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Published on: November 4, 2010
Effects of improved home heating on asthma in community dwelling children: randomised controlled trial
Philippa Howden-Chapman1, Nevil Pierse, Sarah Nicholls
1He Kainga Oranga/Housing and Health Research Programme, University of Otago, Wellington, PO 7343, Wellington South, New Zealand. philippa.howden-chapman@otago.ac.nz
Insights
Upgraded home heating significantly reduced asthma symptoms and healthcare use in children. While lung function didn't improve, fewer school days were missed, and doctor visits decreased, showing a positive impact on child health.
Area of Science:
- Environmental Health
- Pediatric Respiratory Medicine
- Public Health Interventions
Background:
- Childhood asthma is a significant public health concern, often exacerbated by indoor air quality and inadequate home heating.
- Previous research suggests a link between heating systems, indoor pollutants, and respiratory health outcomes in children.
- This study investigates the impact of improved home heating on asthmatic children in New Zealand.
Purpose of the Study:
- To evaluate the effect of installing non-polluting, more effective home heating on the health of children with asthma.
- To assess changes in lung function, respiratory symptoms, medication use, and healthcare utilization.
Main Methods:
- A randomized controlled trial involving 409 children (aged 6-12) with diagnosed asthma in New Zealand.
- Intervention group received new, efficient heaters; control group received theirs post-trial.
- Primary outcomes: lung function (FEV1). Secondary outcomes: respiratory symptoms, medication use, healthcare visits, indoor air quality (NO2), and temperature.
Main Results:
- No significant improvement in lung function (FEV1) was observed.
- Intervention group showed significant reductions in asthma-related days off school, doctor visits, and pharmacist visits.
- Significant decreases in reported respiratory symptoms, disturbed sleep due to wheezing, and improved indoor temperatures and air quality (lower NO2 levels).
Conclusions:
- Installing cleaner, more effective home heating did not significantly improve lung function in asthmatic children.
- The intervention led to significant reductions in asthma symptoms, school absenteeism, and healthcare utilization.
- Improved home heating represents a viable strategy for mitigating the impact of asthma on children's health and well-being.
Objective:
To assess whether non-polluting, more effective home heating (heat pump, wood pellet burner, flued gas) has a positive effect on the health of children with asthma.
Design:
Randomised controlled trial.
Setting:
Households in five communities in New Zealand.
Participants:
409 children aged 6-12 years with doctor diagnosed asthma.
Interventions:
Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial.
Main Outcome Measures:
The primary outcome was change in lung function (peak expiratory flow rate and forced expiratory volume in one second, FEV(1)). Secondary outcomes were child reported respiratory tract symptoms and daily use of preventer and reliever drugs. At the end of winter 2005 (baseline) and winter 2006 (follow-up) parents reported their child's general health, use of health services, overall respiratory health, and housing conditions. Nitrogen dioxide levels were measured monthly for four months and temperatures in the living room and child's bedroom were recorded hourly.
Results:
Improvements in lung function were not significant (difference in mean FEV(1) 130.7 ml, 95% confidence interval -20.3 to 281.7). Compared with children in the control group, however, children in the intervention group had 1.80 fewer days off school (95% confidence interval 0.11 to 3.13), 0.40 fewer visits to a doctor for asthma (0.11 to 0.62), and 0.25 fewer visits to a pharmacist for asthma (0.09 to 0.32). Children in the intervention group also had fewer reports of poor health (adjusted odds ratio 0.48, 95% confidence interval 0.31 to 0.74), less sleep disturbed by wheezing (0.55, 0.35 to 0.85), less dry cough at night (0.52, 0.32 to 0.83), and reduced scores for lower respiratory tract symptoms (0.77, 0.73 to 0.81) than children in the control group. The intervention was associated with a mean temperature rise in the living room of 1.10 degrees C (95% confidence interval 0.54 degrees C to 1.64 degrees C) and in the child's bedroom of 0.57 degrees C (0.05 degrees C to 1.08 degrees C). Lower levels of nitrogen dioxide were measured in the living rooms of the intervention households than in those of the control households (geometric mean 8.5 microg/m(3) v 15.7 microg/m(3), P<0.001). A similar effect was found in the children's bedrooms (7.3 microg/m(3) v 10.9 microg/m(3), P<0.001).
Conclusion:
Installing non-polluting, more effective heating in the homes of children with asthma did not significantly improve lung function but did significantly reduce symptoms of asthma, days off school, healthcare utilisation, and visits to a pharmacist.
Trial Registration:
Clinical Trials NCT00489762.
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