Sick Building Syndrome

Sick Building Syndrome SBS

SBS is a building-related health syndrome

We spend most of our lives indoors and our modern homes and offices are, therefore, designed and constructed to be energy efficient and comfortable. Air conditioning, heating systems, humidifiers, and air cleaners replace the ‘old-fashioned’ methods of opening windows to ventilate the rooms. When these systems are poorly designed or maintained, or when they don’t operate, indoor air pollutants quickly build up. In addition, building materials, furniture, cleaning substances, and pesticides add complex chemical mixtures to the indoor air. The air in our ‘home sweet home’ has become a chemical and dusty soup which causes illnesses that were unknown less than fifty years ago.

sick_building_syndromeWithin the last thirty years, an increasing number of office workers and building residents complained of discomfort, fatigue, headache, allergic reactions and other health problems. The affected people had many and varied symptoms, but the cause was unknown. When the number of complaints grew, medical scientists began to search for the cause. Because the workers or the residents are usually without or with milder symptoms when they are outside of a particular building or a particular room, it is clear that the office or the home has to take the blame. But what is the precise source and what are the specific symptoms associated with it?

If unsure, why not call it a ‘syndrome.’

This is exactly what the medical profession did, they named it the Sick Building Syndrome (SBS). It has become the most common term worldwide, but not the only one. Other terms that describe basically the same phenomenon are: Tight Building Syndrome, Indoor Air Quality Syndrome, and Closed Building Syndrome. The World Health Organization estimates that up to 30% of all new or renovated buildings worldwide contribute to this syndrome.

The indicators for Sick Building Syndrome are therefore:

  • A collection of symptoms that affect the comfort or health of people inside a particular building.
  • The cause is unknown.
  • Symptoms disappear or diminish when the affected person vacates a particular building or room.

Don’t confuse Sick Building Syndrome with other health effects related to buildings, such as the ‘Building Related Illness’ (BRI). This illness is easier to diagnose, because it has an identifiable cause. For example, the bacterial contamination of an air conditioning system that causes humidifier fever or Legionnaires’ Disease, and high dust levels that cause an allergic reaction are building-related illnesses.

SBS is more frequent in countries with cold climates, during winter, when people don’t ventilate their homes as much as people living in temperate climates. The warmer regions share the problem during the cooling period, in summer, when there is a need for homes to become ‘airtight’ to save energy costs. This, of course, has the disadvantage that indoor air pollutants increase in numbers.

Because Sick Building Syndrome can’t be easily quantified, it has its critics. With so many possible causes, I can understand that one can readily argue that the syndrome may be the result of causes other than anything directly related to the building. For example, a patient may have contracted an illness somewhere outside the home but associates it with the building. Or the person may be under physical, mental or emotional stress, but looks somewhere else for answers to his or her symptoms. In other words, the answers a health professional gets from a patient may be very subjective. Nevertheless, because there is now enough evidence that the syndrome exists, a person who presents with relevant symptoms has the right to be taken seriously.

The suspect sources of Sick Building Syndrome

Some potential sources (see also previous sections), keeping in mind, that for the outcome to be Sick Building Syndrome, several of these sources have to be considered at the same time:

Air quality

The burning of fossil fuels as during heating or cooking and tobacco smoke releases so-called combustion products into the indoor air. Carbon monoxide, nitrogen and sulphur dioxide, and fine particles (particulate matter) are some of the potentially hazardous chemicals produced during the burning process.

Naturally occurring dust, or biological contaminants as it is also known, can be found everywhere in the form of allergens, such as animal dander, dust mites, moulds, pollen;  or as disease-carrying bacteria and viruses.

Most building and furnishing materials contain and slowly release chemicals into the indoor air.  Much quicker is the release of these volatile organic compounds (VOC’s) when the home occupants use or apply paint, cleaning agents, pesticides, disinfectants, air fresheners, etc. VOC’s may also arrive indoors from outside sources.

Indoor climate

Very high or very low humidity levels are major contributors to feelings of discomfort. High humidity exacerbates the ill effects of heat and low humidity levels may be the cause of dehydration and irritations to skin and mucous membranes in eye, nose and throat. In addition, high humidity levels aid the development of mould and the breeding process of bacteria and viruses.

Extreme temperatures lead to heat or cold-related disorders. High temperatures also aid the evaporation of chemicals.


Inadequate ventilation is the most often cited reason for poor indoor air quality. Improper design or maintenance of ventilation, heating and cooling systems can lead to an inadequate air-exchange between the building and the outside. Even with an adequate system, the interior design may not allow the fresh air to reach all rooms, or the location of the air intake may draw contaminants into the home.

The designer of the home or the occupant’s intent to save money may lead to the installation of poor lighting. In the long-term, this can result in symptoms similar to SBS.

The home itself or outside sources may contribute to permanent noise and its negative health effects.

Psychological factors

A person strongly dissatisfied with the home, because of poor decoration and ergonomic factors, or a person with a state of high anxiety about e.g. the possibility of being exposed to potentially hazardous substances, may increase the severity of SBS symptoms.


Health Effects of the Sick Building Syndrome

The staggering number of possible sources, the variety of symptoms, and the different reactions of individuals to the same cause, makes diagnosing Sick Building Syndrome a challenge – to put it mildly. A person may leave a building with a terrible headache or a severe allergic reaction, only to arrive at the medical practice in perfect health. The task is a little easier when several people working in a particular building present with similar symptoms. This, however, is usually not the case when the family home is the cause. Then, even the other family members can’t understand why something in the building may affect ‘Mum’ and not ‘Dad,’ or the other way around, of course. It comes as no surprise that many in the medical profession are also very reluctant to accept Sick Building Syndrome as an illness.

The list of symptoms is long, but chiefly involves general discomfort, irritated mucous membranes in eyes, nose and throat, respiratory problems, and allergic reactions (see text box). Health problems may only be temporary during e.g. renovation or redecoration, when new or more pollutants are introduced to the indoor air.

As you can see for yourself, the symptoms are very general and can be caused by a variety of other reasons rather than indoor air pollutants. The indoor climate can also play an important part. Very dry air, as during the heating season, may equally trigger symptoms such as dry throat or irritated eyes. During summer the whole house or some rooms may become uncomfortably hot and cause heat-related symptoms such as fatigue or headache. The house may not be the cause of an allergic reaction at all during the flowering season of particular plants. The pollen easily drift into the home or catch a ride on your guests clothes or your pet’s fur.

Studies show that more women report ill effects of Sick Building Syndrome than men do. This may be due to the grater health awareness amongst women and, as some research suggests, that women may be more likely to suffer from lower exposure levels to indoor air pollutants, in particular chemicals. People living in the inner city and in poor sanitary conditions make up a large percentage of cases with Sick Building Syndrome.

Asthmatics and people suffering from chemical hypersensitivity are often prone to several types of indoor allergens and, thus, the percentage of Sick Building Syndrome is also more prevalent in people with this illness. Reactions sometimes occur while exposed to pollutant levels well below any acceptable standard.

What are the possible solutions?

About half of all buildings have inadequate air exchange rates between the outside and indoors. Improving ventilation should, therefore, always be the first step. This measure, by itself, may already alleviate the problem. Here are some more measures if improved ventilation doesn’t help:

  • Maintain heating, cooling and ventilation systems.
  • Ensure all appliances and fire places are sufficiently flued.
  • Where possible, remove potential pollution sources such as moulds form walls or ceilings, keep pets outdoors as much as possible, keep dust to a minimum, don’t store hazardous chemicals inside the home, and ban smoking indoors.
  • Use low-toxic household cleaning agents and pesticides. Consider natural alternatives to air fresheners, deodorants, perfumes, soaps, shampoos etc.
  • If possible, control temperature extremes with coolers and heaters and control humidity levels by ventilating rooms or with the use of dehumidifiers.
  • Air cleaners may not capture all pollutants, especially not gaseous constituents, but do improve indoor air quality to some extent.
  • ‘Bake out, off-gas, out-gassing,’ are now terms, meaning the same, used in connection with reducing the risk of developing SBS. This procedure, in new and renovated buildings, asks people to delay occupancy for several months, while the building is extensively ventilated and heated to remove the initial burst of volatile chemicals.
  • Improve the comfort level of your home with adequate lighting, friendly decoration, and good ergonomic measures.
  • Seal cracks and gaps between an attached garage and the building.

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