Low Level Carbon Dioxide Indoors—A Pollution Indicator or a Pollutant? A Health-Based Perspective

With modern populations in developed countries spending approximately 90% of their time indoors, and with carbon dioxide (CO2) concentrations inside being able to accumulate to much greater concentrations than outdoors, it is important to identify the health effects associated with the exposure to low-level CO2 concentrations (<5000 ppm) typically seen in indoor environments in buildings (non-industrial environments). Although other reviews have summarised the effects of CO2 exposure on health, none have considered the individual study designs of investigations and factored that into the level of confidence with which CO2 and health effects can be associated, nor commented on how the reported health effects of exposure correspond to existing guideline concentrations. This investigation aimed to (a) evaluate the reported health effects and physiological responses associated with exposure to less than 5000 parts per million (ppm) of CO2 and (b) to assess the CO2 guideline and limit concentrations in the context of (a). Of the 51 human investigations assessed, many did not account for confounding factors, the prior health of participants or cross-over effects. Although there is some evidence linking CO2 exposures with health outcomes, such as reductions in cognitive performance or sick building syndrome (SBS) symptoms, much of the evidence is conflicting. Therefore, given the shortcomings in study designs and conflicting results, it is difficult to say with confidence whether low-level CO2 exposures indoors can be linked to health outcomes. To improve the epidemiological value of future investigations linking CO2 with health, studies should aim to control or measure confounding variables, collect comprehensive accounts of participants’ prior health and avoid cross-over effects. Although it is difficult to link CO2 itself with health effects at exposures less than 5000 ppm, the existing guideline concentrations (usually reported for 8 h, for schools and offices), which suggest that CO2 levels <1000 ppm represent good indoor air quality and <1500 ppm are acceptable for the general population, appear consistent with the current research.