Sick-Building Syndrome? Or Building-Related Illness?

March 14, 2022 Bob Krell

By Jeffrey C. May —

When occupants experience specific symptoms inside a building and feel better when they are away from the building, and their symptoms are not caused by a specific illness, the building could be called a “sick building.” The symptoms that people experience in such a building can be called “sick building syndrome” or “SBS.” When symptoms can be diagnosed as caused by building conditions, however, then the illnesses are called “building-related illnesses” or BRIs.

            But the difference between these two definitions is not always clear. Symptoms building occupants experience can be inconsistent and/or idiosyncratic. Is asthma a BRI, or are those experiencing respiratory symptoms suffering from SBS? Does the number of people who are symptomatic determine the definitions?

            Why does it matter, you might ask. It matters because the responsibility for addressing building problems may shift from building managers/owners to building occupants, depending on the definitions used.

            Let’s look at some scenarios to play this out a little.

            Let’s imagine that there is an office building in which forty people work (post-pandemic). If five of them experience asthma symptoms, is the building management or owner responsible to conduct environmental testing and then take the recommended measures? Or are the sufferers responsible for conferring with their physicians and taking medication to manage their symptoms so that they can work there? What happens if half of the forty workers experience respiratory symptoms? Does the responsibility for figuring out the cause then fall on the building management/ownership? Is this a moral quandary? Or a financial one? Or both?

            Let’s imagine another office building: one with fifteen occupants. This building has below-grade office space that smells musty. Five people work there; one is experiencing exacerbated asthma symptoms, and another has congested sinuses during the workday and feels better when he leaves the building. The other three people have no problem working there. It seems pretty clear to me that asthma is an illness that can be exacerbated by exposures to allergens, and yet many of my clients in this sort of situation are expected to deal with this by seeing their physicians and ratchetting up medications.

            The medical community recognizes that hypersensitivity pneumonitis (HP) is an illness caused by environmental conditions. But if only one person in an office with 20 other people has HP, are those with authority over the building responsible for having environmental testing done?  Or is it up the person with HP to work elsewhere?

            People with chemical sensitivities (sometimes referred to as multiple chemical sensitivity or MCS) are hypersensitive to VOCs (volatile organic compounds) in both indoor and outdoor environments. Such compounds can include smoke, solvents, fuels, pesticides, and even fragrances. People who have chemical sensitivities speak about “brain fog” and fatigue when exposed to VOCs, and yet many physicians don’t believe in MCS. Many of my clients with MCS have told me that their doctors recommended they see psychiatrists.  Since MCS is not a widely recognized diagnosis, the symptoms could be labeled “sick building syndrome,” and the responsibility for avoiding VOC exposures shifts from the building management/owner to the building occupant. An obvious exception, of course, would be exposure to an elevated concentration of carbon monoxide, but that would have a negative effect on all of the building’s occupants, rather than just someone with MCS.  

Read the full article in the Jan-Feb issue of Healthy Indoors Magazine at:

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