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Modelling the effects of low indoor temperatures on the lung function of children with asthma
  1. Nevil Pierse1,
  2. Richard Arnold2,
  3. Michael Keall1,
  4. Philippa Howden-Chapman1,
  5. Julian Crane3,
  6. Malcolm Cunningham4,
  7. the Heating Housing and Health Study Group
  1. 1He Kainga Oranga/Housing and Health Research Programme, Department of Public Health, University of Otago, Wellington, New Zealand
  2. 2School of Mathematics, Statistics, and Operations Research, Victoria University of Wellington, Wellington, New Zealand
  3. 3Department of Medicine, University of Otago, Wellington, New Zealand
  4. 4BRANZ, Porirua City, New Zealand
  1. Correspondence to Dr Nevil Pierse, He Kainga Oranga/Housing and Health Research Programme, Department of Public Health, Wellington School of Medicine, 23A Mein St, Newtown, Wellington 6023, New Zealand; Nevil.pierse{at}


Introduction While many epidemiological studies have shown that low outdoor temperatures are associated with increased rates of hospitalisation and mortality (especially for respiratory or cardiovascular disease), very few studies have looked at the association between indoor temperatures and health. Such studies are clearly warranted, as people have greater exposure to the indoor environment than the outdoor environment.

Objectives To examine the relationship between various metrics of indoor temperature and lung function in children with asthma. Our specific research questions were: (1) In which room of the home is temperature most strongly associated with lung function? (2) Which exposure metric best describes the relationship between indoor temperature and lung function? (3) Over what lag/time period does indoor air temperature affect lung function most strongly?

Methods The Heating Housing and Health Study was a randomised controlled trial that investigated the effect of installing heaters in the homes of children with asthma. This study collected measurements of lung function (daily) and indoor temperature (hourly). Lung function and indoor temperature were measured for 309 children over 12 049 child-days. Statistical models were fitted to identify the best measures and metrics.

Results The strongest association with lung function was found for the severity of exposure to low bedroom temperatures averaged over the preceding periods of 0–7 to 0–12 days. A 1°C increase in temperature was associated with an average increase of 0.010, 0.008, 10.06, 12.06, in our four measures of lung function (peak expiratory flow rate (PEFR) morning, PEFR evening, forced expiratory volume in 1 s (FEV1) morning and FEV1 evening).

Conclusions Indoor temperatures have a small, but significant, association with short-term variations in the lung function of children with asthma.

  • Environmental epidemiology

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