title: Effects of improved home heating on asthma in community dwelling children: randomised controlled trial.
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.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Households in five communities in New Zealand.
  
  
  METHODS
  409 children aged 6-12 years with doctor diagnosed asthma.
  
  
  METHODS
  Installation of a non-polluting, more effective home heater before winter. The control group received a replacement heater at the end of the trial.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Clinical Trials NCT00489762.
authors.affiliation: He Kainga Oranga/Housing and Health Research Programme, University of Otago, Wellington, PO 7343, Wellington South, New Zealand. philippa.howden-chapman@otago.ac.nz
authors.forename: Philippa
authors.initials: P
authors.lastname: Howden-Chapman
authors.forename: Nevil
authors.initials: N
authors.lastname: Pierse
authors.forename: Sarah
authors.initials: S
authors.lastname: Nicholls
authors.forename: Julie
authors.initials: J
authors.lastname: Gillespie-Bennett
authors.forename: Helen
authors.initials: H
authors.lastname: Viggers
authors.forename: Malcolm
authors.initials: M
authors.lastname: Cunningham
authors.forename: Robyn
authors.initials: R
authors.lastname: Phipps
authors.forename: Mikael
authors.initials: M
authors.lastname: Boulic
authors.forename: Pär
authors.initials: P
authors.lastname: Fjällström
authors.forename: Sarah
authors.initials: S
authors.lastname: Free
authors.forename: Ralph
authors.initials: R
authors.lastname: Chapman
authors.forename: Bob
authors.initials: B
authors.lastname: Lloyd
authors.forename: Kristin
authors.initials: K
authors.lastname: Wickens
authors.forename: David
authors.initials: D
authors.lastname: Shields
authors.forename: Michael
authors.initials: M
authors.lastname: Baker
authors.forename: Chris
authors.initials: C
authors.lastname: Cunningham
authors.forename: Alistair
authors.initials: A
authors.lastname: Woodward
authors.forename: Chris
authors.initials: C
authors.lastname: Bullen
authors.forename: Julian
authors.initials: J
authors.lastname: Crane
mesh_terms: D016902:Air Pollution, Indoor / Q000009:adverse effects; D001249:Asthma / Q000503:physiopathology / Q000517:prevention & control*; D002648:Child; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006304:Health Status; D006361:Heating; D006801:Humans; D008297:Male; D009520:New Zealand; D011379:Prognosis