Is CO2 a good proxy for indoor air quality in classrooms? Part 2: Health outcomes and perceived indoor air quality in relation to classroom exposure and building characteristics

The aim of this paper is to investigate whether keeping indoor thermal conditions and carbon dioxide (CO2) levels within the current guideline values can provide a healthy and comfortable school environment. The study was organised as a longitudinal investigation over an academic year using a cohort of 376 students aged 9 to 11 (response rate: 87%) attending 15 classrooms in five London primary schools. The prevalence of asthmatic symptoms and asthma attacks was significantly higher among children attending urban schools (10.2%) than suburban schools (1.5%), and was significantly related to exposure to higher nitrogen dioxide (NO2) concentrations (odds ratio: 1.11, 95% confidence interval: 1.00-1.19). Self-reported dermal, mucosal, respiratory and general symptoms were 18.5%, 60.7%, 28.2% and 43.6% respectively in the heating season, and decreased in the non-heating season. Infiltration rates were negatively associated with prevalence and incidence of all sick building syndrome symptoms. Exposure to traffic-related pollutants, such NO2, ozone (O-3) and tetrachloroethylene (T4CE), associated with mucosal symptoms, also increased dissatisfaction with indoor air quality (IAQ) and, therefore, perceived IAQ might be a first indication of exposure. Among targeted microbial counts, only Trichoderma viride remained significant predictors of satisfaction with IAQ even at low concentrations. The study provides evidence that simultaneous provision for limiting indoor CO2 levels and thermal conditions below current guidelines (e.g. below 1000ppm and 26? or 22? depending on season) may improve perceived IAQ. This paper stresses the need to go beyond current regulations to investigate concentrations of specific pollutants to ensure a healthy school environment, and closes with a section on the practical implications on the UK policy and the building design industry. Practical application: The findings highlight the role and responsibility of stakeholders, from regulators to designers and school authorities, to account for the external environment and take the steps needed to ensure that schools provide a healthy indoor environment for their students. The recommendations focus on the need to decrease outdoor pollution levels in the school vicinity, thus improving health of the students and reducing the prevalence of respiratory illness. Building designers and engineers shall adopt an integrated approach for the simultaneous provision of adequate thermal conditions and IAQ in classrooms.