Modern jetliners have an environmental control system (ECS) that manages the flow of cabin air. Outside air enters the engines and is compressed in the forward section, prior to the combustion section, ensuring no combustion products can enter the cabin. A portion of that compressed bleed air is used to pressurize the cabin. The ECS then recirculates some of that cabin air through HEPA filters, while the rest is directed to outflow valves, ensuring there is a constant supply of fresh, clean air coming into the cabin pressurization system at all times.

It is possible for contaminants to enter the cabin through the air-supply system and through other means. Substances used in the maintenance and treatment of aircraft, including aviation engine oil, hydraulic fluid, cleaning compounds and de-icing fluids, can contaminate the ECS. While ground and flight crews, as well as passengers themselves can be sources of contaminants such as pesticides, bioeffluents, viruses, bacteria, allergens, and fungal spores.

Possible sources of poor-quality cabin air include exposures related to normal operations of the aircraft:

• Ozone (O3)
• Carbon dioxide (passengers exhaling CO2)
• Carbon monoxide (CO - Jet exhaust fumes, Ambient airport air)
• Temperature
• Relative humidity
• Off-gassing from interior material and cleaning agents
• Bioeffluents
• Personal-care products
• Allergens
• Infectious or inflammatory agents
• Cabin pressure/partial pressure of oxygen
• Alcohol
• Formaldehyde
• Deicing fluid.
• Particulate Matter (Including dust which contains microbes).
• Dry ice used to keep food cold.
• Toilet fluid, leaked or spilled.
• Rain repellent fluid.
• Pyrethroid Pesticides
• Pre-existing illness—such as anemia, asthma, COPD, and coronary arterial disease—the stresses of flight could exacerbate symptoms.