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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Built Environ.</journal-id>
<journal-title>Frontiers in Built Environment</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Built Environ.</abbrev-journal-title>
<issn pub-type="epub">2297-3362</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">1510965</article-id>
<article-id pub-id-type="doi">10.3389/fbuil.2025.1510965</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Built Environment</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Health-demand ventilation control strategy in northern Chinese homes: how much ventilation do we need to protect occupants&#x2019; health</article-title>
<alt-title alt-title-type="left-running-head">Wang et al.</alt-title>
<alt-title alt-title-type="right-running-head">
<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fbuil.2025.1510965">10.3389/fbuil.2025.1510965</ext-link>
</alt-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Wang</surname>
<given-names>Zhigang</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff2">
<sup>2</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>&#x2020;</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/investigation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author" equal-contrib="yes">
<name>
<surname>Hou</surname>
<given-names>Jing</given-names>
</name>
<xref ref-type="aff" rid="aff3">
<sup>3</sup>
</xref>
<xref ref-type="author-notes" rid="fn001">
<sup>&#x2020;</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/methodology/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fu</surname>
<given-names>Jinming</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/2113890/overview"/>
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<role content-type="https://credit.niso.org/contributor-roles/visualization/"/>
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<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Tian</surname>
<given-names>Zhe</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
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<role content-type="https://credit.niso.org/contributor-roles/Writing - review &#x26; editing/"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Feng</surname>
<given-names>Shuyuan</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
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</contrib>
<contrib contrib-type="author">
<name>
<surname>Kosonen</surname>
<given-names>Risto</given-names>
</name>
<xref ref-type="aff" rid="aff5">
<sup>5</sup>
</xref>
<uri xlink:href="https://loop.frontiersin.org/people/1716442/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
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</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Sun</surname>
<given-names>Yuexia</given-names>
</name>
<xref ref-type="aff" rid="aff4">
<sup>4</sup>
</xref>
<xref ref-type="corresp" rid="c001">&#x2a;</xref>
<uri xlink:href="https://loop.frontiersin.org/people/164108/overview"/>
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</contrib-group>
<aff id="aff1">
<sup>1</sup>
<institution>Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control</institution>, <institution>School of Mechanical Engineering</institution>, <institution>Tianjin University of Technology</institution>, <addr-line>Tianjin</addr-line>, <country>China</country>
</aff>
<aff id="aff2">
<sup>2</sup>
<institution>National Demonstration Center for Experimental Mechanical and Electrical Engineering Education</institution>, <institution>Tianjin University of Technology</institution>, <addr-line>Tianjin</addr-line>, <country>China</country>
</aff>
<aff id="aff3">
<sup>3</sup>
<institution>School of Mechanical Engineering</institution>, <institution>Tianjin University of Commerce</institution>, <addr-line>Tianjin</addr-line>, <country>China</country>
</aff>
<aff id="aff4">
<sup>4</sup>
<institution>School of Environmental Science and Engineering</institution>, <institution>Tianjin University</institution>, <addr-line>Tianjin</addr-line>, <country>China</country>
</aff>
<aff id="aff5">
<sup>5</sup>
<institution>Department of Mechanical Engineering</institution>, <institution>Aalto University</institution>, <addr-line>Espoo</addr-line>, <country>Finland</country>
</aff>
<author-notes>
<fn fn-type="edited-by">
<p>
<bold>Edited by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/188876/overview">Hasim Altan</ext-link>, Prince Mohammad bin Fahd University, Saudi Arabia</p>
</fn>
<fn fn-type="edited-by">
<p>
<bold>Reviewed by:</bold> <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1909606/overview">Roberto Alonso Gonz&#xe1;lez-Lezcano</ext-link>, CEU San Pablo University, Spain</p>
<p>
<ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/1993789/overview">Naglaa Sami Abdelaziz Mahmoud</ext-link>, Ajman University, United Arab Emirates</p>
</fn>
<corresp id="c001">&#x2a;Correspondence: Yuexia Sun, <email>yuexiasun@tju.edu.cn</email>
</corresp>
<fn fn-type="equal" id="fn001">
<label>
<sup>&#x2020;</sup>
</label>
<p>These authors have contributed equally to this work and share first authorship</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>13</day>
<month>02</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="collection">
<year>2025</year>
</pub-date>
<volume>11</volume>
<elocation-id>1510965</elocation-id>
<history>
<date date-type="received">
<day>14</day>
<month>10</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>23</day>
<month>01</month>
<year>2025</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2025 Wang, Hou, Fu, Tian, Feng, Kosonen and Sun.</copyright-statement>
<copyright-year>2025</copyright-year>
<copyright-holder>Wang, Hou, Fu, Tian, Feng, Kosonen and Sun</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec>
<title>Introduction</title>
<p>Indoor air quality in dwellings has particular importance regarding occupants&#x2019; health. Ventilation is an important means to improve indoor air quality and guarantee occupants&#x2019; health.</p>
</sec>
<sec>
<title>Methods</title>
<p>We utilized CO<sub>2</sub> produced by occupants to measure air exchange rate (i.e., the volumetric out-to-indoor airflow rate divided by building volume, h<sup>&#x2212;1</sup>) in Chinese homes, which were then linked to health outcomes like asthma and sick building syndrome symptom. Finally, we proposed a &#x201c;health-demand&#x201d; ventilation control strategy according to the relationship between air exchange rate and health outcomes.</p>
</sec>
<sec>
<title>Results and Discussion</title>
<p>Each 0.1 h<sup>&#x2212;1</sup> increase in air exchange rate at night was associated with adjusted odds ratios of 0.97 (Confidence Interval (CI): 0.94&#x2013;1.00) for rhinitis among children and 0.95 (95% CI: 0.91&#x2013;0.98) for mucosal sick building symptom among adults. Finally, we proposed a &#x201c;health-demand&#x201d; ventilation control strategy according to the relationship between air exchange rate and health outcomes. Air exchange rate of 2.5 h<sup>&#x2212;1</sup> and 6.5 h<sup>&#x2212;1</sup> was suggested to deal with sick building syndrome symptoms among adults and rhinitis symptoms among children, respectively.</p>
</sec>
</abstract>
<kwd-group>
<kwd>air exchange rate</kwd>
<kwd>carbon dioxide</kwd>
<kwd>sick building syndrome</kwd>
<kwd>asthma and allergy</kwd>
<kwd>dose-response relationship</kwd>
</kwd-group>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Indoor Environment</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec id="s1">
<title>Introduction</title>
<p>People spend most of their time indoors, and especially in homes (<xref ref-type="bibr" rid="B24">Tudor-Locke et al., 2009</xref>). Indoor environment plays an important role on occupants&#x2019; comfort and health. With China&#x2019;s rapid modernization and urbanization in just a few decades, hundreds of millions of Chinese have experienced rapid and dramatic changes in indoor air environment. Dwellings in Chinese cities have changed from Pingfang (i.e., one-story single family house) to high-rise buildings (<xref ref-type="bibr" rid="B5">China Statistical Yearbook, 2018</xref>). A variety of new synthetic building materials, furniture, personal care and indoor cleaning products have been widely used in homes. Pollutants, including formaldehyde, volatile organic compounds (VOCs), semi-VOCs, and bioeffluent have been found indoors, indicating a common indoor air quality (IAQ) issue in Chinese residences (<xref ref-type="bibr" rid="B8">Huang et al., 2017</xref>; <xref ref-type="bibr" rid="B30">Zhang et al., 2020</xref>). Some indoor pollutants produce odors or are related to irritation, while some pose chronic and/or acute health effects on occupants via inhalation, dermal or other pathways (<xref ref-type="bibr" rid="B12">Ostro et al., 2015</xref>; <xref ref-type="bibr" rid="B21">Sundell, 2017</xref>; <xref ref-type="bibr" rid="B32">Zhu et al., 2022</xref>; <xref ref-type="bibr" rid="B25">Wan et al., 2024</xref>; <xref ref-type="bibr" rid="B31">Zhao et al., 2024</xref>).</p>
<p>Ventilation is one of the most important means to remove or dilute indoor pollutants and maintain a habitable space for human beings (<xref ref-type="bibr" rid="B22">Sundell et al., 2011</xref>; <xref ref-type="bibr" rid="B26">Wargocki et al., 2002</xref>; <xref ref-type="bibr" rid="B4">Chenari et al., 2016</xref>). Bornehag (<xref ref-type="bibr" rid="B2">Bornehag et al., 2005</xref>) studied the association of ventilation with asthma and allergy among Swedish children. They found that children with no signs of any allergies were living in homes with higher ventilation rates, compared to those in homes of allergic children (0.37 h<sup>&#x2212;1</sup> v. s. 0.32 h<sup>&#x2212;1</sup>). Smedje (<xref ref-type="bibr" rid="B14">Smedje et al., 2017</xref>) investigated indoor environments in 1,160 adults&#x2019; homes in Sweden and found that both mucous and dermal symptoms were less prevalent among occupants living in bedrooms with higher ventilation rates. Few study on health effects of ventilation has been performed in Chinese homes. Sun et al. reported significant higher prevalence of wheezing and sick building syndrome (SBS) symptoms among college students in dorm rooms with air exchange rate less than 0.7 h<sup>&#x2212;1</sup> (<xref ref-type="bibr" rid="B19">Sun et al., 2011</xref>; <xref ref-type="bibr" rid="B20">Sun et al., 2013</xref>).</p>
<p>The establishment of ventilation requirements for occupied spaces has a long history. The minimum ventilation rate nowadays is recommended mainly on perception of air quality, rather than directly addressing occupants&#x2019; health (<xref ref-type="bibr" rid="B9">Janssen, 1999</xref>; <xref ref-type="bibr" rid="B22">Sundell et al., 2011</xref>; <xref ref-type="bibr" rid="B10">Klauss et al., 2011</xref>). For example, the ASHRAE Standard 62 (<xref ref-type="bibr" rid="B1">ASHRAE, 2016</xref>) sets outdoor airflow rate of 21&#x2013;35 L/s as the required ventilation in homes for a 47&#x2013;93 m<sup>2</sup> floor area, which is equivalent to air exchange rate of 0.5&#x2013;0.6 h<sup>&#x2212;1</sup>. This was basically the lowest permissible ventilation rate to dilute occupant odors to a concentration acceptable to 80% of occupants. Carbon dioxide was used as a surrogate for occupant odor, but not a health risk, with ceiling concentration of 1,000 ppm (0.1%). A ventilation standard based on health effects rather than air quality perception is more important.</p>
<p>Previous studies have not fully established a quantitative relationship between ventilation rate and health outcomes of occupants. Therefore, the aims of this paper are: 1) to provide knowledge on the relationship between ventilation in residences and occupants&#x2019; health; 2) to propose a health-demand ventilation control strategy in residential buildings.</p>
</sec>
<sec sec-type="materials|methods" id="s2">
<title>Materials and methods</title>
<sec id="s2-1">
<title>Measurement of ventilation in northern Chinese homes</title>
<p>We measured ventilation rate (expressed as air exchange rate, h<sup>&#x2212;1</sup>) in northern Chinese homes by using occupants-generated CO<sub>2</sub> as tracer gas (<xref ref-type="bibr" rid="B7">Hou et al., 2018</xref>). This method (&#x201c;CO<sub>2</sub> method&#x201d;) is based on the mass balance of CO<sub>2</sub> in investigated space (<xref ref-type="disp-formula" rid="e1">Equation 1</xref>).<disp-formula id="e1">
<mml:math id="m1">
<mml:mrow>
<mml:mi>F</mml:mi>
<mml:mo>&#x2b;</mml:mo>
<mml:mi>N</mml:mi>
<mml:mi>V</mml:mi>
<mml:mo>&#xb7;</mml:mo>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mi>o</mml:mi>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mi>V</mml:mi>
<mml:mfrac>
<mml:mrow>
<mml:msub>
<mml:mi>d</mml:mi>
<mml:mi>c</mml:mi>
</mml:msub>
</mml:mrow>
<mml:mrow>
<mml:msub>
<mml:mi>d</mml:mi>
<mml:mi>t</mml:mi>
</mml:msub>
</mml:mrow>
</mml:mfrac>
<mml:mo>&#x2b;</mml:mo>
<mml:mi>N</mml:mi>
<mml:mi>V</mml:mi>
<mml:mo>&#xb7;</mml:mo>
<mml:mi>c</mml:mi>
</mml:mrow>
</mml:math>
<label>(1)</label>
</disp-formula>where <inline-formula id="inf1">
<mml:math id="m2">
<mml:mrow>
<mml:mi>F</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the emission rate of CO<sub>2</sub> (m<sup>3</sup>/h), <inline-formula id="inf2">
<mml:math id="m3">
<mml:mrow>
<mml:mi>N</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the air exchange rate (h<sup>&#x2212;1</sup>), <inline-formula id="inf3">
<mml:math id="m4">
<mml:mrow>
<mml:mi>V</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the volume of the space (m<sup>3</sup>), <inline-formula id="inf4">
<mml:math id="m5">
<mml:mrow>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mi>o</mml:mi>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is the outdoor CO<sub>2</sub> concentration (m<sup>3</sup>/m<sup>3</sup>), <inline-formula id="inf5">
<mml:math id="m6">
<mml:mrow>
<mml:mi>c</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the indoor CO<sub>2</sub> concentration (m<sup>3</sup>/m<sup>3</sup>), <inline-formula id="inf6">
<mml:math id="m7">
<mml:mrow>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the time (h).</p>
<p>The emission rate of CO<sub>2</sub> can be calculated as in <xref ref-type="disp-formula" rid="e2">Equation 2</xref> (<xref ref-type="bibr" rid="B13">Persily, 1996</xref>):<disp-formula id="e2">
<mml:math id="m8">
<mml:mrow>
<mml:mi>F</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mi>R</mml:mi>
<mml:mi>Q</mml:mi>
<mml:mo>&#xb7;</mml:mo>
<mml:mn>0.00201</mml:mn>
<mml:mo>&#xb7;</mml:mo>
<mml:msup>
<mml:mi>H</mml:mi>
<mml:mn>0.725</mml:mn>
</mml:msup>
<mml:mo>&#xb7;</mml:mo>
<mml:msup>
<mml:mi>W</mml:mi>
<mml:mn>0.425</mml:mn>
</mml:msup>
<mml:mo>&#xb7;</mml:mo>
<mml:mi>M</mml:mi>
<mml:mo>/</mml:mo>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mn>0.23</mml:mn>
<mml:mo>&#xb7;</mml:mo>
<mml:mi>R</mml:mi>
<mml:mi>Q</mml:mi>
<mml:mo>&#x2b;</mml:mo>
<mml:mn>0.77</mml:mn>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
</mml:mrow>
</mml:math>
<label>(2)</label>
</disp-formula>where <inline-formula id="inf7">
<mml:math id="m9">
<mml:mrow>
<mml:mi>R</mml:mi>
<mml:mi>Q</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the respiratory quotient assumed to be 0.83, <inline-formula id="inf8">
<mml:math id="m10">
<mml:mrow>
<mml:mi>H</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the height of the occupant (m), <inline-formula id="inf9">
<mml:math id="m11">
<mml:mrow>
<mml:mi>W</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the weight of the occupant (kg), <inline-formula id="inf10">
<mml:math id="m12">
<mml:mrow>
<mml:mi>M</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is the metabolic level (met).</p>
<p>By solving <xref ref-type="disp-formula" rid="e1">Equation 1</xref>, indoor CO<sub>2</sub> concentration can be expressed as in <xref ref-type="disp-formula" rid="e3">Equation 3</xref>:<disp-formula id="e3">
<mml:math id="m13">
<mml:mrow>
<mml:mi>c</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mn>1</mml:mn>
</mml:msub>
<mml:mo>&#x2061;</mml:mo>
<mml:mi mathvariant="italic">exp</mml:mi>
<mml:mtext>&#x2009;</mml:mtext>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mo>&#x2212;</mml:mo>
<mml:mi>N</mml:mi>
<mml:mo>&#xb7;</mml:mo>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
<mml:mo>&#x2b;</mml:mo>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mi>F</mml:mi>
<mml:mo>&#xb7;</mml:mo>
<mml:mfrac>
<mml:msup>
<mml:mn>10</mml:mn>
<mml:mn>6</mml:mn>
</mml:msup>
<mml:mrow>
<mml:mi>N</mml:mi>
<mml:mi>V</mml:mi>
</mml:mrow>
</mml:mfrac>
<mml:mo>&#x2b;</mml:mo>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mn>0</mml:mn>
</mml:msub>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mn>1</mml:mn>
<mml:mo>&#x2212;</mml:mo>
<mml:mi mathvariant="italic">exp</mml:mi>
<mml:mtext>&#x2009;</mml:mtext>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mo>&#x2212;</mml:mo>
<mml:mi>N</mml:mi>
<mml:mo>&#xb7;</mml:mo>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
</mml:mrow>
</mml:math>
<label>(3)</label>
</disp-formula>where <inline-formula id="inf11">
<mml:math id="m14">
<mml:mrow>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mn>1</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is CO<sub>2</sub> concentration in the initial measurement (ppm).</p>
<p>We measure CO<sub>2</sub> concentrations in the investigated space continuously by CO<sub>2</sub> monitors (AZ 7798, China, see <xref ref-type="fig" rid="F1">Figure 1</xref>) at an interval of 1 min for at least 24 h and ask the height and weight of each occupant. Outdoor CO<sub>2</sub> concentrations are assumed as 400 ppm. CO<sub>2</sub> concentration measured during sleeping time is used to estimate air exchange rate. A presumed air exchange rate, as well as initial value of measured CO<sub>2</sub> concentration, outdoor CO<sub>2</sub> concentration, emission rate of CO<sub>2</sub>, volume of space are inputted into <xref ref-type="disp-formula" rid="e3">Equation 3</xref> to estimate value of CO<sub>2</sub> concentrations at each <inline-formula id="inf12">
<mml:math id="m15">
<mml:mrow>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula>. The least square method is applied to find the minimum of errors [sum of all individual differences between measured and estimated values (<xref ref-type="disp-formula" rid="e4">Equation 4</xref>)] by changing the value of estimated air exchange rate. Therefore, the air exchange rate is the only one unknown parameter of <xref ref-type="disp-formula" rid="e3">Equation 3</xref>. <xref ref-type="fig" rid="F2">Figure 2</xref> shows the fitting of non-linear curve of measured and estimated CO<sub>2</sub> concentration.<disp-formula id="e4">
<mml:math id="m16">
<mml:mrow>
<mml:mtext>Error</mml:mtext>
<mml:mo>&#x3d;</mml:mo>
<mml:mstyle displaystyle="true">
<mml:munderover>
<mml:mo>&#x2211;</mml:mo>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0</mml:mn>
</mml:mrow>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>&#x3d;</mml:mo>
<mml:mi>m</mml:mi>
</mml:mrow>
</mml:munderover>
</mml:mstyle>
<mml:msup>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>,</mml:mo>
<mml:mi>m</mml:mi>
<mml:mi>e</mml:mi>
<mml:mi>a</mml:mi>
<mml:mi>s</mml:mi>
</mml:mrow>
</mml:msub>
<mml:mo>&#x2212;</mml:mo>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>,</mml:mo>
<mml:mi>e</mml:mi>
<mml:mi>s</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
<mml:mn>2</mml:mn>
</mml:msup>
</mml:mrow>
</mml:math>
<label>(4)</label>
</disp-formula>where <inline-formula id="inf13">
<mml:math id="m17">
<mml:mrow>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>,</mml:mo>
<mml:mi>m</mml:mi>
<mml:mi>e</mml:mi>
<mml:mi>a</mml:mi>
<mml:mi>s</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is measured CO<sub>2</sub> concentration at time i, ppm; <inline-formula id="inf14">
<mml:math id="m18">
<mml:mrow>
<mml:msub>
<mml:mi>c</mml:mi>
<mml:mrow>
<mml:mi>i</mml:mi>
<mml:mo>,</mml:mo>
<mml:mi>e</mml:mi>
<mml:mi>s</mml:mi>
<mml:mi>t</mml:mi>
</mml:mrow>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is estimated CO<sub>2</sub> concentration at time i, ppm.</p>
<fig id="F1" position="float">
<label>FIGURE 1</label>
<caption>
<p>CO<sub>2</sub> monitors used for air exchange rate measurement.</p>
</caption>
<graphic xlink:href="fbuil-11-1510965-g001.tif"/>
</fig>
<fig id="F2" position="float">
<label>FIGURE 2</label>
<caption>
<p>Example on estimation of air exchange rate.</p>
</caption>
<graphic xlink:href="fbuil-11-1510965-g002.tif"/>
</fig>
<p>This &#x201c;CO<sub>2</sub>&#x201d; method does not require apparatus to inject tracer gas, with no intervention on occupants&#x2019; behaver, therefore can measure long-term ventilation rate in real living conditions.</p>
</sec>
<sec id="s2-2">
<title>Investigation on associations of ventilation with children&#x2019;s asthma and allergy</title>
<p>From 2013 to 2016, we performed a study on children&#x2019;s asthma and allergy and home environment in Tianjin, China as part of the CCHH (China, Children, Homes, Health) study. In the Tianjin CCHH study, we surveyed the prevalence rate of asthma and allergy among 7366 children who were 0&#x2013;8 years old (<xref ref-type="bibr" rid="B17">Sun et al., 2019b</xref>). Questionnaires were sent to daycare centers and elementary schools. Parents responded to the questionnaire, giving us information on their children. Based on this cross-sectional data, 200 case children (with at least two symptoms of asthma, rhinitis and eczema) and 200 controls (without any asthma and allergy symptoms) were invited into home inspections, during which we measured ventilation rate (expressed as air exchange rate) in their home based on &#x201c;CO<sub>2</sub> method,&#x201d; as well as a serial of physical (air temperature, relative humidity and CO<sub>2</sub> concentrations), chemical (such as phthalates) and biological (house dust mite allergen and endotoxin) parameters (<xref ref-type="bibr" rid="B18">Sun et al., 2024</xref>).</p>
</sec>
<sec id="s2-3">
<title>Investigation on associations of ventilation with sick building syndrome symptoms</title>
<p>From Mar. 2018 to Feb. 2019, we conducted a &#x201c;Indoor Air Quality (IAQ) and Ventilation in Homes&#x201d; study in Tianjin, China, during which we repeatedly inspected 32 Chinese homes, once during each season. During each home inspection, occupants responded to questionnaires that surveyed their SBS symptoms. The home inspection process included measurements of environmental parameters such as indoor air temperature (T), relative humidity (RH), CO<sub>2</sub>, air exchange rate, volatile organic compounds (VOCs), formaldehyde, particulate matters and ozone (<xref ref-type="bibr" rid="B16">Sun et al., 2019a</xref>).</p>
</sec>
<sec id="s2-4">
<title>Statistical analysis</title>
<p>Logistic regression analyses were used to evaluate the association of occupants&#x2019; health with air exchange rate. Potential confounders were determined <italic>a priori</italic> from literature review (<xref ref-type="bibr" rid="B27">Weinmayr et al., 2013</xref>). The confounders were gender, age, family allergic history, dampness, environmental tobacco smoke exposure, outdoor PM<sub>10</sub> and measurement seasons for the asthma and allergy analysis. Gender, age and household income were adjusted for SBS symptoms analysis. These variables have been found to be related to either ventilation or health outcomes. Therefore, they were adjusted for the association of ventilation with asthma and allergy, and SBS symptoms.</p>
</sec>
</sec>
<sec sec-type="results|discussion" id="s3">
<title>Results and discussion</title>
<p>Northern China is cold and dry in winter, and warm and moist in summer. Almost all homes in China have natural ventilation system, which rely on opening windows and infiltration for outdoor air supply. In northern China, people prefer to close windows on most days, especially in cold winter to keep indoor thermal comfort. Previous study has reported that more than 70% of the time during winter months had window closed at home (<xref ref-type="bibr" rid="B7">Hou et al., 2018</xref>).</p>
<sec id="s3-1">
<title>Dose-response relationship between air exchange rate and asthma and allergy among children</title>
<p>In the &#x201c;China, Children, Homes, Health&#x201d; study, we surveyed the prevalence of wheeze, rhinitis and eczema symptoms in the last 12 months among 7,366 children (aged 0&#x2013;8 years old) in Tianjin region (see <xref ref-type="table" rid="T1">Table 1</xref>). We obtained the air exchange rates in 374 children&#x2019;s bedroom (see <xref ref-type="table" rid="T2">Table 2</xref>) and investigated its association with children&#x2019;s asthma and allergy (see <xref ref-type="table" rid="T3">Table 3</xref>). It shows that the median value of air exchange rate was 0.4 h<sup>&#x2212;1</sup>. Air exchange rate in child&#x2019;s bedroom revealed a clear dose-response relationship with child&#x2019;s rhinitis symptom in the last 12 months. Previous study discovered that with the increment of air exchange rate (&#x394; &#x3d; 1 h<sup>&#x2212;1</sup>), house dust mite allergen concentration decreased by 32%&#x2013;57% (<xref ref-type="bibr" rid="B15">Sun et al., 2022</xref>). Epidemiologic studies have shown that exposure to house dust mite increased the prevalence rate of asthma and allergy (<xref ref-type="bibr" rid="B3">Celed&#xf3;n et al., 2007</xref>; <xref ref-type="bibr" rid="B25">Wan et al., 2024</xref>). Therefore, the impact of insufficient ventilation on child&#x2019;s asthma and allergy might be explained through the &#x201c;chain&#x201d; of house dust mite exposure in tightly constructed buildings.</p>
<table-wrap id="T1" position="float">
<label>TABLE 1</label>
<caption>
<p>Prevalence of wheeze, rhinitis and eczema in the last 12 months among children 0&#x2013;8 years old in Tianjin, China, 2013.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="left"/>
<th align="left">Total, N<xref ref-type="table-fn" rid="Tfn1">
<sup>a</sup>
</xref> &#x3d; 7,366</th>
<th align="left">0&#x2013;2 years, N &#x3d; 225</th>
<th align="left">3&#x2013;5 years, N &#x3d; 3,238</th>
<th align="left">6&#x2013;8 years, N &#x3d; 3,903</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Wheeze, n (%)<xref ref-type="table-fn" rid="Tfn2">
<sup>b</sup>
</xref>
</td>
<td align="left">333 (4.9)</td>
<td align="left">18 (8.5)</td>
<td align="left">172 (5.8)</td>
<td align="left">143 (4.0)</td>
</tr>
<tr>
<td align="left">Rhinitis, n (%)</td>
<td align="left">2002 (29.8)</td>
<td align="left">63 (30.9)</td>
<td align="left">960 (32.3)</td>
<td align="left">979 (27.6)</td>
</tr>
<tr>
<td align="left">Eczema, n (%)</td>
<td align="left">998 (14.9)</td>
<td align="left">63 (30.3)</td>
<td align="left">494 (16.7)</td>
<td align="left">441 (12.5)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="Tfn1">
<label>
<sup>a</sup>
</label>
<p>Sample size.</p>
</fn>
<fn id="Tfn2">
<label>
<sup>b</sup>
</label>
<p>Number and valid percentage for the related symptom.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" position="float">
<label>TABLE 2</label>
<caption>
<p>Distribution of air exchange rates in children&#x2019;s bedrooms, Tianjin, China, 2013<xref ref-type="table-fn" rid="Tfn3">
<sup>a</sup>
</xref>.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" align="center"/>
<th colspan="3" align="center">Air exchange rate, h<sup>&#x2212;1</sup>
</th>
</tr>
<tr>
<th align="center">1st quartile</th>
<th align="center">Median</th>
<th align="center">3rd quartile</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Total, N<xref ref-type="table-fn" rid="Tfn4">
<sup>b</sup>
</xref> &#x3d; 374</td>
<td align="center">0.21</td>
<td align="center">0.37</td>
<td align="center">0.70</td>
</tr>
<tr>
<td align="left">Spring, N &#x3d; 62</td>
<td align="center">0.18</td>
<td align="center">0.29</td>
<td align="center">0.50</td>
</tr>
<tr>
<td align="left">Summer, N &#x3d; 65</td>
<td align="center">0.30</td>
<td align="center">1.06</td>
<td align="center">2.09</td>
</tr>
<tr>
<td align="left">Autumn, N &#x3d; 97</td>
<td align="center">0.19</td>
<td align="center">0.32</td>
<td align="center">0.50</td>
</tr>
<tr>
<td align="left">Winter, N &#x3d; 150</td>
<td align="center">0.23</td>
<td align="center">0.37</td>
<td align="center">0.56</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="Tfn3">
<label>
<sup>a</sup>
</label>
<p>Bedroom had the same air exchange rate as the whole residence if the differences of CO<sub>2</sub> concentrations in different zones were &#x3c;10%.</p>
</fn>
<fn id="Tfn4">
<label>
<sup>b</sup>
</label>
<p>Sample size.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T3" position="float">
<label>TABLE 3</label>
<caption>
<p>Dose-response relationship between air exchange rate in child&#x2019;s bedroom and allergic symptoms among children, Tianjin, China.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" colspan="2" align="left"/>
<th colspan="3" align="center">Adjusted odds ratio (95% confidence interval)<xref ref-type="table-fn" rid="Tfn5">
<sup>a</sup>
</xref>
</th>
</tr>
<tr>
<th align="center">Wheeze<xref ref-type="table-fn" rid="Tfn6">
<sup>b</sup>
</xref>
</th>
<th align="center">Rhinitis</th>
<th align="center">Eczema</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td rowspan="4" align="center">Air exchange rate, h<sup>-1</sup>
</td>
<td align="left">4th Quartile (&#x3e;0.71)</td>
<td align="center">1.00</td>
<td align="center">1.00</td>
<td align="center">1.00</td>
</tr>
<tr>
<td align="left">3rd Quartile (0.37&#x2013;0.71)</td>
<td align="center">0.88 (0.31, 2.47)</td>
<td align="center">1.79 (0.93, 3.44)</td>
<td align="center">1.64 (0.81, 3.29)</td>
</tr>
<tr>
<td align="left">2nd Quartile (0.22&#x2013;0.37)</td>
<td align="center">1.30 (0.50, 3.35)</td>
<td align="center">1.76 (0.91, 3.38)</td>
<td align="center">1.00 (0.49, 2.05)</td>
</tr>
<tr>
<td align="left">1st Quartile (&#x3c;0.22)</td>
<td align="center">0.52 (0.18, 1.48)</td>
<td align="center">
<bold>2.23 (1.18, 4.19)</bold>
<sup>c</sup>
</td>
<td align="center">0.78 (0.39, 1.56)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="Tfn5">
<label>
<sup>a</sup>
</label>
<p>Odds ratios are adjusted for gender, age, family allergic history, dampness, environmental tobacco smoke exposure, outdoor PM<sub>10</sub> and measurement seasons.</p>
</fn>
<fn id="Tfn6">
<label>
<sup>b</sup>
</label>
<p>Current wheeze, rhinitis, eczema symptoms in the last 12 months.</p>
</fn>
<fn>
<p>
<sup>c</sup>Bold indicates <italic>P</italic>-value &#x3c; 0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>In this study the adjusted odds ratio (AOR) of stepwise increment of air exchange rate (&#x394; &#x3d; 0.1 h<sup>&#x2212;1</sup>) was 0.97 (95% Confidence Interval (CI): 0.94&#x2013;1.00) for rhinitis symptom. Based on the background level of 29.8% for rhinitis (see <xref ref-type="table" rid="T1">Table 1</xref>) and the median value of 0.4 h<sup>&#x2212;1</sup> for air exchange rate in children&#x2019;s bedrooms (see <xref ref-type="table" rid="T2">Table 2</xref>), the prevalence of rhinitis could be regressed as a function of air exchange rate, as shown in <xref ref-type="disp-formula" rid="e5">Equation 5</xref>. Assuming this relationship to be causal, we may predict the rhinitis prevalence with various ventilation rates.<disp-formula id="e5">
<mml:math id="m19">
<mml:mrow>
<mml:msub>
<mml:mi>y</mml:mi>
<mml:mn>1</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0.341</mml:mn>
<mml:msup>
<mml:mi>e</mml:mi>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>0.336</mml:mn>
<mml:mi>N</mml:mi>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
</mml:msup>
</mml:mrow>
</mml:math>
<label>(5)</label>
</disp-formula>Where <inline-formula id="inf15">
<mml:math id="m20">
<mml:mrow>
<mml:msub>
<mml:mi>y</mml:mi>
<mml:mn>1</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is the prevalence of rhinitis symptoms among children; <inline-formula id="inf16">
<mml:math id="m21">
<mml:mrow>
<mml:mi>N</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is air exchange rate, h<sup>-1</sup>.</p>
</sec>
<sec id="s3-2">
<title>Dose-response relationship between air exchange rate and SBS symptoms among adults</title>
<p>In the &#x201c;IAQ and Ventilation in Homes&#x201d; study, we surveyed and measured 32 homes repeatedly in each season. Among the 120 valid samples for self-reported SBS symptoms, the complaining frequency for general symptoms was 73%, followed by 67% for mucous and 40% for dermal symptoms (see <xref ref-type="table" rid="T4">Table 4</xref>). The distribution of 123 measurements of air exchange rate in adults&#x2019; bedrooms at night and its association with SBS symptoms are shown in <xref ref-type="table" rid="T5">Tables 5</xref>, <xref ref-type="table" rid="T6">6</xref> respectively. Dose-response relationship was observed between air exchange rate and SBS symptoms, especially for mucosal symptoms which indicated that a low air exchange rate at night increased the risk of mucosal complaints. Our result is consistent with previous studies. The Swedish Office Illness study indicated that increased air exchange rate decreased the risk of SBS (<xref ref-type="bibr" rid="B23">Sundell et al., 1994</xref>). <xref ref-type="bibr" rid="B20">Sun et al. (2013)</xref> found that prevalence of general and skin symptoms among students living in dorms increased with air exchange rate below 0.7 h<sup>&#x2212;1</sup>. In another paper, we observed that low air exchange rate in rooms led to higher concentrations of formaldehyde and volatile organic compounds (<xref ref-type="bibr" rid="B16">Sun et al., 2019a</xref>). Studies in Australia, Japan and Sweden have shown that high formaldehyde concentration was associated with increased risk of SBS symptoms as well as of asthma, allergies, and airway diseases (<xref ref-type="bibr" rid="B33">Zuraimi et al., 2007</xref>; <xref ref-type="bibr" rid="B11">Norback et al., 1995</xref>; <xref ref-type="bibr" rid="B6">Garrett et al., 1999</xref>; <xref ref-type="bibr" rid="B28">Wieslander et al., 1997</xref>). Exposure to higher concentration of VOCs due to low ventilation might be the mechanism &#x201c;chain&#x201d; for the association between air exchange rate and SBS symptom complaints.</p>
<table-wrap id="T4" position="float">
<label>TABLE 4</label>
<caption>
<p>Prevalence of sick building syndrome symptoms among adults in the investigate homes in Tianjin, China, 2018.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th align="center"/>
<th align="center">Yes, n (%)</th>
<th align="center">No, n (%)</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">&#x2265;One general symptom<xref ref-type="table-fn" rid="Tfn7">
<sup>a</sup>
</xref>
</td>
<td align="center">88 (73.4)</td>
<td align="center">32 (26.6)</td>
</tr>
<tr>
<td align="left">&#x2003;Fatigue</td>
<td align="center">79 (66.3)</td>
<td align="center">40 (33.7)</td>
</tr>
<tr>
<td align="left">&#x2003;Heavy head</td>
<td align="center">28 (23.3)</td>
<td align="center">92 (76.7)</td>
</tr>
<tr>
<td align="left">&#x2003;Headache</td>
<td align="center">26 (21.8)</td>
<td align="center">93 (78.2)</td>
</tr>
<tr>
<td align="left">&#x2003;Dizziness</td>
<td align="center">14 (11.7)</td>
<td align="center">106 (88.3)</td>
</tr>
<tr>
<td align="left">&#x2003;Difficulty concentrating</td>
<td align="center">26 (21.6)</td>
<td align="center">94 (78.4)</td>
</tr>
<tr>
<td align="left">&#x2265;One mucous symptom<xref ref-type="table-fn" rid="Tfn8">
<sup>b</sup>
</xref>
</td>
<td align="center">80 (66.7)</td>
<td align="center">40 (33.3)</td>
</tr>
<tr>
<td align="left">&#x2003;Eye irritation</td>
<td align="center">29 (24.2)</td>
<td align="center">91 (75.8)</td>
</tr>
<tr>
<td align="left">&#x2003;Nose irritation</td>
<td align="center">33 (27.7)</td>
<td align="center">86 (72.3)</td>
</tr>
<tr>
<td align="left">&#x2003;Throat hoarse</td>
<td align="center">65 (54.1)</td>
<td align="center">55 (45.9)</td>
</tr>
<tr>
<td align="left">&#x2003;Cough</td>
<td align="center">47 (39.2)</td>
<td align="center">73 (60.8)</td>
</tr>
<tr>
<td align="left">&#x2265;One dermal symptom<xref ref-type="table-fn" rid="Tfn9">
<sup>c</sup>
</xref>
</td>
<td align="center">48 (40.0)</td>
<td align="center">72 (60.0)</td>
</tr>
<tr>
<td align="left">&#x2003;Dry facial skin</td>
<td align="center">27 (22.5)</td>
<td align="center">93 (77.5)</td>
</tr>
<tr>
<td align="left">&#x2003;Itchy ears</td>
<td align="center">31 (25.8)</td>
<td align="center">89 (74.2)</td>
</tr>
<tr>
<td align="left">&#x2003;Dry hands</td>
<td align="center">25 (21.0)</td>
<td align="center">94 (79.0)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="Tfn7">
<label>
<sup>a</sup>
</label>
<p>At least one of the following general SBS, symptoms: fatigue, heavy head, headache, dizziness, difficulty concentrating.</p>
</fn>
<fn id="Tfn8">
<label>
<sup>b</sup>
</label>
<p>At least one of the following mucosal SBS, symptoms: eye irritation, nose irritation, throat hoarse, cough.</p>
</fn>
<fn id="Tfn9">
<label>
<sup>c</sup>
</label>
<p>At least one of the following skin SBS, symptoms: dry facial skin, itchy ears, dry hands.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T5" position="float">
<label>TABLE 5</label>
<caption>
<p>Distribution of air exchange rates in adults&#x2019; bedrooms, Tianjin, China, 2018.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" align="center"/>
<th colspan="3" align="center">Air exchange rate, h<sup>&#x2212;1</sup>
</th>
</tr>
<tr>
<th align="center">1st quartile</th>
<th align="center">Median</th>
<th align="center">3rd quartile</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td align="left">Total, N<xref ref-type="table-fn" rid="Tfn10">
<sup>a</sup>
</xref> &#x3d; 123</td>
<td align="center">0.24</td>
<td align="center">0.45</td>
<td align="center">0.78</td>
</tr>
<tr>
<td align="left">Spring, N &#x3d; 32</td>
<td align="center">0.22</td>
<td align="center">0.36</td>
<td align="center">0.66</td>
</tr>
<tr>
<td align="left">Summer, N &#x3d; 32</td>
<td align="center">0.37</td>
<td align="center">0.78</td>
<td align="center">1.85</td>
</tr>
<tr>
<td align="left">Autumn, N &#x3d; 29</td>
<td align="center">0.24</td>
<td align="center">0.37</td>
<td align="center">0.62</td>
</tr>
<tr>
<td align="left">Winter, N &#x3d; 30</td>
<td align="center">0.21</td>
<td align="center">0.41</td>
<td align="center">0.73</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="Tfn10">
<label>
<sup>a</sup>
</label>
<p>Sample size.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T6" position="float">
<label>TABLE 6</label>
<caption>
<p>Dose-response relationship between air exchange rate in adults&#x2019; bedroom and sick building syndrome symptoms, Tianjin, China.</p>
</caption>
<table>
<thead valign="top">
<tr>
<th rowspan="2" colspan="2" align="left"/>
<th colspan="3" align="center">Adjusted odds ratio (95% confidence interval)<xref ref-type="table-fn" rid="Tfn11">
<sup>a</sup>
</xref>
</th>
</tr>
<tr>
<th align="center">One general symptom<xref ref-type="table-fn" rid="Tfn12">
<sup>b</sup>
</xref>
</th>
<th align="center">One mucosal symptom<xref ref-type="table-fn" rid="Tfn12">
<sup>b</sup>
</xref>
</th>
<th align="center">One dermal symptom<xref ref-type="table-fn" rid="Tfn12">
<sup>b</sup>
</xref>
</th>
</tr>
</thead>
<tbody valign="top">
<tr>
<td rowspan="4" align="center">Air exchange rate, h<sup>&#x2212;1</sup>
</td>
<td align="left">4th Quartile (&#x3e;0.78)</td>
<td align="center">1.00</td>
<td align="center">1.00</td>
<td align="center">1.00</td>
</tr>
<tr>
<td align="left">3rd Quartile (0.45&#x2013;0.78)</td>
<td align="center">1.04 (0.31,3.56)</td>
<td align="center">0.75 (0.26,2.19)</td>
<td align="center">0.73 (0.24,2.22)</td>
</tr>
<tr>
<td align="left">2nd Quartile (0.24&#x2013;0.45)</td>
<td align="center">1.54 (0.43,5.49)</td>
<td align="center">2.30 (0.73,7.26)</td>
<td align="center">0.72 (0.24,2.18)</td>
</tr>
<tr>
<td align="left">1st Quartile (&#x3c;0.24)</td>
<td align="center">1.25 (0.34,4.67)</td>
<td align="center">2.25 (0.66,7.70)</td>
<td align="center">1.23 (0.39,3.92)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="Tfn11">
<label>
<sup>a</sup>
</label>
<p>Adjusted for gender, age, household income.</p>
</fn>
<fn id="Tfn12">
<label>
<sup>b</sup>
</label>
<p>At least one general/mucosal/dermal symptoms: yes vs. never.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>We found the adjusted odds ratio (AOR) of stepwise increment of air exchange rate (&#x394; &#x3d; 0.1 h<sup>&#x2212;1</sup>) was 0.95 (95% CI: 0.91&#x2013;0.98) for mucous symptom. Based on the background level of 66% for mucous symptoms among adults (see <xref ref-type="table" rid="T4">Table 4</xref>) and the median value of 0.4 h<sup>&#x2212;1</sup> for air exchange rate in Tianjin homes (see <xref ref-type="table" rid="T5">Table 5</xref>), the prevalence of mucous SBS symptom complaint can be expressed as a function of air exchange rate, see <xref ref-type="disp-formula" rid="e6">Equation 6</xref>.<disp-formula id="e6">
<mml:math id="m22">
<mml:mrow>
<mml:msub>
<mml:mi>y</mml:mi>
<mml:mn>2</mml:mn>
</mml:msub>
<mml:mo>&#x3d;</mml:mo>
<mml:mn>0.832</mml:mn>
<mml:msup>
<mml:mi>e</mml:mi>
<mml:mrow>
<mml:mfenced open="(" close=")" separators="|">
<mml:mrow>
<mml:mo>&#x2212;</mml:mo>
<mml:mn>0.555</mml:mn>
<mml:mi>N</mml:mi>
</mml:mrow>
</mml:mfenced>
</mml:mrow>
</mml:msup>
</mml:mrow>
</mml:math>
<label>(6)</label>
</disp-formula>Where <inline-formula id="inf17">
<mml:math id="m23">
<mml:mrow>
<mml:msub>
<mml:mi>y</mml:mi>
<mml:mn>2</mml:mn>
</mml:msub>
</mml:mrow>
</mml:math>
</inline-formula> is the prevalence of mucosal SBS symptoms among adults; <inline-formula id="inf18">
<mml:math id="m24">
<mml:mrow>
<mml:mi>N</mml:mi>
</mml:mrow>
</mml:math>
</inline-formula> is air exchange rate, h<sup>&#x2212;1</sup>.</p>
</sec>
<sec id="s3-3">
<title>Practical application of a health-demand ventilation control strategy</title>
<p>The dose-response relationship between air exchange rate and health outcomes (i.e., <xref ref-type="disp-formula" rid="e5">Equations 5</xref>, <xref ref-type="disp-formula" rid="e6">6</xref>) provides basic data and guidance on ventilation to guarantee occupants&#x2019; health in dwellings, based on which we propose a health-demand ventilation control strategy to meet the health needs of occupants and to minimize energy consumption as well. For occupancy scenario, ventilation shall be maintained to protect child from rhinitis and adult from mucosal SBS symptom. Otherwise minimum ventilation rate recommended in the existing domestic/international standards for indoor air quality shall be met.</p>
<p>The health-demand ventilation control strategy is described as follows in details:<list list-type="simple">
<list-item>
<p>&#x2022; When the space is not occupied, ventilation is maintained at base rate as recommended in the existing ventilation standards (e.g., 0.5 h<sup>&#x2212;1</sup> as in ASHRAE Standard 62, 2016);</p>
</list-item>
<list-item>
<p>&#x2022; When the space is occupied, required ventilation is determined directly to deal with health effects.</p>
<list list-type="simple">
<list-item>
<p>&#x25c6; The cause of SBS symptoms might be within host factors as well, besides by environmental factors. We are dealing with a window of complaint rate above 20% (<xref ref-type="bibr" rid="B29">Wolkoff, 2018</xref>). When the SBS symptoms among adults are supposed to be at 20%, the demand ventilation is 2.5 h<sup>&#x2212;1</sup> (see <xref ref-type="disp-formula" rid="e6">Equation 6</xref>);</p>
</list-item>
<list-item>
<p>&#x25c6; The population attributable fraction of genetic factor to rhinitis among child was 12% (<xref ref-type="bibr" rid="B17">Sun et al., 2019b</xref>). Therefore, we are dealing with a lower limit of 4% [i.e., prevalence of rhinitis 29.8% (see <xref ref-type="table" rid="T1">Table 1</xref>)&#x2a;12% &#x3d; 4%] regarding the rhinitis symptom among child. The corresponding demand ventilation is 6.5 h<sup>&#x2212;1</sup> (see <xref ref-type="disp-formula" rid="e5">Equation 5</xref>).</p>
</list-item>
</list>
</list-item>
</list>
</p>
<p>We additionally calculated required ventilation rate for controlling formaldehyde and house dust mite concentrations in typical northern Chinese homes, as shown in Supplementary Material. The minimum ventilation rate for indoor air quality demand regarding formaldehyde or house dust mite concentration was supposed to be 0.57 h<sup>&#x2212;1</sup> and 0.46 h<sup>&#x2212;1</sup>, respectively. This is lower than the required ventilation rate for health demand, which indicates the complex health effects of indoor pollutants&#x2019; mixture. Source control strategy can be effective in reducing concentration of indoor pollutants, such as using indoor decoration materials with low emission rate of volatile organic compounds and/or decreasing occupancy level to reduce indoor moisture contents. When it is not possible to remove or control the source of indoor air pollution, and air filtration is ineffective, the pollution concentration can only be lowered by ventilation with fresh air, i.e., by diluting the indoor pollutants with outdoor fresh air. Sufficient ventilation rate to guarantee occupants&#x2019; health should be regulated.</p>
<p>The health-demand ventilation control strategy can be implemented through a smart ventilation control system, which consists of data detection unit, central processing unit (CPU) and terminal display unit (as shown in <xref ref-type="fig" rid="F3">Figure 3</xref>). The data detection unit includes CO<sub>2</sub> sensor and occupancy sensor. The CPU processes CO<sub>2</sub> concentration and occupancy level to estimate real-time air exchange rate by using CO<sub>2</sub> method, meanwhile the corresponding prevalence rate of rhinitis and mucosal SBS symptom can be predicted using <xref ref-type="disp-formula" rid="e5">Equations 5</xref>, <xref ref-type="disp-formula" rid="e6">6</xref> respectively. Terminal display unit demonstrates the real-time air exchange rate and the predicted prevalence of health outcomes. In addition, the CPU compare the real-time air exchange rate and the desired values in different scenarios, based on which to control and adjust ventilator.</p>
<fig id="F3" position="float">
<label>FIGURE 3</label>
<caption>
<p>Implement process of health-demand ventilation control system. <sup>a</sup>Empty scenario: ACR &#x3d; 0.5 h<sup>&#x2212;1</sup> is set as recommended in ASHRAE Standard 62; <sup>b</sup>Occupancy with adult scenario: ACR &#x3d; 2.5 h<sup>&#x2212;1</sup> is set to guarantee mucosal sick building symptom among adults as low as 20%; <sup>c</sup>Occupancy with child scenario: ACR &#x3d; 6.5 h<sup>&#x2212;1</sup> is set to guarantee rhinitis symptom among children as low as 4%.</p>
</caption>
<graphic xlink:href="fbuil-11-1510965-g003.tif"/>
</fig>
<p>This smart control system can work for hybrid ventilation, which is a combination of mechanical and natural ventilation. When wind pressure or temperature gradients are not sufficient to drive the flow by natural means, the desired ventilation rates can still be maintained by the mechanical systems. We believe the control system simultaneously guarantees occupants&#x2019; health and lowers energy consumption.</p>
</sec>
<sec id="s3-4">
<title>Strengths and limitations</title>
<p>The clear dose-response relationship between ventilation and health outcomes were obtained through systematic measurements and multivariable analysis in large scale Chinese home studies.</p>
<p>There are several limitations. Firstly, we only considered the health effects of ventilation on asthma, allergy, and SBS symptoms. Other health outcomes should be considered in further studies. Secondly, the health effects investigated in this study were specific to residential building, and the applicability may vary in other types of building. Thirdly, air exchange rate was estimated during night with ignoring diurnal dynamic variations. However, the significant associations between air exchange rate and health outcomes cannot be explained by this limitation.</p>
</sec>
</sec>
<sec sec-type="conclusion" id="s4">
<title>Conclusion</title>
<p>Dose-response relationships between ventilation and asthma and allergy among children {prevalence of current rhinitis &#x3d; 0.341&#x2a;e&#x5e; [&#x2212;0.336&#x2a;(air exchange rate)]} and SBS symptoms among adults {prevalence of mucous symptoms &#x3d; 0.832&#x2a;e&#x5e; [&#x2212;0.555&#x2a;(air exchange rate)]} are established. Further studies on dose-response relationship between ventilation and other health outcomes are needed in the future. Based on the health effects of ventilation, a health-demand ventilation control strategy is proposed, with required air exchange rate of 0.5 h<sup>&#x2212;1</sup> and 2.5&#x223c;6.5 h<sup>&#x2212;1</sup> for empty and occupancy scenario, respectively. This indicates that in order to guarantee occupants&#x2019; health in urban area as Tianjin, ventilation rate in dwellings needs to be improved greatly.</p>
</sec>
</body>
<back>
<sec sec-type="data-availability" id="s5">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec sec-type="ethics-statement" id="s6">
<title>Ethics statement</title>
<p>The studies involving humans were approved by the Tianjin University Research Office. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants&#x2019; legal guardians/next of kin.</p>
</sec>
<sec sec-type="author-contributions" id="s7">
<title>Author contributions</title>
<p>ZW: Conceptualization, Investigation, Writing&#x2013;original draft, Writing&#x2013;review and editing. JH: Data curation, Methodology, Writing&#x2013;original draft, Writing&#x2013;review and editing. JF: Formal Analysis, Visualization, Writing&#x2013;original draft, Writing&#x2013;review and editing. ZT: Conceptualization, Supervision, Writing&#x2013;original draft, Writing&#x2013;review and editing. SF: Data curation, Writing&#x2013;original draft, Writing&#x2013;review and editing. RK: Conceptualization, Writing&#x2013;original draft, Writing&#x2013;review and editing. YS: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Supervision, Methodology, Writing&#x2013;original draft, Writing&#x2013;review and editing.</p>
</sec>
<sec sec-type="funding-information" id="s8">
<title>Funding</title>
<p>The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the (China-Finland Intergovermental Joint Project) under Grant (2024YFE0106800) (National Key Research and Development Program of China) under Grant (2023YFC3708400); and (National Natural Science Foundation of China) under Grant (21207097).</p>
</sec>
<sec sec-type="COI-statement" id="s9">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
<p>The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.</p>
</sec>
<sec sec-type="ai-statement" id="s10">
<title>Generative AI statement</title>
<p>The author(s) declare that no Generative AI was used in the creation of this manuscript.</p>
</sec>
<sec sec-type="disclaimer" id="s11">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<sec id="s12">
<title>Supplementary material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fbuil.2025.1510965/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fbuil.2025.1510965/full&#x23;supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="Supplementaryfile1.docx" id="SM1" mimetype="application/docx" xmlns:xlink="http://www.w3.org/1999/xlink"/>
</sec>
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