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When a patient shows up at the internist's office complaining of chronic cough and mild asthma symptoms, most doctors look to the usual suspects — allergies. But how many physicians think a sick building might be making their patient sick? Not enough of them, according to Jeffrey C. May, author of My Office is Killing Me! The Sick Building Survival Guide. "I don't think most doctors look at the work environment closely, or the home environment, for that matter. I do work with some physicians who are somewhat enlightened, especially allergists and pulmonologists," May said. "They will try medications and find out that the patient is simply not getting better, or the patient gets better in the hospital — and then they send them back home and to work again, and then they get sick right away. They will ask me to do an evaluation, and most of the time, the problems that I find are just unbelievable." With a bachelor's in chemistry from Columbia College and a master's in organic chemistry from Harvard University, May is the founder and principal scientist of May Indoor Air Investigations in Cambridge, Mass. He's also certified as an indoor air quality professional by the Association of Energy Engineers. May has also written My House is Killing Me! and coauthored The Mold Survival Guide: For Your Home and Your Health . May said "you'd be surprised" at the number of allergy and asthma symptoms and illnesses caused by indoor air pollution. May divides sick-building ailments into two categories: sick-building symptoms and building-related illnesses. "Really, only a few people have building-related illnesses, while 20 percent may have sick-building symptoms," he said. "Building-related illnesses are very, very serious and sometimes life-threatening," May said. They include hypersensitivity pneumonitis and sarcoidosis, which is inflammation that produces tiny lumps of cells in organs. They also include conditions that range from debilitating fibromyalgia to miscarriages and even cancer. In addition to asthma and chronic cough, the number and variety of sick-building symptoms are staggering: dizziness or nausea; headache; eye, nose or throat irritation; dry or itchy skin; difficulty concentrating; fatigue; sensitivity to odors; muscle aches; chest tightness; and fever and chills. The chief culprit is bioaerosols, which May defined as "particles in the air that come from a living thing — bacteria, yeast or spores from fungi or even particles from dust mites." Other bioaerosols are pollen and the bacteria Legionella, which has caused both Legionnaire's disease and Pontiac fever. "In the beginning when [researchers] first started looking at sick buildings, they sort of concluded a little bit too quickly that most of the problems were due to inadequate ventilation. But it isn't really the lack of ventilation that's the problem, although it certainly exacerbates this," May said. "It's the presence of chemicals and bioaerosols that really creates the problem. They now think that more than half of indoor air-quality problems are the result of bioaerosols, the products of biological growth." May recommended that physicians suspicious of sick-building syndrome try a simple experiment first with their patients. To rule out airborne allergens, patients should wear a mask while in the work environment, and the mask should be model number N95, manufactured by 3M and approved by the National Institute for Occupational Safety and Health. "I have had a lot of clients put on that mask and just stop coughing immediately," he said. "They don't cough until they take the mask off in that environment. That's very, very characteristic, since the mask stops the particles." May said a total spore count test, and nothing less, should be conducted to determine whether bioaerosols are present in the atmosphere. Yet they aren't the only guilty parties when it comes to sick-building symptoms. Chemicals, flickering lights and sounds may also prompt discomfort. "Two blowers can be close in pitch, and you actually get a beat similar to what you would from an instrument," he explained. "I actually got dizzy once in a building, and I realized the fan wasn't balanced. As the fan was spinning, it was also vibrating back and forth, and that changed the air pressure." While May's book on home pollution is full of suggestions to remedy problems, he said the book on office air pollution contains more information on the problems themselves, since sometimes workers have little control over their office environment. "It's very, very important that when you can't control directly the situation, then at least you understand what testing involves and what the results mean." He acknowledges that there can be a feeling of helplessness. "I know teachers whose lives have been ruined because they've taught in the same environment for years and years and gotten sicker and sicker," he said, adding that physicians can be patients' best advocates when the office environment is suspected to cause problems. April 2007

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