ObjectiveHome dampness and the presence of mold and allergens have been associated with asthma morbidity. We examined changes in asthma morbidity in children as a result of home remediation aimed at moisture sources.DesignIn this prospective, randomized controlled trial, symptomatic, asthmatic children (n = 62), 2–17 years of age, living in a home with indoor mold, received an asthma intervention including an action plan, education, and individualized problem solving. The remediation group also received household repairs, including reduction of water infiltration, removal of water-damaged building materials, and heating/ventilation/air-conditioning alterations. The control group received only home cleaning information. We measured children’s total and allergen-specific serum immuno-globulin E, peripheral blood eosinophil counts, and urinary cotinine. Environmental dust samples were analyzed for dust mite, cockroach, rodent urinary protein, endotoxin, and fungi. The follow-up period was 1 year.ResultsChildren in both groups showed improvement in asthma symptomatic days during the preremediation portion of the study. The remediation group had a significant decrease in symptom days (p = 0.003, as randomized; p = 0.004, intent to treat) after remodeling, whereas these parameters in the control group did not significantly change. In the postremediation period, the remediation group had a lower rate of exacerbations compared with control asthmatics (as treated: 1 of 29 vs. 11 of 33, respectively, p = 0. 003; intent to treat: 28.1% and 10.0%, respectively, p = 0.11).ConclusionConstruction remediation aimed at the root cause of moisture sources and combined with a medical/behavioral intervention significantly reduces symptom days and health care use for asthmatic children who live in homes with a documented mold problem.

Deep energy retrofits (DER) for residential housing have been proposed to reduce greenhouse gas emissions; these result in ~50% additional energy efficiency compared to standard renovations, energy star (ES) renovations. However, the impact of increased energy efficiency on indoor air quality (IAQ) is poorly understood. We conducted a longitudinal study to compare IAQ and occupant comfort in 12 low income single-family homes renovated to a DER or ES standard. Quarterly visits were conducted for a median of 18 months post-renovation; IAQ was assessed in 4 rooms per visit for a total of 237 measurements. Multivariable regression models accounted for repeated measurements and controlled for house-and family-related covariates. In fully adjusted models, average difference (95% confidence interval) in IAQ parameters in DER homes versus ES homes were: temperature: -0.3 C (-1.2, 0.6); relative humidity: 0.4 % (-1.1, 1.8); carbon dioxide: 43.7 ppm (-18.8, 106.2); and total volatile organic compounds: 198 ppb (-224, 620). Residents in DER homes were significantly less likely to report their homes were comfortable, most likely due to initial difficulties with new heating system technology. We found no differences in IAQ between DER and ES homes; however, education is strongly recommended when incorporating new technology into residences.

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Healthy Homes programs seek to integrate the evaluation and management of a multitude of health and safety risks in households. The education of physicians in the identification, evaluation, and management of these home health and safety issues continues to be deficient. Healthy Homes programs represent a unique opportunity to educate physicians in the home environment and stimulate ongoing, specific patient-physician discussions and more general learning about home environmental health. The Case Healthy Homes and Patients Program addresses these deficiencies in physician training while providing direct services to high-risk households. Pediatric and family practice resident physicians participate in healthy home inspections and interventions for their primary care patients and follow up on identified risks during health maintenance and acute illness visits.

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