Sick Building Syndrome (SBS)

“Take care of your body. It’s the only place you have to live in.” but only taking care of the body is
enough? Should we have to take care of the environment also, in which our body resides? Building
or People: Who needs treatment?

Overview
Sick Building Syndrome is a condition, phenomenon or situation in which people experience
some acute symptoms of illness and or get infected with a disease by being in a building or
other type of enclosed space for a defined period of time. SBS is also called as Tight Building
Syndrome. [1][2]

Signs and Symptoms

SBS affects everyone differently, some may not experience any of the symptoms, although if
they are spending noticeable amount of time in a specific building, some may experience
them after leaving the building whereas some may face all of them at once residing in the
building only. [2] Usually these appear to mimic other health conditions and thus its
diagnosis is a matter of perplexion.
The wide range of symptoms may be general, ocular, respiratory, dermal, neurological, etc.
These can be: - High blood pressure, airway infection, dizziness, breathing difficulties,
stomach problems, sensoric and or mucous membrane irritations in eyes, nose or throat;
hoarseness or changed voice, drying, reddening or irritation of skin; asthma-like symptoms
in non-asthmatic persons, headache, lethargy, nausea, reduced memory, mental fatigue,
difficulties in concentration, fever, chills, body aches, nausea, tightness in chest, personality
changes, etc. [2][3][4][5][6][7]

Identification or diagnosis
Observing how your body reacts while remaining in a particular building, if the symptoms
arise and get worse the longer you reside in and get better as soon as you leave the building
then it confirms the presence of SBS. Also if you are getting recurring symptoms that seem
to appear whenever you’re in a particular building, it is SBS. [2][3]

Causes or Etiology
Although the exact cause is undetermined so, we can say it may be due to a combination of
things, these causes may vary from building to building. The possible causes: [2]
1. Chemical Contaminants
 1.1 From outdoor sources: The contaminants like radon, asbestos, formaldehyde, lead
paint, pollutants from motor vehicle exhaust, can enter the building through poorly
located air vents, windows and other openings.
1.2 From indoor sources: The volatile organic compounds from adhesives, upholstery,
carpeting, pesticides, copy machines etc. can contaminate indoors.
2. Biological Contaminants:
Bacteria, viruses, fungus, pollen, etc. which can breed in stagnant water that can be
accumulated in humidifiers, drainpipes, or where water has collected. Insect and bird
droppings can also be a source of contamination.
3. Inadequate ventilation:
Poor ventilation can harbour the organic growth and may distribute contaminants from
one area throughout the building.
4. Psychological Factors:
Lack of local control, work-related stress, poor communication, poor inter-personal
relationships, attitude, certain personality and behaviour patterns, excessive work or
dissatisfaction, depression and anxiety are often seen to be associated with SBS.
5. Poor lighting:
Visual environments other than the normally accepted range of lighting are most likely
to lead to unsatisfactory conditions, overly brightening and flickering lights or very dim
ones can cause eye strains, discomfort and can be a very obvious cause of SBS.
6. Congested and older buildings:
Small sized areas can be the breeding grounds for the microbes as the dust and air get
collected there. [8][5]

History of SBS
In 1970’s, to increase energy efficiency, following the Arab oil embargo of 1973, the
ventilation standards for commercial buildings were decreased due to which cases of
inadequate ventilation were increased and in the mid-1970’s SBS started appearing. [9]

Specialists that treat SBS

The individuals in Occupational Safety and health administration (OSHA), or those in
Environmental Protection Agency (EPA) can be first referred about the problems with the
building in which patients are becoming ill. Symptoms that are related to the air quality in
buildings, are usually treated by primary-care physicians and paediatricians. [7]

Controversial – Sick building syndrome

The controversy prevails because a number of people have a constellation of nonspecific
symptoms that have no proven etiology (cause), yet believe they occur from sources inside
buildings. American Medical Association (AMA), a medical organization say without any
defined symptoms and no convincing evidence of a given source or cause, no test to
diagnose the syndrome, and no treatment for the syndrome, there is no such medical
syndrome. [7]

Diagnostic Tests
Whether the vast majority of clinicians agree or disagree that SBS exists as a medical entity,
agree on one point; that there are no tests that can reliably diagnose the SBS. [7]

The Perplexion
SBS is often confused with Building-Related Illness as in both the symptoms and causes are
much similar. But they are not same, in SBS a collection of symptoms are there for which no
specific cause can be found and may fade away after leaving the building whereas in
Building related-illness particular and specific causes can be found which may persist after
leaving the building. [8][10]

Females suffer more

In Swedish office workers the prevalence of symptoms were studied and was found that SBS
cases are 12% for females and 4% for males. [7]

Prevention and control

1. Proper ventilation: The ventilation, heating and air-conditioning systems should be
designed to meet ventilation standards in the buildings.
2. Removal of pollutants: The modification or removal of the pollutant source can be
carried out by a routine maintenance of HVAC (Heating, ventilation, and air
conditioning) systems, replacing water-strained ceiling tiles and carpets, venting
contaminants to the outside, etc. in well-ventilated areas. Air filters can be used for
the removal of pollutants.
3. Legislation: With the help of laws, banning of smoking in the workplace or restricting
smoking to some designated well-ventilated areas.
4. Research: A Germany originated field called Bau-biologie or Building biology suggests
some principles of building biology that can help to maintain or create a healthy
environment in building, these are-
i. Site status: The buildings should be geologically uninterrupted. Residential
areas should be far away from industries, traffic routes and housing should
have sufficient green space and harmony.
ii. Constructional concepts: Unadulterated, natural and nontoxic building
material should be used; the walls, floors and ceilings should not be
 susceptible to mould or fungi; the basement should be well-ventilated and
waterproof. [8]

References:-
1. Indoor Air Facts No. 4 (revised) Sick building syndrome. Available from:
http://www.epa.gov/iaq/pubs/sbs.html .
2. https://www.healthline.com/health/sick-building-syndrome .
3. https://www.nhs.uk/conditions/sick-building-syndrome/ .
4. https://www.cdc.gov/niosh/nioshtic-2/20031618.html#:~:text=The%20most%20frequent
%20constellation%20of,frequently%2C%20dry%20or%20itchy%20skin
5. https://link.springer.com/article/10.1057/rlp.2008.20
6. https://onlinelibrary.wiley.com/doi/10.1111/ina.12635 .
7. https://www.medicinenet.com/sick_building_syndrome/article.htm .
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796751/#:~:text=The%20sick
%20building%20syndrome%20(SBS,or%20cause%20can%20be%20identified .
9. https://www.britannica.com/science/sick-building-syndrome .
10. https://www.ccjm.org/content/ccjom/64/6/303.full.pdf .