Causation and Diagnosis of Sick Building Syndrome

Saturday, November 22, 2003 | 0

This is a two part article on Sick Building Syndrome by Donald Lee, D.O., a specialist on environmental and occupational medicine. With an increase in mold related workers' compensation claims, essentially a form of sick building syndrome, a review of the history, causation and diagnosis of the syndrome will assist in understanding the medical-legal ramifications of this current trend.

Sick Building Syndrome
Donald Lee, D.O.
Environmental & Occupational Medicine

The term "sick building syndrome" (SBS) originated 18 years ago and referred to situations in which building occupants experience acute health and discomfort effects. These effects appear to be linked to time spent in a building, but no specific illness or cause can be identified. The complaints may be localized in a particular room or zone, or may be widespread throughout the building.

"Building-related illness" (BRI) is a more accurate term than SBS and is used when symptoms of diagnosable illness are identified and can be attributed directly to airborne building contaminants.

Epidemiology

Studies on the adverse health effects of indoor air have increased since the 1960s. A 1984 Work Health Organization Committee report suggested that up to 30 percent of new and remodeled buildings worldwide might be the subject of excessive complaints related to indoor air quality (IAQ). Often this condition is temporary, but some buildings have long-term problems. Frequently, problems result when a building is operated or maintained in a manner that is inconsistent with its original design or prescribed operating procedures. Sometimes indoor air problems are a result of poor building design or occupant activities.

Indicators

The indicators of SBS include:

a) Building occupants complain of symptoms associated with acute discomfort, e.g., headache; eye, nose, or throat irritation; dry cough; dry or itchy skin; dizziness and nausea; difficulty in concentrating; fatigue; and sensitivity to odors.
b) The cause of the symptoms is not known.
c) Most of the complainants report relief soon after leaving the building.

The indicators of BRI include:
a) Building occupants complain of symptoms such as cough, chest tightness, fever, chills, and muscle aches.
b) The symptoms can be clinically defined and have clearly identifiable causes.
c) Complainants might require prolonged recovery times after leaving the building.

It is important to note that complaints may result from other causes. These include an illness contracted outside the building, acute sensitivity (e.g., allergies), job-related stress or dissatisfaction, and other psychosocial factors. Nevertheless, studies show that symptoms may be caused or exacerbated by indoor air quality problems.

Causes of Sick Building Syndrome

The following have been cited causes of or contributing to SBS:

a) Inadequate Ventilation: In the early and mid 1900s, building ventilation standards called for approximately 15 cubic feet per minute (cfm) of outside air for each building occupant primarily to dilute and remove body odors. Recently the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) recently revised its ventilation standard to provide a minimum of 15 cfm of outdoor air per person (20 cfm / person in office spaces). Up to 60 cfm / person may be required in some spaces (such as smoking lounges) depending on the activities that normally occur in that space (see ASHRAE Standard 62-1989).
b) Chemical Contaminants from Indoor Sources: Most indoor air pollution comes from sources inside the building. Adhesives, carpeting, upholstery, manufactured wood products, copy machines, pesticides, and cleaning agents may emit volatile organic compounds (VOCs), including formaldehyde. Environmental tobacco smoke contributes high levels of VOCs, other toxic compounds, and respirable particular matter. Combustion products such as carbon monoxide, nitrogen dioxide, as well as respirable particles, can come from unventilated kerosene and gas space heaters, woodstoves, fireplaces and gas stoves.
c) Chemical Contaminants from Outdoor Sources: The outdoor air that enters a building can be a source of indoor air pollution. Pollutants from motor vehicle exhausts, plumbing vents, and building exhausts can enter the building through poorly located air intake vents, windows, and other openings. In addition, combustion products can enter a building from a nearby garage.
d) Biological Contaminants: Bacteria, molds, pollen, and viruses are types of biological contaminants. These contaminants may breed in stagnant water that has accumulated in ducts, humidifiers and drain pans, or where water has collected on ceiling tiles, carpeting, or insulation. Sometimes insect or bird droppings can be a source of biological contaminants.

These elements may act in combination, and may supplement other complaints, such as inadequate temperature, humidity, or lightning. At times even after a building investigation, however, the specific causes of the complaints may remain unknown.

Part 2 of this article series will review causative factors, classifications, and diagnosis of SBS.

Dr. Lee is represented by MedLink in the Sacramento, CA, area. MedLink represents 35 forensic physicians in Northern California in nearly every forensic specialty. Appointments can be made through MedLink at: www.camedlink.com.