OBJECTIVE--To examine the relation between ventilation rate and occurrence of symptoms of the eyes, nose, throat, and skin as well as general symptoms such as lethargy and headache, often termed the sick building syndrome. METHODS--A cross sectional population based study was carried out in 399 workers from 14 mechanically ventilated office buildings without air recirculation or humidification, selected randomly from the Helsinki metropolitan area. The ventilation type and other characteristics of these buildings were recorded on a site visit and the ventilation in the rooms was assessed by measuring the airflow through the exhaust air outlets in the room. A questionnaire directed at workers inquired about the symptoms and perceived air quality and their possible personal and environmental determinants (response rate 81%). The outcomes were weekly work related symptoms experienced during the previous 12 months and symptom groups defined either by their anatomical location or hypothesised mechanism. RESULTS--In logistic regression analysis, the adjusted odds ratio (OR) for any symptom of interest was 3.03 (95% confidence interval (95% CI) 1.13 to 8.10) in the very low ventilation category of below 5 l/s per person and 2.24 (0.89 to 5.65) in the high ventilation category of over 25 l/s per person compared with the reference (15- < 25 l/s). The ORs for ocular (1.27, 1.11 to 1.46), nasal (1.17, 1.06 to 1.29), skin symptoms (1.18, 1.05 to 1.32), and lethargy (1.09, 1.00 to 1.19) increased significantly by a unit decrease in ventilation from 25 to 0 l/s per person. CONCLUSION--The results suggest that outdoor air ventilation rates below the optimal (15 to 25 l/s per person) increase the risk of the symptoms of sick building syndrome with the sources of pollutants present in mechanically ventilated office buildings. The Finnish guideline value is 10 l/s per person.
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