Linking Health, Comfort and Indoor Environmental Quality in Classrooms with Mechanical Ventilation or Window Airing: A Controlled Observational Study

Effective classroom ventilation is essential for indoor environmental quality (IEQ), comfort and health of schoolchildren, who spend substantial time indoors. This controlled observational study compared manual window airing (WA) with decentralized mechanical ventilation (DV) in six classrooms of two elementary schools during the winter infection period. Symptoms of upper respiratory tract infections, salivary biomarkers, well-being, perceived comfort, and classroom-level IEQ were assessed through questionnaires, saliva samples and long-term monitoring. Ninety-eight schoolchildren participated (64 WA, 34 DV). Symptom-based outcomes of the WURSS-K questionnaire showed consistently lower illness burden in group DV, with several parameters reaching statistical significance and an absolute risk reduction of 7.8%. Salivary immunoglobulin A (sIgA) concentrations were also significantly lower in group DV (approximately 39–59%, p ≤ 0.01). Sensitivity analyses showed positive associations of CO2 and PM2.5 with sIgA and indicated that PM2.5 exposure accounted for group differences. Comfort perceptions mirrored measured IEQ: DV classrooms exhibited warmer, more stable thermal conditions, lower CO2 and PM2.5, and slightly better thermal and draught-related impressions. Overall, decentralized mechanical ventilation supported favorable IEQ and comfort and may influence mucosal immune activity through reduced particulate exposure, complementing the observed reduction in symptom burden. A multidimensional approach integrating medical outcomes with continuous IEQ monitoring proved valuable and should be expanded in larger, balanced cohort studies.