UCL Institute for Environmental Design and Engineering


The association of indoor air quality and ‘sick building syndrome’ health impacts in offices

27 May 2020

A blog by Health Wellbeing and Sustainable Buildings MSc student Prisca Winata

Man in office by window

Some estimates claim that people spent 90-95% of their time in indoor environments, which makes buildings important factors in our health and wellbeing1. Sick Building Syndrome (SBS) has become a major health issue in offices since the 1970s as an impact of the World Energy Crisis2. Building designs were meant to reduce energy costs, for example by using mechanical air recirculation ventilation systems, and removing natural ventilation. These design approaches limited the amount of fresh air in buildings; hence it increased the concentration of indoor pollutants.  The symptoms of SBS are described by the World Health Organization as headaches, dizziness, nausea, skin irritation, nausea, eye irritation, nose and throat irritation which are associated with indoor physical environment3. Although these health effects often disappear after leaving the building, SBS could decrease productivity and increase stress levels, potentially resulting in economic losses for both companies and staff4. Prolonged stress can impair the immune system and lead to heart attack, cancer, arthritis, dementia, neuro-degenerative diseases and death5. This post focuses on indoor air quality as one of the factors which affects SBS symptoms and suggests some ways for building managers to manage the associated causes.

 Previous research has identified indoor air quality as the most important factor in SBS symptoms in offices. Over the past two decades, studies on SBS have identified the following risk factors in the physical indoor environment: ventilation systems, carbon dioxide (CO2) concentration, and relative humidity6. Although some researchers found a correlation between room temperature and SBS symptoms7, others found no significant relationship8. A study in East Africa found that SBS symptoms were significantly higher in office workers in buildings with mechanical ventilation versus natural ventilation9. In Iran, a study showed that high CO2 concentration was associated with SBS symptoms including dry throat, breathing difficulty, and nose irritation10

A recent study associated the average CO2 concentration at 700-740 ppm with a high prevalence of SBS symptoms6. These concentrations are above the CIBSE building standards which specify a range of CO2 concentration in a closed environment of 450-675 ppm11. If it exceeds 800 ppm, people will notice the lack of fresh air and it will lead to fatigue, headache, difficulty concentrating, and dissatisfaction. However, the ventilation strategy depends on the sources and the amount of indoor air pollutants. There have been numerous studies on the association between indoor air pollutants and the existence of SBS symptoms, such as the concentration of particulate matter, volatile organic compounds (VOCs), formaldehyde, and other pollutants12. However, personal factors (e.g. gender, personal traits, allergy, smoking habits) and psychosocial work environment (e.g. occupational stress, dissatisfaction of work, managerial type of work) are also associated with SBS symptoms13.

The Health and Safety Executive recommends that building managers start by identifying what is polluting the air when SBS symptoms occur. Second, they should improve ventilation to provide adequate fresh air supply and remove pollutants. Third, sources of pollutants need to be reduced. Finally, regular maintenance and cleaning of building components are also required, including ventilation, heating, air-conditioning, dehumidifier, lighting, building furnishing and office equipment14.

Prisca Winata is a student on the MSc Health, Wellbeing, and Sustainable Buildings programme. She studied architecture and started her career as a Junior Architect in an architecture firm focusing on mixed use, commercial offices, and hospitality. 


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 2 Indoor Air Pollutants and Sick Building Syndrome: A Case Study and Implications for the Community Health Nurse. Tsacoyianis, Rosemary. 1, 1997, Public Health Nursing, Vol. 14, pp. 58-75. 10.1111/j.1525-1446.1997.tb00411.x.
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 4 Ventilation and performance in office work. Seppanen, O, Fisk, W. J. and Lei, Q. H. 1, 2006, Indoor Air, Vol. 16, pp. 28-26.
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10 Indoor carbon dioxide concentrations and sick building syndrome symptoms in office workers of petroleum industry health organization. Jafari, Mohammad Javad, et al. 3, 2018, International Archives of Health Sciences, Vol. 5, p. 82. 10.4103/iahs.iahs_27_18.
11 CIBSE. Application Manual (AM) 10: Natural Ventilation in Non Domestic Buildings. London, UK : Chartered Institution of Buildings Services Enginners (CIBSE), 2005.
12 Indoor Air Quality and Prevalence of Sick Building Syndrome Among Office Workers in Two Different Offices in Selangor. Zamani, Mohd Ezman, Jalaludin, Juliana and Shaharom, Nafiz. 10, s.l. : American , 2013, American Journal of Applied Sciences, Vol. 10, pp. 1140-1147.
13 Gender and the physical and psychosocial work environments are related to indoor air symptoms. Bakke, Jan Vilhelm, et al. 6, 2007, Journal of Occupational and Environmental Medicine, Vol. 49, pp. 641-650. 10.1097/JOM.0b013e31806e5fa0.
14 How to deal with sick building syndrome ( SBS ). HSE, Safety Executive. 2000, pp. 1-20.