Indoor environment in dwellings, asthma, allergies, and sick building syndrome in the Swedish population: a longitudinal cohort study from 1989 to 1997

Original Article



To investigate changes of sick building syndrome (SBS) and different types of indoor exposures at home over an 8-year follow-up period (1989–1997), and onset of SBS symptoms in relation to size of residence town and education level.


A random sample (0.1%) of the population in a 3-county region in Sweden, initially aged 20–65 years (n = 466). In total, 348 (75%) answered the postal follow-up questionnaire.


Water leakage during the last year had decreased from 11.2 to 4.8% visible indoor mould had decreased from 4.7 to 1.6%, and any sign of building dampness decreased from 16.1 to 9.5%. The prevalence of current smoking had decreased from 30 to 19%. Smokers at baseline reported more onset of SBS symptoms than non-smokers. Furthermore, remission from mucosal symptoms was less likely in subjects that were tobacco smoker. Subjects with any indoor painting during follow-up period reported more onset of SBS symptoms, and those with intermediate education level had more onset of skin symptoms.


Smoking and indoor painting could be predictors of new onset of SBS symptoms. Focus on indoor environment in Sweden the last decades may have resulted in environmental improvements in the dwellings, which can be beneficial both for the inhabitants and for the future public health.


Asthma Building dampness Sick building syndrome Indoor environment Cohort study Risk factors 


  1. Andreas S, Herth FJ, Rittmeyer A, Kyriss T, Raupach T (2007) Tabakrauchen, chronisch obstruktive Lungenerkrankung und Lungenkarzinom. Pneumologie 61:590–594CrossRefGoogle Scholar
  2. Apter A, Bracker A, Hodgson M, Sidman J, Leung WY (1994) Epidemiology of the sick building syndrome. J Allergy Clin Immunol 94:277–288Google Scholar
  3. Björnsson E, Janson C, Norbäck D, Boman G (1998) Symptoms related to the sick building syndrome in a general population sample: associations with atopy, bronchial hyper-responsiveness and anxiety. Int J Tuberc Lung Dis 2:1023–1028Google Scholar
  4. Bornehag CG, Blomquist G, Gyntelberg F, Jarvholm B, Malmberg P, Nordvall L, Nielsen A, Pershagen G, Sundell J (2001) Dampness in buildings and health. Nordic interdisciplinary review of the scientific evidence on associations between exposure to “dampness” in buildings and health effects (NORDDAMP). Indoor Air 11:72–86CrossRefGoogle Scholar
  5. Brauer C, Kolstad H, Orbaek P, Mikkelsen S (2006) No consistent risk factor pattern for symptoms related to the sick building syndrome: a prospective population based study. Int Arch Occup Environ Health 79:453–464CrossRefGoogle Scholar
  6. Brunekreef B (1992) Damp housing and adult respiratory symptoms. Allergy 47:498–502CrossRefGoogle Scholar
  7. Chinn S, Jarvis D, Burney P, Luczynska C, Ackermann-Liebrich U, Anto JM, Cerveri I, De Marco R, Gislason T, Heinrich J, Janson C, Kunzli N, Leynaert B, Neukirch F, Schouten J, Sunyer J, Svanes C, Vermeire P, Wjst M (2004) Increase in diagnosed asthma but not in symptoms in the European Community Respiratory Health Survey [see comment]. Thorax 59:646–651CrossRefGoogle Scholar
  8. Dales RE, Raizenne M, el-Saadany S, Brook J, Burnett R (1994) Prevalence of childhood asthma across Canada. Int J Epidemiol 23:775–781CrossRefGoogle Scholar
  9. Engvall K, Norrby C, Norbäck D (2001) Sick building syndrome in relation to building dampness in multi-family residential buildings in Stockholm. Int Arch Occup Environ Health 74:270–278CrossRefGoogle Scholar
  10. Engvall K, Norrby C, Norbäck D (2003) Ocular, nasal, dermal and respiratory symptoms in relation to heating, ventilation, energy conservation, and reconstruction of older multi-family houses. Indoor Air 13:206–211CrossRefGoogle Scholar
  11. Fisk WJ, Lei-Gomez Q, Mendell MJ (2007) Meta-analyses of the associations of respiratory health effects with dampness and mould in homes. Indoor Air 17:284–296CrossRefGoogle Scholar
  12. Gunnbjörnsdóttir MI, Franklin KA, Norbäck D, Björnsson E, Gislason D, Lindberg E, Svanes C, Omenaas E, Norrman E, Jõgi R, Jensen EJ, Dahlman-Höglund A, Janson C (2006) RHINE study group prevalence and incidence of respiratory symptoms in relation to indoor dampness: the RHINE study. Thorax 61(3):221–225 (Epub 5 Jan 2006)CrossRefGoogle Scholar
  13. Hodgson M (1995) The sick-building syndrome. Occup Med 10:167–175Google Scholar
  14. Husman T (1996) Health effects of indoor-air microorganisms. Scand J Work Environ Health 22:5–13Google Scholar
  15. Mendell MJ (1993) Non-specific symptoms in office workers: a review and summary of the epidemiological literature. Indoor Air 3:227–236CrossRefGoogle Scholar
  16. Norbäck D, Edling C (1991) Environmental, occupational, and personal factors related to the prevalence of sick building syndrome in the general population. British J Ind Med 48:451–462Google Scholar
  17. Norbäck D, Björnsson E, Janson C, Widstrom J, Boman G (1995) Asthmatic symptoms and volatile organic compounds, formaldehyde, and carbon dioxide in dwellings. Occup Environ Med 52:388–395CrossRefGoogle Scholar
  18. Norbäck D, Björnsson E, Janson C, Palmgren U, Boman G (1999) Current asthma and biochemical signs of inflammation in relation to building dampness in dwellings. Int J Tuberc Lung Dis 3:368–376Google Scholar
  19. Norlen U, Andersson K (1993) An indoor climate survey of the Swedish housing stock (the ELIB study)”. In: Proceedings of indoor air ‘93, Helsinki, international conference on indoor air quality and climate, vol 1, pp 743–748Google Scholar
  20. Norlen U, Andersson K (1995) Indoor climate in Swedish dwellings. In: Proceedings of healthy buildings 95, Milano, vol. 1, pp 743–748Google Scholar
  21. Peat JK, Dickerson J, Li J (1998) Effects of damp and mould in the home on respiratory health: a review of the literature. Allergy 53:120–128CrossRefGoogle Scholar
  22. Platt SD, Martin CJ, Hunt SM, Lewis CW (1989) Damp housing, mould growth, and symptomatic health state [see comment]. BMJ 298:1673–1678CrossRefGoogle Scholar
  23. Rogier C, Dabis F, Teissier R, Salamon R (1989) Which role do smoking and air conditioning play in the occurrence of building sickness among hospital personell? Rev Epidemiol Sante Publique 37(3):255–262Google Scholar
  24. Seppanen OA, Fisk WJ, Mendell MJ (1999) Association of ventilation rates and CO2 concentrations with health and other responses in commercial and institutional buildings. Indoor Air 9:226–252CrossRefGoogle Scholar
  25. Skov P, Valbjörn O, Pedersen BV, Danish Indoor Climate Study Group (1989) Influence of personal characteristics, job-related factors and psycosocial factors on the sick building syndrome”. Scand J Work Environ Health 15:286–295Google Scholar
  26. Toren K, Gislason T, Omenaas E, Jogi R, Forsberg B, Nystrom L, Olin AC, Svanes C, Janson C, Group R (2004) A prospective study of asthma incidence and its predictors: the RHINE study. Eur Respir J 24:942–946CrossRefGoogle Scholar
  27. Verhoeff AP, Burge HA (1997) Health risk assessment of fungi in home environments. Ann Allergy Asthma Immunol 78:544–554 quiz 555-6CrossRefGoogle Scholar
  28. Wargocki P, Wyon DP, Sundell J, Clausen G, Fanger PO (2000) The effects of outdoor air supply rate in an office on perceived air quality, sick building syndrome (SBS) symptoms and productivity. Indoor Air 10:222–236CrossRefGoogle Scholar
  29. Wieslander G, Norbäck D, Björnsson E, Janson C, Boman G (1997) Asthma and the indoor environment: the significance of emission of formaldehyde and volatile organic compounds from newly painted indoor surfaces. Int Arch Occup Environ Health 69:115–124CrossRefGoogle Scholar
  30. Wieslander G, Norbäck D, Nordström K, Wålinder R, Venge P (1999) Nasal and ocular symptoms, tear film stability and biomarkers in nasal lavage, in relation to building-dampness and building design in hospitals. Int Arch Occup Environ Health 72(7):451–461CrossRefGoogle Scholar
  31. World Health Organisation (1983) Indoor air pollutants: exposure and health effects report on WHO meeting, vol 78. WHO Regional Office for Europe. EURO Reports and Studies 1983, pp 78, 1–48Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Occupational and Environmental MedicineUppsala University Hospital and Uppsala UniversityUppsalaSweden

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