggest that ventilation rate increases up to 10 L/s person may be effective in reducing symptom prevalence and occupant dissatisfaction with air quality and that higher ventilation rates are not effective. Because of complex relationships between ventilation rates, contaminant levels, and building-related health complaints/dissatisfaction with air quality, the use of ventilation as a mitigation measure for air quality problems should be tempered with an understanding of factors which may limit its effectiveness.     

Indoor air quality at nine shopping malls in Hong Kong.

Hong Kong is one of the most attractive shopping paradises in the world. Many local people and international tourists favor to spend their time in shopping malls in Hong Kong. Good indoor air quality is, therefore, very essential to shoppers. In order to characterize the indoor air quality in shopping malls, nine shopping malls in Hong Kong were selected for this study. The indoor air pollutants included carbon dioxide (CO2), carbon monoxide (CO), total hydrocarbons (THC), formaldehyde (HCHO), respirable particulate matter (PM10) and total bacteria count (TBC). More than 40% of the shopping malls had 1-h average CO2 levels above the 1000 ppm of the ASHRAE standard on both weekdays and weekends. Also, they had average weekday PM10 concentrations that exceeded the Hong Kong Indoor Air Quality Objective (HKIAQO). The highest indoor PM10 level at a mall was 380 microg/m3. Of the malls surveyed, 30% had indoor airborne bacteria levels above 1000 cfu/m3 set by the HKIAQO. The elevated indoor CO2 and bacteria levels could result from high occupancy combined with insufficient ventilation. The increased PM10 levels could be probably attributed to illegal smoking inside these establishments. In comparison, the shopping malls that contained internal public transport drop-off areas, where vehicles were parked with idling engines and had major entry doors close to heavy traffic roads had higher CO and PM10 indoor levels. In addition, the extensive use of cooking stoves without adequate ventilation inside food courts could increase indoor CO2, CO and PM10 levels.     

Outdoor ozone and building-related symptoms in the BASE study

Reactions between ozone and indoor contaminants may influence human health and indoor air quality. The U.S. EPA Building Assessment Survey and Evaluation (BASE) study data were analyzed for associations between ambient ozone concentrations and building-related symptom (BRS) prevalence. Multiple logistic regression (MLR) models, adjusted for personal, workplace, and environmental variables, revealed positive relationships (P < 0.05) between ambient ozone concentrations and upper respiratory (UR), dry eyes, neurological and headache BRS (odds ratios ranged from 1.03 to 1.04 per 10 mug/m(3) increase in ambient ozone concentrations). Other BRS had marginally significant relationships with ambient ozone (P < 0.10). A linear dose-response in UR symptoms was observed with increasing ambient ozone (P = 0.03); most other symptoms showed similar but not statistically significant trends. Ambient ozone correlated with indoor concentrations of some aldehydes, a pattern suggesting the occurrence of indoor ozone chemistry. Coupled with the MLR ambient ozone-BRS analysis, this correlation is consistent with the hypothesis that ozone-initiated indoor reactions play an important role in indoor air quality and building occupant health. Replication with increased statistical power and with longitudinal data is needed. If the observed associations are confirmed as causal, ventilation system ozone removal technologies could reduce UR BRS prevalence when higher ambient ozone levels are present. PRACTICAL IMPLICATIONS: This paper provides strong statistical evidence that supports (but does not prove) the hypothesis that ozone entrained into buildings from the outdoor air is involved in increasing the frequency that occupants experience and a range of upper and lower respiratory, mucosal and neurological symptoms by as much as a factor of 2 when ambient ozone levels increase from those found in low-ozone regions to those typical of high-ozone regions. Although replication is needed, the implication is that reducing the amount of ozone entrained into building ventilation systems, either by ambient pollution reduction or engineered gas-phase filtration, may substantially reduce the prevalence of these symptoms experienced by occupants.     

Personal exposures to volatile organic compounds among outdoor and indoor workers in two Mexican cities

There are limited data on exposures to ambient air toxics experienced by inhabitants of urban areas in developing countries that have high levels of outdoor air pollution. In particular, little is known about exposures experienced by individuals working outdoors - typically as part of the informal sector of the economy - as compared to workers in office-type environments that approach the indoor air quality conditions of the more developed countries. The objective of this study is to explore these differences in personal exposures using a convenience sample of 68 outdoor and indoor workers living in Mexico City (higher outdoor air pollution) and Puebla (lower outdoor air pollution), Mexico. Occupational and non-occupational exposures to airborne volatile organic compounds (VOCs) were monitored during a 2 day period, monitoring 2 consecutives occupational and non-occupational periods, using organic vapor monitors (OVMs). Socio-demographic and personal time-location-activity information were collected by means of questionnaires and activity logs. Outdoor workers experienced significantly higher exposures to most VOCs compared to indoor workers in each of these cities. The outdoor workers in Mexico City had the highest exposures both during- and off-work, with maximum occupational exposures for toluene, MTBE, n-pentane, and d-limonene exceeding 1 mg/m(3). The inter-city pattern of exposures between the outdoor workers is consistent with the higher outdoor air pollution levels in Mexico City, and is above exposures reported for urban areas of the more developed countries. Results from this study suggest that elevated outdoor air pollution concentrations have a larger impact on outdoor workers' personal exposures compared to the contribution from indoor pollution sources. This contrasts with the more dominant role of indoor air VOC contributions to personal exposures typically reported for urban populations of the more developed countries.     

The Danish Twin Apartment Study – Part II: Mathematical modeling of the relative strength of sources of indoor air pollution

Abstract This study deals with the modeling of air pollution in apartments from laboratory measurements of source strengths, using formaldehyde and Total Volatile Organic Compounds (TVOCs) as model pollutants. The sources in two test apartments were grouped into two: building-related sources and occupant-related sources. The measured source strengths and ventilation rates were used for the prediction of concentrations expected in the apartments. These predictions were compared to measurements in the apartment over 12 months. The conclusions were that the model predictions based on emission rates measured in the laboratory can be used to predict the long-term concentration of the two model pollutants in the apartments. Considering the measured differences in ventilation between the apartments, an occupant emission rate of between 0.2 and 0.3 mg/h/kg body weight could be estimated. Based on previous suggested limits of acceptable exposures of humans to VOCs, an acceptable average emission rate of VOCs from building materials in general was estimated to be about 30 (μ/m²/h. The modeling showed that during the first 200 days, building materials dominated the emissions. After this, sources relating to the occupants dominated. On average about half of the VOC pollution originated from the building materials.     

Nasal Mucosal Swelling in Relation to Low Air Exchange Rate in Schools

Abstract Acoustic rhinometry and hygienic measurements of indoor air pollutants were applied in a field study on nasal congestion among 27 subjects working in two primary schools. One school had natural ventilation only and a low air exchange rate (0.6 ac/h); the other had balanced mechanical ventilation and a high air exchange rate (5.2 ac/h). The minimal cross-sectional area and volume of the nasal cavity were estimated with acoustic rhinometry. The degree of swelling of the nasal mucosa was measured as the increase of the cross-sectional area after standardized application of nasal spray containing a decongestive adrenergic substance. Reports on weekly symptoms of nasal congestion were similar (33%) in both schools. A significantly increased decongestive effect was noticed for the minimal cross-sectional area (MCA2) among personnel in the school with a low air exchange rate. The difference between the schools in decongestive effect on MCA2 was 23%, corresponding to a 3% increase of MCA2 for a difference in personal outdoor airflow of one litre. Indoor concentration of volatile organic compounds (VOC), respirable dust, bacteria, moulds and VOCs of possible microbial origin (MVOC) were 2–8 times higher in the naturally ventilated school. In conclusion, inadequate outdoor air supply in schools may lead to raised levels of indoor air pollutants, causing a sub-clinical swelling of the nasal mucosa. Our results indicate that acoustic rhinometry could be applied in field studies, and that objective measurement of nasal decongestion might be a more sensitive measure of biological effects of indoor air pollution than symptom reporting.     

Are We Measuring the Relevant Indoor Pollutants?

Abstract Concentrations of volatile organic compounds (VOCs) measured indoors may exceed their odor thresholds, but are usually far below TLV estimates. Even applying additivity to eye and airway irritation effects, it is difficult to rationalize increased sick building syndrome (SBS) symptoms by exposure to generally chemically inert VOCs in the indoor environment. Several studies suggest that chemical reactions in indoor air are linked with SBS symptoms and the examination of these reactions may be necessary in order to understand the role of VOCs as causative agents of SBS symptoms. The usual evaluation of odor annoyance of VOCs based on odor thresholds should be modified, taking into account the large variation of individual human odor thresholds for single substances, and specific additivity phenomena even at subthreshold levels of VOCs. The conclusion of this review is that chemical reactions between oxidizable VOCs and oxidants, such as ozone and possibly nitrogen oxides, can form irritants which may be responsible for the reported symptoms. Compounds adsorbed to particles may also contribute to SBS symptoms. The individual effects of indoor pollutants may act in concert with temperature and relative humidity. New analytical methods are required to measure the oxidative and reactive species or specific markers thereof in indoor air.     

Risk factors in heating, ventilating, and air-conditioning systems for occupant symptoms in US office buildings: the US EPA BASE study

Building-related symptoms in office workers worldwide are common, but of uncertain etiology. One cause may be contaminants related to characteristics of heating, ventilating, and air-conditioning (HVAC) systems. We analyzed data from 97 representative air-conditioned US office buildings in the Building Assessment and Survey Evaluation (BASE) study. Using logistic regression models with generalized estimating equations, we estimated odds ratios (OR) and 95% confidence intervals for associations between building-related symptom outcomes and HVAC characteristics. Outdoor air intakes less than 60 m above ground level were associated with significant increases in most symptoms: e.g. for upper respiratory symptoms, OR for intake heights 30 to 60 m, 0 to <30 m, and below ground level were 2.7, 2.0, and 2.1. Humidification systems with poor condition/maintenance were associated with significantly increased upper respiratory symptoms, eye symptoms, fatigue/difficulty concentrating, and skin symptoms, with OR = 1.5, 1.5, 1.7, and 1.6. Less frequent cleaning of cooling coils and drain pans was associated with significantly increased eye symptoms and headache, with OR = 1.7 and 1.6. Symptoms may be due to microbial exposures from poorly maintained ventilation systems and to greater levels of vehicular pollutants at air intakes nearer the ground level. Replication and explanation of these findings is needed. PRACTICAL IMPLICATIONS: These findings support current beliefs that moisture-related HVAC components such as cooling coils and humidification systems, when poorly maintained, may be sources of contaminants that cause adverse health effects in occupants, even if we cannot yet identify or measure the causal exposures. While finding substantially elevated risks for poorly maintained humidification systems, relative to no humidification systems, the findings do not identify important (symptom) benefits from well-maintained humidification systems. Findings also provide an initial suggestion, needing corroboration, that outdoor air intakes lower than 18 stories in office buildings may be associated with substantial increases in many symptoms. If this is corroborated and linked to ground-level vehicle emissions, urban ventilation air intakes may need to be located as far above ground level as possible or to incorporate air cleaners that remove gaseous pollutants.