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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.
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Effects of improved home heating on asthma in community dwelling
children: randomised controlled trialBritish Medical
Journal (BMJ). 2008; 337: a1411. Published online 2008 September
23. doi: 10.1136/bmj.a1411. PMCID: PMC2658826,
Copyright © Howden et al 2008
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Philippa Howden-Chapman, professor
and director,1
Nevil Pierse, statistician,1
Sarah Nicholls, programme manager,1
Julie Gillespie-Bennett, PhD student,1
Helen Viggers, research fellow,1
Malcolm Cunningham, principal physicist,2
Robyn Phipps, director,3
Mikael Boulic, PhD student,3
Pär Fjällström, postdoctoral student,3
Sarah Free, MPH student,1
Ralph Chapman, associate professor and director of environmental
studies,4
Bob Lloyd, associate professor and director,5
Kristin Wickens, senior research fellow,6
David Shields, research assistant,1
Michael Baker, associate professor and codirector,1
Chris Cunningham, professor,7
Alistair Woodward, professor and head,8
Chris Bullen, associate director of clinical trials unit,8
Julian Crane, professor and codirector1
1He Kainga Oranga/Housing
and Health Research Programme, University of Otago, Wellington,
PO 7343, Wellington South, New Zealand
2BRANZ, Porirua City, New Zealand
3School of Engineering and Advanced Technology,
Massey University, Palmerston North, New Zealand
4School of Geography, Environment and Earth Sciences,
Victoria University, Wellington
5Energy Studies, Physics Department, University of
Otago, Dunedin, New Zealand 6Wellington Asthma
Research Group, University of Otago
7Research Centre for Māori Health and Development,
Massey University, Wellington 8School of
Population
Health, University of Auckland Corresponding author.
Correspondence to: P Howden-Chapman Email:
philippa.howden-chapman@otago.ac.nz
Accepted July 15, 2008.
This is an open-access article
distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is
properly cited. |
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Abstract
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, FEV1). 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 FEV1 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°C (95% confidence interval 0.54°C to 1.64°C) and in the
child’s bedroom of 0.57°C (0.05°C to 1.08°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 μg/m3 v 15.7 μg/m3, P<0.001). A similar
effect was found in the children’s bedrooms (7.3 μg/m3 v 10.9 μg/m3,
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. |
