Sick Building Syndrome


Sick Building Syndrome


Indoor air is a health hazard in about 30% of all buildings, according to the World Health Organization (WHO). The Environmental Protection Agency (EPA) lists IAQ fourth among top environmental health threats. The problem of SBS is of increasing concern to employees and occupational health specialists, as well as landlords and corporations who fear the financial consequences of illnesses among tenants and employees, respectively. Respiratory diseases attributed to SBS account for about 150 million lost workdays each year, $59 billion in indirect costs, and $15 billion in medical costs.

Sick building syndrome was first recognized in the 1970s around the time of the energy crisis and the move toward conservation. Because heating and air conditioning systems accounted for a major portion of energy consumption in the United States, buildings were sealed for energy efficiency. In these buildings, occupants depend on mechanical systems rather than open windows for outside air and ventilation. There are three methods in which outside air can enter a building, including infiltration, natural ventilation, and mechanical ventilation. Infiltration occurs when outside air enters a building through cracks around windows, floors, doors, and walls. Natural ventilation occurs through open doors or windows. For mechanical ventilation, outdoor-vented fans for heating, venting, and air conditioning systems (HVAC) bring outside air in and move inside air out. A building that is well-insulated and sealed for energy efficiency, referred to as a tight building, can seal in and create contaminants.

According to the U.S. Environmental Protection Agency (EPA), SBS is strongly identified when the following situations are present:


Causes and symptoms

According to the Environmental Protection Agency, SBS is caused by four major factors:

Common symptoms of SBS include dizziness, skin irritation, headaches, fatigue, dry cough, sneezing, nausea, hoarseness of voice, allergies, asthma attacks, cold, flu-like symptoms, difficulty concentrating, and irritations of the eyes, nose and throat. In addition, many people have more general symptoms, including personality changes, hypersensitivity reactions, and odor and taste sensations. Symptoms are caused by a range of contaminants including volatile organic compounds (VOC), which are chemicals that turn to gas at room temperature and are given off by paints, adhesives, caulking, vinyl, telephone cable, printed documents, furniture, and solvents. Most common VOCs are benzene (C6H6) and chloroform (CHCl3), both of which have been shown to be carcinogenic. Formaldehyde (CH2O) in building materials is also an indoor irritant. However, the concentrations of VOCs at which SBS is observed are usually well below the concentrations at which the common symptoms would be expected.

Carbon monoxide—
With the chemical formula CO (where C stands for carbon, and O for oxygen), a colorless, odorless, and tasteless gas that is toxic to humans in higher than normal concentrations.
Nitrogen dioxide—
With the chemical formula IO2 (where I stands for nitrogen, and O for oxygen), a reddish-brown toxic gas that is one of several nitrogen oxides.
Any type of poison made by humans or introduced into the environment by human activity, such as insecticides.
Volatile organic chemicals—
Any organic chemicals with a high vapor pressure at ordinary, room-temperatures.

Biological agents such as viruses, bacteria, fungal spores, algae, pollen, mold, and dust mites add to the problems. These are produced by water-damaged carpet and furnishing or standing water in ventilation systems, humidifiers, and flush toilets.

Carbon dioxide (CO2) levels increase as the number of people in a room increases, and too much can cause occupants to suffer hyperventilation, headaches, dizziness, shortness of breath, and drowsiness, as does carbon monoxide (CO) and the other toxins from cigarette smoke.

Schoolchildren are considered more vulnerable to SBS because schools typically have more people per room breathing the same stale air. Their size, childhood allergies, and asthmas increase their vulnerability.


The diagnosis for SBS is difficult because a specific illness or cause cannot be easily identified by the medical community.


Sick buildings can be treated by updating and cleaning ventilation systems regularly and using air cleaners and filtration devices. Also, plants spaced every 100 square feet (9.3 square meters) in offices, homes, and schools have been shown to filter out pollutants in recycled air.

A simple survey of the indoor environment can detect many SBS problems. Each room should have an air source; if windows cannot be opened, every room should have a supply vent and exhaust vent. The vents should be cleaned regularly. A tissue can be place at each vent opening to check that air is circulating through the system. The tissue should blow out at a supply vent and be pulled in at an exhaust vent. Vents should not be blocked by partitions, file cabinets, or boxes. Supply and exhaust vents should be more than a few feet apart. Dead spaces where air stagnates and pollutants build up should be renovated. Printing and copying machines should be moved away from people and should be given adequate exhaust. The ventilation system should be checked every season for verification of full operation.

Public health role and response

The EPA enforces laws on outdoor air pollution but not for indoor air except for some smoking bans. Yet almost every pollutant, according to the EPA, is at higher levels indoors than outdoors. Help in detecting and correcting SBS is available from the National Institute of Occupational Safety and Health (NIOSH), the federal agency responsible for conducting research and making recommendations for safe and healthy work standards. The EPA and the NIOSH have developed a Building Air Quality Action plan with guidelines for improving and maintaining IAQ in public and commercial buildings.


The prognosis for sick building syndrome is generally good if the cause of the disorder can be identified. However, because its symptoms vary widely and no one specific illness is easily identified, the diagnosis of SBS may be lengthy.


Important factors that can prevent and control SBS are:


See also Asthma ; Benzene ; Benzene and benzene derivatives exposure ; Mold ; Smoking ; Viruses .



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Bluyssen, Philomena M. The Indoor Environment Handbook: How to Make Buildings Healthy and Comfortable. London: Earthscan, 2009.

Larsen, Laura, ed. Environmental Health Sourcebook. Detroit: Omnigraphics, 2010.

May, Jeffrey C. My Office Is Killing Me! The Sick Building Survival Guide. Baltimore: Johns Hopkins University Press, 2006.

Natelson, Benjamin H. Your Symptoms Are Real: What to Do When Your Doctor Says Nothing Is Wrong. Hoboken, NJ: John Wiley, 2008.

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Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA, 30341, (800) 232-4636, .

American Academy of Environmental Medicine, 6505 E Central Ave., No. 296, Wichita, KS, 67206, (316) 684-5500, Fax: (316) 684-5709,, .

Environmental Protection Agency, 1200 Pennsylvania Ave., NW, Ariel Rios Bldg., Washington, DC, 20460, (202) 272-0167, .

National Institute of Occupational Safety and Health, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA, 30333, (800) 232-4636,, .

Occupational Safety and Health Organization, U.S. Department of Labor, 200 Constitution Ave. NW, Washington, DC, 20210, (800) 321-6742, .

Linda Rehkopf

  This information is not a tool for self-diagnosis or a substitute for professional care.