Health Effects
A number of well-identified illnesses, such as Legionnaires' disease, asthma, hypersensitivity Pneumonitis, and humidifier fever, have been directly traced to specific building problems. These are called building-related illnesses. Most of these diseases can be treated, nevertheless, some pose serious risks.

Sometimes, however, building occupants experience symptoms that do not fit the pattern of any particular illness and are difficult to trace to any specific source. This phenomenon has been labeled sick building syndrome. People may complain of one or more of the following symptoms: dry or burning mucous membranes in the nose, eyes, and throat; sneezing; stuffy or runny nose; fatigue or lethargy; headache; dizziness; nausea; irritability and forgetfulness. Poor lighting, noise, vibration, thermal discomfort, and psychological stress may also cause, or contribute to, these symptoms.

There is no single manner in which these health problems appear. In some cases, problems begin as workers enter their offices and diminish as workers leave; other times, symptoms continue until the illness is treated. Sometimes there are outbreaks of illness among many workers in a single building; in other cases, health symptoms show up only in individual workers.

In the opinion of some World Health Organization experts, up to 30 percent of new or remodeled commercial buildings may have unusually high rates of health and comfort complaints from occupants that may potentially be related to indoor air quality.

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What Causes Problems?
Three major reasons for poor indoor air quality in office buildings are the presence of indoor air pollution sources; poorly designed, maintained, or operated ventilation systems; and uses of the building that were unanticipated or poorly planned for when the building was designed or renovated.

Sources of Office Air Pollution
As with homes, the most important factor influencing indoor air quality is the presence of pollutant sources. Commonly found office pollutants and their sources include environmental tobacco smoke; asbestos from insulating and fire-retardant building supplies; formaldehyde from pressed wood products; other organics from building materials, carpet, and other office furnishings, cleaning materials and activities, restroom air fresheners, paints, adhesives, copying machines, and photography and print shops; biological contaminants from dirty ventilation systems or water-damaged walls, ceilings, and carpets; and pesticides from pest management practices.

Ventilation Systems
Mechanical ventilation systems in large buildings are designed and operated not only to heat and cool the air, but also to draw in and circulate outdoor air. If they are poorly designed, operated, or maintained, however, ventilation systems can contribute to indoor air problems in several ways.

For example, problems arise when, in an effort to save energy, ventilation systems are not used to bring in adequate amounts of outdoor air. Inadequate ventilation also occurs if the air supply and return vents within each room are blocked or placed in such a way that outdoor air does not actually reach the breathing zone of building occupants. Improperly located outdoor air intake vents can also bring in air contaminated with automobile and truck exhaust, boiler emissions, fumes from dumpsters, or air vented from restrooms. Finally, ventilation systems can be a source of in door pollution themselves by spreading biological contaminants that have multiplied in cooling towers, humidifiers, dehumidifiers, air conditioners, or the inside surfaces of ventilation duct work.

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Use of the Building
Indoor air pollutants can be circulated from portions of the building used for specialized purposes, such as restaurants, print shops, and dry-cleaning stores, into offices in the same building. Carbon monoxide and other components of automobile exhaust can be drawn from underground parking garages through stairwells and elevator shafts into office spaces.

In addition, buildings originally designed for one purpose may end up being converted to use as office space. If not properly modified during building renovations, the room partitions and ventilation system can contribute to indoor air quality problems by restricting air recirculation or by providing an inadequate supply of outdoor air.

What to Do if You Suspect a Problem
If you or others at your office are experiencing health or comfort problems that you suspect may be caused by indoor air pollution, you can do the following:

• Talk with other workers, your supervisor, and union representatives to see if the problems are being experienced by others and urge that a record of reported health complaints be kept by management, if one has not already been established.
• Talk with your own physician and report your problems to the company physician, nurse, or health and safety officer.
• Call your state or local health department or air pollution control agency to talk over the symptoms and possible causes.
• Encourage building management to obtain a copy of Building Air Quality: A Guide for Building Owners and Facility Managers. Building Air Quality (BAQ) is simply written, yet provides comprehensive information for identifying, correcting, and preventing indoor air quality problems. BAQ also provides supporting information such as when and how to select outside technical assistance, how to communicate with others regarding indoor air issues, and where to find additional sources of information. To obtain the loose leaf format version of the Building Air Quality, complete with appendices, an index, and a full set of useful forms, and the newly released, Building Air Quality Action Plan, order GPO Stock # 055-000-00602-4, for $28, contact the: Superintendent of Documents, U.S. Government Printing Office (GPO), P.O. Box 371954, Pittsburgh, PA 15250-7954, or call (202) 512-1800, fax (202) 512-2250.
• Obtain a copy of "An Office Building Occupant's Guide to Indoor Air Quality," EPA-402-K-97-003, October 1997 from IAQ INFO at 1-800-438-4318.
• Frequently, indoor air quality problems in large commercial buildings cannot be effectively identified or remedied without a comprehensive building investigation. These investigations may start with written questionnaires and telephone consultations in which building investigators assess the history of occupant symptoms and building operation procedures. In some cases, these inquiries may quickly uncover the problem and on-site visits are unnecessary.
• More often, however, investigators will need to come to the building to conduct personal interviews with occupants, to look for possible sources of the problems, and to inspect the design and operation of the ventilation system and other building features. Because taking measurements of pollutants at the very low levels often found in office buildings is expensive and may not yield information readily useful in identifying problem sources, investigators may not take many measurements. The process of solving indoor air quality problems that result in health and comfort complaints can be a slow one, involving several trial solutions before successful remedial actions are identified.
• If a professional company is hired to conduct a building investigation, select a company on the basis of its experience in identifying and solving indoor air quality problems in non-industrial buildings.
• Work with others to establish a smoking policy that eliminates involuntary nonsmoker exposure to environmental tobacco smoke.
• Call the National Institute for Occupational Safety and Health (NIOSH) for information on obtaining a health hazard evaluation of your office (800-35NIOSH), or contact the Occupational Safety and Health Administration, (202) 219-8151.

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