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      Effects of improved home heating on asthma in community dwelling children: randomised controlled trial

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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, 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°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/m 3 v 15.7 μg/m 3, P<0.001). A similar effect was found in the children’s bedrooms (7.3 μg/m 3 v 10.9 μg/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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          Most cited references 37

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          Epidemiology of fine particulate air pollution and human health: biologic mechanisms and who's at risk?

           C Pope (2000)
          This article briefly summarizes the epidemiology of the health effects of fine particulate air pollution, provides an early, somewhat speculative, discussion of the contribution of epidemiology to evaluating biologic mechanisms, and evaluates who's at risk or is susceptible to adverse health effects. Based on preliminary epidemiologic evidence, it is speculated that a systemic response to fine particle-induced pulmonary inflammation, including cytokine release and altered cardiac autonomic function, may be part of the pathophysiologic mechanisms or pathways linking particulate pollution with cardiopulmonary disease. The elderly, infants, and persons with chronic cardiopulmonary disease, influenza, or asthma are most susceptible to mortality and serious morbidity effects from short-term acutely elevated exposures. Others are susceptible to less serious health effects such as transient increases in respiratory symptoms, decreased lung function, or other physiologic changes. Chronic exposure studies suggest relatively broad susceptibility to cumulative effects of long-term repeated exposure to fine particulate pollution, resulting in substantive estimates of population average loss of life expectancy in highly polluted environments. Additional knowledge is needed about the specific pollutants or mix of pollutants responsible for the adverse health effects and the biologic mechanisms involved.
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            Effect of insulating existing houses on health inequality: cluster randomised study in the community.

            To determine whether insulating existing houses increases indoor temperatures and improves occupants' health and wellbeing. Community based, cluster, single blinded randomised study. Seven low income communities in New Zealand. 1350 households containing 4407 participants. Installation of a standard retrofit insulation package. Indoor temperature and relative humidity, energy consumption, self reported health, wheezing, days off school and work, visits to general practitioners, and admissions to hospital. Insulation was associated with a small increase in bedroom temperatures during the winter (0.5 degrees C) and decreased relative humidity (-2.3%), despite energy consumption in insulated houses being 81% of that in uninsulated houses. Bedroom temperatures were below 10 degrees C for 1.7 fewer hours each day in insulated homes than in uninsulated ones. These changes were associated with reduced odds in the insulated homes of fair or poor self rated health (adjusted odds ratio 0.50, 95% confidence interval 0.38 to 0.68), self reports of wheezing in the past three months (0.57, 0.47 to 0.70), self reports of children taking a day off school (0.49, 0.31 to 0.80), and self reports of adults taking a day off work (0.62, 0.46 to 0.83). Visits to general practitioners were less often reported by occupants of insulated homes (0.73, 0.62 to 0.87). Hospital admissions for respiratory conditions were also reduced (0.53, 0.22 to 1.29), but this reduction was not statistically significant (P=0.16). Insulating existing houses led to a significantly warmer, drier indoor environment and resulted in improved self rated health, self reported wheezing, days off school and work, and visits to general practitioners as well as a trend for fewer hospital admissions for respiratory conditions.
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              Chest

              A newborn baby was admitted for respiratory distress, soon after a Caesarian section performed for acute polyhydramnios in the third trimester. The baby had not cried after birth and, at admission, was moaning, cyanosed, drowsy, limp, and not responding to stimuli; APGAR scores were 4/10, 8/10, and 7/10. The baby showed nasal flaring and sternal and substernal retraction. All neonatal reflexes were absent and there was hypotonia of all the muscles. The baby was put under an oxygen hood, but then required mechanical ventilation. Neuro USG showed no hemorrhage in the germinal matrix or the ventricle. Chest radiographs revealed normal lungs on day 1 [Figure 1] but showed a collapsed left lung on day 2 [Figure 2]. Figure 1 Chest radiograph on day 1 Figure 2 Chest radiograph on day 2. Note the left lung collapse The baby succumbed to the respiratory distress. What is the Diagnosis?
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                Author and article information

                Contributors
                Role: professor and director
                Role: statistician
                Role: programme manager
                Role: PhD student
                Role: research fellow
                Role: principal physicist
                Role: director
                Role: PhD student
                Role: postdoctoral student
                Role: MPH student
                Role: associate professor and director of environmental studies
                Role: associate professor and director
                Role: senior research fellow
                Role: research assistant
                Role: associate professor and codirector
                Role: professor
                Role: professor and head
                Role: associate director of clinical trials unit
                Role: professor and codirector
                Journal
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1468-5833
                2008
                2008
                23 September 2008
                : 337
                Affiliations
                [1 ]He Kainga Oranga/Housing and Health Research Programme, University of Otago, Wellington, PO 7343, Wellington South, New Zealand
                [2 ]BRANZ, Porirua City, New Zealand
                [3 ]School of Engineering and Advanced Technology, Massey University, Palmerston North, New Zealand
                [4 ]School of Geography, Environment and Earth Sciences, Victoria University, Wellington
                [5 ]Energy Studies, Physics Department, University of Otago, Dunedin, New Zealand
                [6 ]Wellington Asthma Research Group, University of Otago
                [7 ]Research Centre for Māori Health and Development, Massey University, Wellington
                [8 ]School of Population Health, University of Auckland
                Author notes
                Correspondence to: P Howden-Chapman philippa.howden-chapman@ 123456otago.ac.nz
                Article
                howp521955
                10.1136/bmj.a1411
                2658826
                18812366
                © Howden et al 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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