Enhancing ventilation in homes of children with asthma: pragmatic randomised controlled trial

Abstract

BackgroundFew robust studies have tested whether enhancing housing also improves health. AimTo evaluate the effectiveness of installing ventilation systems, and central heating where necessary, in the homes of children with moderate or severe asthma. Design and settingPragmatic randomised controlled trial (RCT) in homes within Wrexham County Borough, Wales, UK. MethodA pragmatic RCT was carried out, of a tailored package of housing improvements providing adequate ventilation and temperature, following inspection by a housing officer. One hundred and ninety-two children with asthma aged 5 to 14 years, identified from general practice registers, were randomised to receive this package, either immediately or a year after recruitment. At baseline, and after 4 and 12 months, parents reported their child's asthma-specific and generic quality of life, and days off school. ResultsThe package improved parent-reported asthmaspecific quality of life significantly at both 4 and 12 months. At 12 months, this showed an adjusted mean difference between groups of 7.1 points (95% confidence interval [CI] = 2.8 to 11.4, P = 0.001): a moderate standardised effect size of 0.42. The generic quality-of-life scale showed reported physical problems were significantly reduced at 4 months, but not quite at 12 months, when the mean difference was 4.5 (95% CI = -0.2 to 9.1, P = 0.061). The improvement in psychosocial quality of life at 12 months was not significant, with a mean difference of 2.2 (95% CI = -1.9 to 6.4, P = 0.292). Parent-reported school attendance improved, but not significantly. ConclusionThis novel and pragmatic trial, with integrated economic evaluation, found that tailored improvement of the housing of children with moderate to severe asthma significantly increases parent-reported asthma-related quality of life and reduces physical problems. Collaborative housing initiatives have potential to improve health.

Enhancing ventilation in homes of children with asthma: cost-effectiveness study alongside randomised controlled trial

“…11 The analysis estimates the cost of a single-point improvement in the PedsQL asthmaspecific quality-of-life score at £234. At baseline, the median reported asthmarelated quality-of-life score was 67, with a lower quartile of 56 and an upper quartile of 79; 12 months later, parents of children in the intervention group reported a median score of 76, with a lower quartile of 64 and an upper quartile of 87.…”

“…After 12 months, the PedsQL showed a mean (adjusted) improvement of 8.65 in the intervention group and 1.58 in the control group. 11 The resulting difference of 7.07 (95% CI = 2.79 to 11.36) between groups is equivalent to a standardised effect size of 0.42.…”

“…11 Fifteen children who had no follow-up questionnaire were excluded. For eight children who did not complete a 12-month PedsQL questionnaire, scores at 12 months were imputed by regression on scores at baseline and 4 months.…”

Can housing improvements cure or prevent the onset of health conditions over time in deprived areas?

“…Previous studies have generally found improvements against a wide range of respiratory outcomes [5, 11, 16–20] related to warmth and energy efficiency works, particularly when targeted at households with inadequate warmth and where at least one member had a pre-existing respiratory condition. Platt et al [19] and Shortt and Rugkåsa [11] report both positive and negative outcomes.…”

How the low carbon economy can improve health

“…Adequate ventilation needs to be built into energy efficient building projects, to avoid dampness, mould, radon, and other indoor pollutants. 13 Improved ventilation may enhance quality of life in asthma 14 and reduce transmission of some respiratory diseases in healthcare settings. Screens on windows and doors protect from vector borne diseases like malaria and reduce energy consumption from air conditioning and related greenhouse gases.…”