Background: Associations of higher indoor carbon dioxide (CO2) concentrations with impaired work performance, increased health symptoms, and poorer perceived air quality have been attributed to correlation of indoor CO2 with concentrations of other indoor air pollutants that are also influenced by rates of outdoor-air ventilation.Objectives: We assessed direct effects of increased CO2, within the range of indoor concentrations, on decision making.Methods: Twenty-two participants were exposed to CO2 at 600, 1,000, and 2,500 ppm in an office-like chamber, in six groups. Each group was exposed to these conditions in three 2.5-hr sessions, all on 1 day, with exposure order balanced across groups. At 600 ppm, CO2 came from outdoor air and participants’ respiration. Higher concentrations were achieved by injecting ultrapure CO2. Ventilation rate and temperature were constant. Under each condition, participants completed a computer-based test of decision-making performance as well as questionnaires on health symptoms and perceived air quality. Participants and the person administering the decision-making test were blinded to CO2 level. Data were analyzed with analysis of variance models.Results: Relative to 600 ppm, at 1,000 ppm CO2, moderate and statistically significant decrements occurred in six of nine scales of decision-making performance. At 2,500 ppm, large and statistically significant reductions occurred in seven scales of decision-making performance (raw score ratios, 0.06–0.56), but performance on the focused activity scale increased.Conclusions: Direct adverse effects of CO2 on human performance may be economically important and may limit energy-saving reductions in outdoor air ventilation per person in buildings. Confirmation of these findings is needed.

This paper reviews current literature on the associations of ventilation rates and carbon dioxide concentrations in non-residential and non-industrial buildings (primarily offices) with health and other human outcomes. Twenty studies, with close to 30,000 subjects, investigated the association of ventilation rates with human responses, and 21 studies, with over 30,000 subjects, investigated the association of carbon dioxide concentration with these responses. Almost all studies found that ventilation rates below 10 Ls-1 per person in all building types were associated with statistically significant worsening in one or more health or perceived air quality outcomes. Some studies determined that increases in ventilation rates above 10 Ls-1 per person, up to approximately 20 Ls-1 per person, were associated with further significant decreases in the prevalence of sick building syndrome (SBS) symptoms or with further significant improvements in perceived air quality. The carbon dioxide studies support these findings. About half of the carbon dioxide studies suggest that the risk of sick building syndrome symptoms continued to decrease significantly with decreasing carbon dioxide concentrations below 800 ppm. The ventilation studies reported relative risks of 1.5-2 for respiratory illnesses and 1.1-6 for sick building syndrome symptoms for low compared to high low ventilation rates.

Ventilation with outdoor air plays an important role influencing human exposures to indoor pollutants. This review and assessment indicates that increasing ventilation rates above currently adopted standards and guidelines should result in reduced prevalence of negative health outcomes. Building operators and designers should avoid low ventilation rates unless alternative effective measures, such as source control or air cleaning, are employed to limit indoor pollutant levels.

IntroductionThe association of adverse health effects with dampness and mold in buildings has been the subject of much research. Most studies on this topic have found an increased risk of one or more adverse health effects in buildings with signs of dampness or visible mold. The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review (IOM, 2004) of this scientific literature. The IOM concluded that excessive indoor dampness is a public health problem, noted that dampness problems are common, and recommended corrective measures. While the IOM report summarized the main features and results of the reviewed studies, which included a broad range of health outcomes, it provided no quantitative summaries of the findings of these studies.In this paper, we report the results of quantitative meta-analyses of the studies reviewed in the IOM report and other similar studies that met specified study inclusion criteria. A meta-analysis uses statistical methods to combine data from different but comparable research studies, in order to provide a quantitative summary estimate on the size and variability of an association. Studies are generally selected for relevance, quality, and similarity. The contribution of larger, more precise studies to the summary estimate is generally more heavily weighted. Results of metaanalyses presented here are central point estimates and confidence intervals (CIs) of odds ratios (ORs) that summarize the magnitude of increased risk of several health outcomes in buildings with dampness and mold. The central estimates and CIs of ORs, if assumed to reflect causal relationships, can be used to communicate Abstract The Institute of Medicine (IOM) of the National Academy of Sciences recently completed a critical review of the scientific literature pertaining to the association of indoor dampness and mold contamination with adverse health effects. In this paper, we report the results of quantitative meta-analyses of the studies reviewed in the IOM report plus other related studies. We developed point estimates and confidence intervals (CIs) of odds ratios (ORs) that summarize the association of several respiratory and asthma-related health outcomes with the presence of dampness and mold in homes. The ORs and CIs from the original studies were transformed to the log scale and random effect models were applied to the log ORs and their variance. Models accounted for the correlation between multiple results within the studies analyzed. Central estimates of ORs for the health outcomes ranged from 1.34 to 1.75. CIs (95%) excluded unity in nine of 10 instances, and in most cases the lower bound of the CI exceeded 1.2. Based on the results of the meta-analyses, building dampness and mold are associated with approximately 30-50% increases in a variety of respiratory and asthma-related health outcomes. Practical ImplicationsThe results of these meta-analyses reinforce the IOM's recommendation that actions be taken to prevent and reduce building dampness problems, and a...

The existing literature contains strong evidence that characteristics of buildings and indoor environments significantly influence rates of respiratory disease, allergy and asthma symptoms, sick building symptoms, and worker performance. Theoretical considerations, and limited empirical data, suggest that existing technologies and procedures can improve indoor environments in a manner that significantly increases health and productivity. At present, we can develop only crude estimates of the magnitude of productivity gains that may be obtained by providing better indoor environments; however, the projected gains are very large. For the U.S., we estimate potential annual savings and productivity gains of $6 billion to $19 billion from reduced respiratory disease; $1 billion to $4 billion from reduced allergies and asthma, $10 billion to $20 billion from reduced sick building syndrome symptoms, and $12 billion to $125 billion from direct improvements in worker performance that are unrelated to health. Sample calculations indicate that the potential financial benefits of improving indoor environments exceed costs by a factor of 18 to 47. The policy implications of the findings are discussed and include a recommendation for additional research.