Patients report that they constantly suffer from the feeling, which is difficult to describe, that there is something disturbing and constricting in their throat and that it has to come out somehow. They constantly feel the need to swallow or clear their throat. For some, it also triggers an urge to cough or shortness of breath.
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Complaints
Many complaints
Many office workers spend between 80 and 90% of their time indoors. In this way, they are protected from the fluctuations of the climate (cold, wet, solar radiation, wind). Air conditioning systems create optimal conditions for working in the comfort zone.
This means a temperature between 20° and 23°C, humidity between 40 and 60%, low solar radiation and low air movement (no drafts).
If the temperature is too high or too low, the ability to work decreases, and if the air is too dry, mucous membrane diseases increase. Humid air favors the growth of microorganisms (fungi, bacteria, mites, viruses). Air-conditioning systems thus create an optimal regulation and enable work in the comfort zone.
Working indoors leads to further consequences. Of necessity, people living there are exposed to substances released by the building and its furnishings. The following problematic substances are held responsible for the symptomatology and are sometimes removed at great expense:
- House dust, molds, pet dander.
- Formaldehyde, wood preservatives, herbicides, fungicides
- Pentachlorophenol (PCP), Lindane, Polychlorinated Biphenyls (PCB's)
- Volatile substances, solvents, terpenes
- Ozone, cleaning agents
- Asbestos, other fibers
- Electrosmog
No findings
If there is indeed relevant pollution, then there is of course a need for action. Above all, molds in the case of increased humidity and poor ventilation seem to be able to become a problem. Volatile organic and non-organic compounds can also occasionally be responsible for symptoms. Similarly, air conditioning systems require regular maintenance and cleaning.
But in the vast majority of cases, no abnormal findings are found. No pollutants are detectable either in the room air or in the air conditioning system. On the contrary, the air in rooms with air conditioning is usually better than that in conventionally ventilated rooms; this is the result of numerous investigations.
This is in stark contrast to the subjective perception of those affected. They usually blame the air conditioning system for the symptoms. This is particularly true when windows cannot be opened for normal ventilation.
Functional syndrome?
So if neither pollutants nor microorganisms are responsible for the strange symptoms, what is the actual cause?
Are the sufferers hypochondriacs? Are the symptoms just an expression of a general dissatisfaction with work? Is it all just "imaginary"?
TheGerman Federal Environmental Agency expresses the dilemma a bit more discreetly: "In summary, the studies have shown that personal factors and feelings of the affected persons, their job and the user-friendliness of their workplace were often more decisive for the occurrence of sick building syndrome than the influences of the office building.
In fact, studies show that some people are particularly susceptible to sick building syndrome.
Two groups seem to be particularly affected.
- People who suffer more from allergies, hay fever and bronchial asthma.
- People with high physical or psychological tension, anxiety, depression and increased psychosomatic complaints.
As with other functional and psychosomatic disorders (e.g., fibromyalgia, irritable bowel syndrome, functional respiratory problems, etc.), women are more likely than men to suffer from sick building syndrome.
In summary, apparently people with increased sensitivity and increased immunological responsiveness are more susceptible to symptomatology.
Causes
Carbon dioxide?
In recent years, a number of studies have appeared that have investigated the connection between elevated carbon dioxide concentrations in indoor spaces and sick building syndrome. A clear tendency emerged: the higher the proportion of CO2 in indoor air, the more strongly general well-being and performance were impaired and numerous complaints were promoted.
While outdoor air has around 400 parts of CO2 per million parts of air (ppm), the concentration of CO2 in a normal office is significantly higher. Depending on ventilation, this can rise to 1000 ppm or even higher. Above 1400 ppm, most people experience symptoms (difficulty concentrating, head pressure, claustrophobia).
However, people react subjectively differently to the increasing concentration. While some contemporaries calmly tolerate high CO2 levels, others are already clearly irritated by a slight increase in carbon dioxide.
As a rule of thumb, the higher the general sensitivity, irritability and anxiety, the higher the sensitivity to carbon dioxide.
Increased sensitivity to CO2
So what is the consequence of the increased sensitivity to CO2?
When CO2 rises in the air we breathe, this triggers deepened, accelerated breathing in all people (albeit at different rates). Medically, this is called "hyperventilation". This then leads secondarily to complex changes in blood gases, pH (acid-base balance) and electrolytes.
While acute hyperventilation is hard to miss (palpitations, cramps, shortness of breath, anxiety/panic),chronic hyperventilation, on the other hand, is often not noticed.
In summary, the following physiological changes occur:
- Drop in magnesium and calcium in cells (especially nerve cells).
- decrease of CO2 concentration in blood and increase of blood pH
- decrease in cerebral blood flow
- deterioration of oxygen delivery by red blood cells
- increase in the tendency of smooth and striated muscles to spasm
Overlaps
The leading symptoms of chronichyperventilation syndrome are:
- Head pressure/headaches
- Feeling uncomfortable in closed rooms with many people
- Difficulty concentrating
- Forgetfulness
- Irritability
- Dizziness and lightheadedness
- chest pain
- cold hands and feet
- fatigue
- listlessness
- drowsiness
- weather sensitivity
- Dryness of the mucous membranes
- Inner tension, anxious or depressive symptoms
Thus, there is a clear overlap between the symptoms of sick building syndrome and chronic hyperventilation.
Brain circulation
In recent years, our own clinical work has focused on the connections betweenfatigue andrespiration.
Two mechanisms play a central role in supplying the brain with oxygen:
- The lower the CO2 content in the blood, the more cerebral blood flow decreases.
- The lower the CO2 content in the blood, the worse the delivery of oxygen by the red blood cells (more precisely: hemoglobin).
In chronic hyperventilation, therefore, there is a deficiency in the supply of oxygen via two different pathways. This is likely to be at least one significant factor in the development of head pressure, exhaustion, poor performance and concentration problems.