ObjectivesMany studies have shown consistent associations between evident indoor dampness or mold and respiratory or allergic health effects, but causal links remain unclear. Findings on measured microbiologic factors have received little review. We conducted an updated, comprehensive review on these topics.Data sourcesWe reviewed eligible peer-reviewed epidemiologic studies or quantitative meta-analyses, up to late 2009, on dampness, mold, or other microbiologic agents and respiratory or allergic effects.Data extractionWe evaluated evidence for causation or association between qualitative/subjective assessments of dampness or mold (considered together) and specific health outcomes. We separately considered evidence for associations between specific quantitative measurements of microbiologic factors and each health outcome.Data synthesisEvidence from epidemiologic studies and meta-analyses showed indoor dampness or mold to be associated consistently with increased asthma development and exacerbation, current and ever diagnosis of asthma, dyspnea, wheeze, cough, respiratory infections, bronchitis, allergic rhinitis, eczema, and upper respiratory tract symptoms. Associations were found in allergic and nonallergic individuals. Evidence strongly suggested causation of asthma exacerbation in children. Suggestive evidence was available for only a few specific measured microbiologic factors and was in part equivocal, suggesting both adverse and protective associations with health.ConclusionsEvident dampness or mold had consistent positive associations with multiple allergic and respiratory effects. Measured microbiologic agents in dust had limited suggestive associations, including both positive and negative associations for some agents. Thus, prevention and remediation of indoor dampness and mold are likely to reduce health risks, but current evidence does not support measuring specific indoor microbiologic factors to guide health-protective actions.

Data from published studies were combined and analyzed to develop best-fit equations and curves quantifying the change in sick building syndrome (SBS) symptom prevalence in office workers with ventilation rate. For each study, slopes were calculated, representing the fractional change in SBS symptom prevalence per unit change in ventilation rate per person. Values of ventilation rate, associated with each value of slope, were also calculated. Linear regression equations were fitted to the resulting data points, after weighting by study size. Integration of the slope-ventilation rate equations yielded curves of relative SBS symptom prevalence versus ventilation rate. Based on these analyses, as the ventilation rate drops from 10 to 5 L/s-person, relative SBS symptom prevalence increases approximately 23% (12% to 32%), and as ventilation rate increases from 10 to 25 L/s-person, relative prevalence decreases approximately 29% (15% to 42%). Variations in SBS symptom types, building features, and outdoor air quality may cause the relationship of SBS symptom prevalence with ventilation rate in specific situations to differ from the average relationship predicted in this paper.

Some prior research in office buildings has associated higher indoor temperatures even within the recommended thermal comfort range with increased worker symptoms. We reexamined this relationship in data from 95 office buildings in the U.S. Environmental Protection Agency's Building Assessment Survey and Evaluation (BASE) Study. We investigated relationships between building-related symptoms and thermal metrics constructed from real-time measurements. We estimated odds ratios (ORs) and 95% confidence intervals in adjusted logistic regression models with general estimating equations, overall and by season. Winter indoor temperatures spanned the recommended winter comfort range; summer temperatures were mostly colder than the recommended summer range. Increasing indoor temperatures, overall, were associated with increases in few symptoms. Higher winter indoor temperatures, however, were associated with increases in all symptoms analyzed. Higher summer temperatures, above 23°C, were associated with decreases in most symptoms. Humidity ratio, a metric of absolute humidity, showed few clear associations. Thus, increased symptoms with higher temperatures within the thermal comfort range were found only in winter. In summer, buildings were overcooled, and only the higher observed temperatures were within the comfort range; these were associated with decreased symptoms. Confirmation of these findings would suggest that thermal management guidelines consider health effects as well as comfort.Practical Implications: In winter, higher temperatures within the thermal comfort range are common in U.S. office buildings and may be associated with increased symptoms. In summer, temperatures below the thermal comfort range are common and may be associated with increased symptoms. Results from this large study thus suggest that in U.S. office buildings, less winter heating (in buildings that are in heating mode) and less summer cooling may reduce acute symptoms while providing substantial energy conservation benefits, with no expected thermal comfort penalty and, in summer, even thermal comfort benefits. If confirmed, this would be welcome news.

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The effect of liquefied natural gas on pollutant emissions was evaluated experimentally with used and new appliances in the laboratory and with appliances installed in residences, targeting information gaps from previous studies. Burner selection targeted available technologies that are projected to comprise the majority of installed appliances over the next decade. Experiments were conducted on 13 cooktop sets, 12 ovens, 5 broiler burners, 5 storage water heaters, 4 forced air furnaces, 1 wall furnace, and 6 tankless water heaters. Air-free concentrations and fuel-based emission factors were determined for carbon monoxide, nitrogen oxides, nitrogen dioxide, and the number of (predominantly ultrafine) particles over complete burns-including transient effects (device warm-up and intermittent firing of burners) following ignition-and during more stable end-of-burn conditions. Formaldehyde was measured over multi-burn cycles. The baseline fuel was Northern California line gas with Wobbe number (a measure of fuel energy delivery rate) of 1320-1340; test fuels had Wobbe numbers of roughly 1390 and 1420, and in some cases 1360. No ignition or operational problems were observed during test fuel use. Baseline emissions varied widely across and within burner groups and with burner operational mode. Statistically significant emissions changes were observed for some pollutants on some burners.