Building-related symptoms and issues

Building-Related Illnesses (BRI) are diseases that are directly caused by air-related problems and poor indoor environments in buildings. There has to be a proven connection between a building-related exposure and a specific illness for it to be considered a BRI.

BRIs differ from sick building syndrome (SBS) because the causes can be determined, whereas sick building syndrome is used as a term to refer to symptoms of acute health and/or comfort effects for which no specific cause can be found but that can be attributed to time spent in a particular building.

What are the differences between SBS and BRI?

SBS and BRI are both categories of illness where individuals or groups of people are made sick by something in a building (usually a home or workplace). There is a wide range of symptoms and diagnoses that exist under these umbrella terms, and there may be some overlap.

The two primary differences between SBS and BRI are:

  • SBS consists of a set of symptoms, of which the cause is unknown. With BRI, the cause of the illness is known. With SBS, the symptoms/illness will usually go away when the individual(s) leave the building.
  • With BRI, the illness caused by the building will usually stick around and require treatment, even after the individual has been out of the building for quite some time.

What about "old building syndrome?"

Old Building Syndrome is another related term you might come come across, although there isn’t really a distinct definition for this one. The idea behind Old Building Syndrome is that there is a greater chance of having SBS and/or BRI with older buildings.

This is because:

a) older buildings may have been built using toxic materials that are now outlawed or limited (i.e. lead)

b) since they’ve been around longer, there is a great chance that older buildings have water damage from leaks, flooding, etc., as well as more time for things like toxic mold to grow and spread

Many more different terms

Many different terms have been used to describe the phenomenon of reported high incidence of illness or unwellness suffered by people for no apparent reason in certain buildings; these include "building sickness", "sick office syndrome", "tight-building syndrome" and "office-eye syndrome". There are also older and more vague terms such as "tight building syndrome" or "toxic carpet syndrome".

Concept and definition of sick building syndrome (SBS)

The concept of SBS was defined by the World Health Organization (WHO) in 1983 as: „a collection of nonspecific symptoms including eyes, nose and throat irritation, mental fatigue, headaches, nausea, dizziness and skin irritation, that seem to be associated with occupancy of certain workplaces“.

Later, further information on the severity of the negative effects of the SBS phenomenon was disclosed as: „symptoms with a temporary connection to a particular building but with no specific or obvious cause“.

Finally, SBS was defined by two criteria: the first criterion is that: „the density of workers´ complaints to be 20% of building occupants presenting with symptoms of SBS“. Later, the second criterion was added as: „the identical medical problem is observed for at least 2 weeks“.

Many symptoms usually occur simultaneously, and the negative effects are linked together as the occurrence of one effect can lead to the manifestation of another. Yet most symptoms may be transient and their effects will disappear when people leave the place, although some symptoms may have long-term effects such as respiratory related issues.

Contributing factors for symptoms are also physical factors such as noise, uncomfortable temperatures, low relative humidity and poor lighting. Furthermore, psychological factors are associated with SBS, such as stress, low paid jobs, routine work, and lack of personal control. Some studies also suggest that there is a link between SBS symptoms and poor general management, employee´ complaints and low general satisfaction with work or organisation.

Facts about indoor air - including SBS and BRIs

Research suggests that over 30% of buildings may be the subject of excessive complaints related to indoor air quality (IAQ). Some problems in buildings may be short-term, but others could be long-term issues.

Indicators of SBS include:

  • 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.
  • The cause of the symptoms is not known.
  • Most of the complainants report relief soon after leaving the building.

Indicators of BRI include:

  • Building occupants complain of symptoms such as cough; chest tightness; fever, chills; and muscle aches.
  • The symptoms can be clinically defined and have clearly identifiable causes.
  • Complainants may require prolonged recovery times after leaving the building.

Causes of problems in buildings

The following could be causes or contributing factors.

  • Inadequate ventilation - the reduced outdoor air provided for ventilation in building and not efficiently distributed air to the buildings occupants
  • Chemicals and indoor contamination - from building materials and equipment indoors (e.g, adhesives, carpeting, upholstery, manufactured wood products, copy machines, pesticides, and cleaning agents may emit volatile organic compounds (VOCs), including formaldehyde)
  • Chemicals from outdoors - i.e. air pollution, combustion products, pollutants from motor vehical exhausts
  • Biological contaminants - bacteria, molds, pollen, and viruses

A Word About Radon and Asbestos...

SBS and BRI are associated with acute or immediate health problems; radon and asbestos cause long-term diseases which occur years after exposure, and are therefore not considered to be among the causes of sick buildings.

Symptoms and illnesses

Symptoms and illnesses related or attributed to indoor environments are common. A variety of factors associated with the environment and with the patient impact these symptoms, which may reflect new disorders, exacerbation of preexisting conditions (eg, rhinitis, asthma), and/or disorders caused by specific workplace exposures (eg, occupational asthma, hypersensitivity pneumonitis).

Building-related symptoms can have a substantial impact on health. It is important for the clinician to recognize when symptoms are related to the patient's workplace, as these should be treated as occupational illnesses.


Building related illnesses with known causes

Symptoms of sick building syndrome

Allergic and immunologic disease

  • Hypersensitivity pneumonitis
  • Humidifier fever
  • Rhinitis 
  • Sinusitis
  • Asthma


  • Legionnaire's disease
  • Pontiac fever
  • Viral infections
  • Influenza
  • Common cold 
  • Rubella 
  • Variacella
  • Bacterial pneumonia 
  • Mycobacterial (tuberculosis)

Chemicals and other substances

  • Man-made mineral fibers (fibrous glass)
    Detergent residues (carpet shampoos)
  • Carbon monoxide
  • Carbonless copy paper 
  • Formaldehyde
  • Pesticides
  • Volatile organice compounds
  • Carcinogens (radon, asbestos)

Irritation of the eyes, nose and throat

  • Dryness
  • Stinging
  • Hoarseness

Skin irritation

  • Reddening 
  • Stinging 
  • Dryness


  • Fatigue 
  • Lethary 
  • Reduced memory or concentration
  • Headache 
  • Dizziness 
  • Nausea

Odor or taste complaints 

  • Unpleasant odor or taste
  • Changed sensitivity

Non-specific reactions

  • Chest sounds 
  • Asthma-like symptoms 



Solutions to SBS and BRIs

All buildings should monitor the indoor climate to avoid possible problems with air quality and to provide good environment for buildings occupants.

  • indoor air quality monitoring - along with the HVAC maintanence, focused on reducing contaminant sources indoors
  • increasing ventilation rates and improving air distribution in the building - together with air cleaning via filters
  • education and communicaton - to remedy and / or prevent - for all building occupants incl. management and maintanenace people

Can SBS be prevented? Yes, use adequate ventilation and source control!

Given that good indoor air quality is a major factor, monitoring and improving indoor air quality can reduce SBS relatively effectively. The best approach is to find the cause of the pollutants and eliminate it. Every building should maintain building ventilation rates at or above the minimum rates specified in current codes and standards. Furthermore, ventilation systems should be maintained regularly and minimize pressure differences enveloping structures to deter harmful pollutants from entering the building. Fresh air needs to be filtered to avoid bringing microbiological pollutants in the buildings and also the ventilation system should secure removing chemical emissions from inside the buildings.

The role of holistic facility maintenance in buildings is the key to eliminating sick building syndrome to ensure all possibilities are addressed. Controlling the source of pollution is better than continual removal of pollutions. Scheduled facility maintenance, cleaning and air cleaning with filters in HVAC systems could prevent mould and improve indoor air quality throughout the facility. During and after renovation (painting, cleaning and other pollutant generating activities), it is recommended to the increase of ventilation rates when the building is not occupied.

Identifying strategies to improve SBS issues lies in the right design of ventilation systems with sufficient fresh air at comfortable temperatures while maintaining indoor air quality inside the buildings, while preventing air stagnation and draughts. The buildings should have a thermally comfortable environment (acceptable level of temperature, humidity, predicted mean vote), acceptable level of CO2 and minimized level of indoor pollutants (low emitting building materials and furniture, less VOCs), sufficient daylight without glare and control of solar gain with shading devices (to avoid internal overheating), adequate acoustic level and minimal external noise levels.

Also important is the interior design of building spaces, such as the proper colour use for the function of spaces, effective arrangement of furniture arrangement to promote flexibility and collaboration (ergonomic indoor layout), and ensuring an appropriate landscape allocation with views and contact to the nature.

Are building related health issues making an unwanted comeback?

We take a look into the concept of a sick building syndrome, how this has come about and are we facing this again today?

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What can employees' do to improve indoor air quality and health in the workplace

Education and communication are important elements in both remedial and preventive indoor air quality management programs. Employees who suspect that they are working in a sick building should talk about their symptoms to higher management and other occupants.

Employees should consider these questions, and in particular, look for patterns in terms of indoor air quality and health: what are symptoms and their recurrence, the relation of symptoms to certain location at work, and new renovations or construction projects at work. All concerns need to be documented. Although the buildings with SBS symptoms can be up to code, and management may reject those concerns, it may be appropriate to contact the relevant organizations for air quality investigation.

Employees can reduce their own risk factors for sick building syndrome, for example: taking regular breaks outside the building (eating lunch outdoors), if possible, opening windows to get fresh air (avoid opening windows during high levels of outdoor pollen and smog), standing or walking around the office and looking away from computer screen, among others.

Building-related illness, in which an identifiable factor causes a specific illness, is much less common than sick building syndrome, in which there is no identifiable cause for nonspecific symptoms.
Edward P. Horvath, Director of Occupational Health at the Cleveland Clinic