Science of the Total Environment 409 (2011) 36283633

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Investigation of different approaches to reduce allergens in asthmatic children's

homes The Breath of Fresh Air Project, Cornwall, United Kingdom
Susan Ann Eick a,, George Richardson b
a
b

University of Plymouth, Drake Circus, Plymouth, PL4 8AA, UK

AC & T Ltd, 12 Woolwell Drive, Plymouth, PL6 7JP, UK

a r t i c l e

i n f o

Article history:
Received 1 March 2010
Received in revised form 1 June 2011
Accepted 6 June 2011
Available online 13 July 2011
Keywords:
Asthma
Ventilation
Respiratory health
Anti-allergy
Indoor environment
Housing

a b s t r a c t
During 2001 to 2004, a study was conducted to assess the indoor environmental and health impact of
installing allergen-reducing interventions in the homes of asthmatic children. Based on the results of a pilot
study, to determine an intervention that would provide improved symptom scores and a reduction in house
dust mite allergen (Der p 1), mechanical ventilation and heat recovery (MVHR) systems were installed in 16
homes. Environmental and respiratory health assessments were conducted before and after the installation of
the MVHR systems. The results indicated that the installation of MVHR systems reduced Der p 1
concentrations in living room carpets and mattresses. There were signicant reductions in symptom scores
for breathlessness during exercise, wheezing, and coughing during the day and night. Although, there was not
a parallel control group for the main study, the lack of change in the pilot study control group (who did not
receive an intervention), indicated that the changes in symptom scores were in part to do with the
intervention. Larger scale trials are needed to determine the efcacy of MVHR systems in homes to improve
indoor air quality and reduce asthma symptoms.
2011 Elsevier B.V. All rights reserved.

1. Introduction
Housing conditions are very important for human health, particularly for children who might remain indoors for up to 78% of their time
(WHO, 2001; Bonnefoy et al., 2003; US DHHS, 2009). There is a
correlation between the changes in indoor environments, particularly in
the home, over the last 50 to 60 years and the increasing incidence of
asthma (Ashmore, 1998; Howieson et al., 2003; Jacobs et al., 2009).
Increased indoor temperatures, reduced natural ventilation and
increasing energy efciency requirements have altered the indoor
environment (Richardson and Eick, 2006; Crump et al., 2009). The home
environment is a source of exposure to various indoor and outdoor
generated pollutants that have health implications (NAS, 2001; SCHER,
2007; CLG, 2008).
Physical changes can be made to the home environment to make it
more healthy and interventions have been developed to this effect, for
example, ventilation, anti-allergy products, deep cleaning, and in addition,
projects designed to change behaviours that lead to exposure to asthma
triggers (NAS, 2001; Richardson et al., 2005; Krieger et al., 2005).

dent study (the Breath of Fresh Air Project) in Cornwall, UK, to identify
possible interventions to reduce children's medically documented
respiratory symptoms through the introduction of interventions to
their home environment.
The inclusion criteria for participation were that at least one
asthmatic child (clinically diagnosed) under the age of 12 years permanently lived in the household and that the household received
income related, state funded benets.
3. Methods
3.1. Study design
The Breath of Fresh Air Project had two phases. A pilot study was
conducted to determine a suitable allergen reducing intervention,
which could then be investigated further in a larger study (herein
referred to as the main study). Indoor environmental and health
assessments were conducted before and after the installation of an
intervention in each home. Participants could not be blinded due to
the nature of the interventions.

2. Background
3.2. Recruitment strategy
The West of Cornwall Primary Care Trust, Kerrier and Penwith
District councils, and Enact Energy initiated and designed an indepen Corresponding author.
E-mail address: susan.eick@plymouth.ac.uk (S.A. Eick).
0048-9697/$ see front matter 2011 Elsevier B.V. All rights reserved.
doi:10.1016/j.scitotenv.2011.06.011

Participant recruitment was based on referrals from local medical

practices, health visitors, and a public news media campaign. Taking
part in the study was non-contributory, non-compulsory, and did not
preclude taking part in any other studies or interfere with normal

S.A. Eick, G. Richardson / Science of the Total Environment 409 (2011) 36283633

medical treatments. No nancial incentives were offered for participation or towards the long-term operating costs of the interventions. A
representative from each participating family was asked to sign a
consent form and agree for anonymous data to be shared for research
purposes.
3.3. Demographics
All homes were in southwest Cornwall with an assortment of
heating systems (Table 1). All homes were naturally ventilated (open
windows, inltration). Some had basic forms of passive ventilation,
for example trickle vents in windows. The homes were a mixture of
social rented (public sector tenant), private rented (tenant of
independent landlord), and privately owned (owner-occupied).
In total, 126 children were recruited into the study (pilot study= 70;
main study = 56). There were no signicant differences between the
pilot study and main study at baseline apart from outdoor conditions,
which were adjusted for. There were no signicant differences between
the dropouts and completers of the study at baseline (Table 2).
3.4. Interventions
Table 3 shows the distribution of the following interventions and
control homes in the pilot study.
3.4.1. MVHR
Retrotted, whole-house mechanical ventilation with heat recovery (MVHR) system (Model WH320, ADM Systems, Skipton, UK and
an equivalent Model VVX-200, Villavent Ltd., Oxon, UK). The MVHR
systems provided a low-level continuous supply of fresh air (~ 90 m 3
h -1 equal to ~0.5 ac h 1, for a 90 m 2 house with a volume of
~ 200 m 3), ltration of coarse particles from the input air (EU3 type
lter 510 m with 85% efciency) and recycling of latent heat in the
exhaust air (~70% efciency) to the input air. Stale air was extracted
from kitchens and bathrooms and fresh preheated outdoor air was
vented into living rooms and bedrooms.

3629

Table 2
Inter-comparison of groups at baseline: Dropouts vs. Completers.
Pilot study

Main study

Averages

Dropouts
13 children
(11 homes)

Retained
46 children
(33 homes)

Dropouts
42 children
(31 homes)

Retaineda
14 children
(13 homes)

Child's age
Total symptom score
Number of smokers per
home
Outdoor temperature (C)
Outdoor relative humidity
(%)
Living room temperature
(C)
Living room relative
humidity (%)

2.8
24.0
1.1

6.6
16.2
0.7

6.0
23.0
0.6

6.0
19.4
0.6

12.7
47.2

12.3
56.2

12.0
56.0

11.1
57.8

18.0

18.6

19.0

18.5

48.9

49.5

53.0

50.9

a
In addition, 3 control homes from the previous groups were analysed therefore the
total sample in the main study was 17 children in 16 homes.

allergy duvet, pillows (Thermoll Fresh Allerban, Dupont) and

mattress (Healthbeds Ltd, Rotherham, UK) were provided for the
asthmatic child's bed. Further, a central vacuum cleaning system was
installed with suction connection points on ground and rst oors
(ADM Systems, and Villavent Ltd.).
3.4.3. Central heating
Heating was provided by a whole-house, water borne, central
heating system.
3.4.4. Control homes
Nine homes were randomly chosen to act as control homes and did
not receive an intervention until during the main study. Control
homes were assessed in the same way as the homes receiving
interventions.
3.5. Environmental data collection

3.4.2. Surfaces
Laminate ooring (low formaldehyde content, wood composite)
laid in the living room and the asthmatic child's bedroom. An antiTable 1
Summary of housing characteristics.
Characteristics
Age

Type

Number of oor levels

Volume

Type of heating

Natural gas.

b1930
193049
195069
197089
1990
Mid-terraced
End-terraced
Semi detached
Ground oor at
Upstairs at
Bungalow
1
2
3
b100 m3
100150 m3
150250 m3
N 250 m3
Electric res
Coal red
Gasa central heating
Gasa res only
Bottled butane gas
Gasa & electric res

Pilot study (%)

Main study (%)

14
16
30
27
14
57
10
23
5
7
0
9
84
7
9
50
39
2
8
20
48
4
3
2

25
16
21
36
2
61
7
25
2
0
5
9
82
9
7
45
43
5
20
20
52
8
0
0

Averages were calculated from three measurements taken from

the living room, asthmatic child's bedroom, and outdoors. Measurement methods (Table 4) are described in detail in Richardson et al.
(2000) and Richardson et al. (2006). In addition to the recorded
variables shown in Table 4, the following observations were made:
building characteristics, regularity of opening windows, mode of
ventilation and type of heating, presence of smokers, available living
space, clutter, observed mould (over 10 cm 2) and condensation,
number and type of pets, general hygiene, existing anti-allergy
strategies (i.e. ooring, mattress covers, type of vacuum cleaners,
presence of soft toys), and number of people in permanent residence.
3.6. Health data collection
Retrospective health questionnaires were adapted by the project
steering committee from a Symptom Based Outcome Measure for

Table 3
Distribution of interventions in the pilot study.
Intervention

Number of children (number of homes)

MVHR
Surfaces
Central heating
Control homes
Total

16 (8)
10 (9)
9 (7)
11 (9)
46 (33)

3630

S.A. Eick, G. Richardson / Science of the Total Environment 409 (2011) 36283633

Table 4
Environmental variables recorded during each one hour assessment.
Variables

Units

Outdoors Living room Bedroom

Temperature
Relative humidity
Fine particles (0.33.0 m)
Coarse particles (3.07.0 m)
Wall/wall surface moisturea
Dust mite allergen (Der p 1)b
Microbial coloniesc
Carbon dioxided
Carbon monoxidee

C
%
Particles L 1
Particles L 1
WME %
g g 1
number slide 1
ppm
ppm

Measured as wood moisture equivalent (Protimeter PLC. 2001).

Dust samples were collected from the asthmatic child's bed mattress and the living
room oor. Dust was collected on a lter by vacuuming 1 m2 for 1 min. The allergen Der
p 1 was extracted from the lters using the standard ELISA enzyme linked
immunosorbent assay (Indoor Biotechnologies, Cardiff & North West Lung Centre,
Manchester). The assay has a lower detection level of 0.01 g g 1 (concentration of
allergen per gram of dust).
c
Samples were collected using a Hygicult (Orion Diagnostica Oy, Finland) exposed
for one hour. After counting, microbial colonies were then identied to genus level
where possible (School of Biological Sciences, University of Plymouth, UK).
d
Kane CO2 monitor (Kane International, Welwyn Garden City, UK) range 0
2000 ppm, 0 to 40 C, 090% relative humidity. Accuracy 10%.
e
Kane CO monitor (Kane International, Welwyn Garden City, UK) range 0999 ppm,
0 to 50 C, 099% relative humidity. Accuracy 5%.
b

(Adult) Asthma (Steen et al., 1994). The questionnaires were

conducted each year in April, before and after installation of the
interventions (from 2001 through to 2004). Responses were given by

the children's mainly female (~ 85%), adult guardian during face-toface interviews in their home by a qualied nurse. The number of
children assessed was higher than the number of homes because
there was often more than one asthmatic child.

3.7. Statistical analysis

Before and after analyses were conducted. The statistical analyses
were conducted using SPSS for Windows 15 (LEAD Technologies Ltd.
USA). Non-parametric statistics were used throughout, including
sample size calculations, descriptive statistics, and paired Wilcoxon
signed rank tests for signicant differences before and after the
interventions. The MannWhitney U test was performed to determine
signicant differences between the intervention and control groups in
the pilot study. A statistical signicance level of 95% (p b 0.05) was used
throughout.

4. Results
4.1. Response rates
No participants objected to the assessors visiting their homes. In the
pilot study, 22 homes dropped out (11 prior to the start of the study), in
the main study, 42 homes dropped out (due to MVHR system installation delays).

Table 5
Environmental results (median values, signicant statistics in bold).
Pilot study
Variable
Temperature living room
(C)
Temperature bedroom
(C)
Relative humidity living room
(%)
Relative humidity bedroom
(%)
Absolute humidity living room
(g kg1)
Absolute humidity bedroom
(g kg 1)
Airborne microbes bedroom
(number slide 1)
Coarse particles living room
(particles L 1)
Coarse particles bedroom
(particles L 1)
Fine particles living room
(particles L 1 103)
Fine particles bedroom
(particles L 1 103)
Der p1 bedroom mattress
(g g 1)
Der p1 living room carpet
(g g 1)

Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value

MVHR
(n = 8)

Surfaces
(n = 9)

Central heating
(n = 7)

Control
(n = 9)

Main study
(n = 16)

21
18
0.17
20
19
0.33
44
39
0.12
49
38
0.03
6.87
5.37
0.05
7.21
5.19
0.04
3
1
0.19
377
404
0.67
228
259
0.89
95
108
0.80
83
96
0.64
5.87
2.86
0.31
0.70
0.36
0.35

18
16
0.82
19
17
0.95
47
46
0.05
48
41
0.01
6.90
5.52
0.08
6.46
5.35
0.05
2
5
0.95
294
211
0.31
166
189
0.42
108
61
0.50
92
52
0.72
2.84
3.20
0.36
2.37
0.00
0.32

17
19
0.38
18
19
0.28
56
46
0.05
52
45
0.01
6.74
6.18
0.24
6.15
5.87
0.15
4
5
0.48
387
307
0.47
317
212
0.08
86
67
0.09
91
67
0.93
4.87
8.50
0.13
5.08
2.28
0.76

20
19
0.13
20
19
0.16
46
42
0.04
47
41
0.02
6.83
5.49
0.01
6.60
5.86
0.02
2
7
0.06
302
385
0.16
181
229
0.34
57
118
0.12
57
110
0.01
4.25
4.00
0.97
2.05
9.33
0.10

18
19
0.23
19
19
0.06
49
51
0.90
48
50
0.55
6.73
7.22
0.38
6.60
7.10
0.69
4
4
0.58
368
325
0.35
283
201
0.08
65
276
0.02
54
269
0.02
4.00
0.04
0.24
2.65
0.38
0.07

S.A. Eick, G. Richardson / Science of the Total Environment 409 (2011) 36283633

4.2. Indoor environmental outcomes

4.2.1. General results
The median concentration of Der p 1 before the interventions for
all homes was 4.5 g g 1 in mattresses and 2.2 g g 1 in living room
carpets. For 36 of the homes, Der p 1 concentrations in mattress
samples were above 2 g g 1 and 14 had samples above 10 g g 1.
Living room carpet samples indicated that 27 homes had levels above
2 g g 1 and ve had above 10 g g 1.
Pets were present in 76% of homes, dominated by cats and dogs
(66%). Pet ownership (average of two pets per household) did not
change signicantly over the course of the study.
Before the intervention, 79% of homes had a median living room
temperature below 21 C and 22% had a median bedroom temperature below 18 C (UK government recommended temperatures for
these types of rooms (DTI and DEFRA, 2001)).
Mould, and or mould damage was observed in 55% of the homes
before interventions. There was no signicant change in observed
mould after the interventions were installed, however the overall
(pilot and main study) observed presence of mould dropped to 41% of
homes. In the subgroup of homes that received the Surfaces package
in the pilot study, observed mould increased from 33% to 56%.
Six percent of homes had measurable wall surface moisture above
20% (threshold thought to lead to permanent building damage
(Protimeter PLC, 2001)). There were no signicant changes in wall
surface moisture after the interventions.
Carbon dioxide was below 1000 ppm (the threshold thought to reect
poor air quality (Portnoy et al., 2001)) in all the homes apart from one,
once. Carbon monoxide was below the level of detection in all homes.
There was a high prevalence of smoking indoors (46%). There were
no changes during the study.

3631

4.2.2. Justication for the choice of MVHR

The choice of intervention for the main study was based on nonsignicant reductions in Der p 1 concentrations (Table 5). The results
from the pilot study indicated that in homes with the central heating
and Surfaces (homes receiving laminate ooring, bedding and central
vacuum systems) interventions, Der p 1 concentrations in mattress
samples increased. Whereas, Der p 1 concentrations in mattress
samples in MVHR homes decreased.
The only signicant reductions in symptom scores had occurred in
homes with MVHR and central heating. In the Surfaces group, the
children had few improvements, with some symptoms increasing
after installation. Therefore, MVHR systems were installed, based on
improved symptoms scores and reduced concentrations of house dust
mite allergen.
4.2.3. MVHR results
No signicant indoor environmental changes were found after the
installation of MVHR in the main study. The non-signicant reductions
in Der p 1 concentrations associated with the MVHR systems in the pilot
study were repeated (Table 5). An association with outdoor environmental conditions was indicated, where an increase in outdoor
humidity and the number of ne particles was reected in indoor
measurements.
4.3. Health assessments
4.3.1. Symptom scores
There was a trend towards lower asthma and other respiratory
symptom scores (Table 6) after the installation of MVHR systems. The
small number of children remaining in the main study (n = 17) meant
that very small changes in health were unlikely to be detectable. To

Table 6
Symptom scores (median values, signicant values in bold).
Pilot study
Symptom
Breathless during the day
when not exercising
Breathless during the day
when exercising
Wheezy during the day

Wheezy during the night

Cough during the day

Cough during the night

Runny nose

Blocked nose

Hay fever

Total symptom score

Total asthma symptom score

Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value
Before
After
p value

MVHR
(n = 16)

Surfaces
(n = 10)

Central heating
(n = 9)

Control
(n = 11)

Main study
(n = 17)

1
1
0.19
0
0
0.32
1
1
0.27
1
1
0.20
2
1
0.05
3
1
0.02
2
1
0.24
0
1
0.52
0
0
0.16
9
6
0.04
6
4
0.02

2
2
0.67
0
1
0.74
0
1
1.00
1
1
1.00
2
1
0.12
2
1
0.43
0
1
0.67
0
0
0.40
0
0
0.32
8
8
0.39
8
6
0.38

2
1
0.03
1
1
0.46
1
1
0.10
1
1
0.68
3
1
0.03
2
1
0.08
3
2
0.02
3
2
0.53
0
0
0.32
14
9
0.02
8
5
0.01

1
2
0.06
1
1
0.74
1
1
0.71
2
1
0.52
2
1
0.21
2
2
0.07
2
1
0.07
0
2
0.13
0
0
0.16
9
11
0.14
9
9
0.76

1
0
0.03
1
0
0.02
1
0
0.01
1
0
0.01
2
0
b 0.01
2
0
b 0.01
1
0
0.01
1
0
b 0.01
0
0
0.18
12
1
b 0.01
9
1
b 0.01

3632

S.A. Eick, G. Richardson / Science of the Total Environment 409 (2011) 36283633

improve the reliability of the results, data from the pilot homes that
received MVHR systems were included in the analysis (homes = 24;
children = 33). Further signicance tests were conducted. The results
in Table 7 are very similar to the results for the 17 children in the main
study.
4.3.2. Medical events
The data from the combined MVHR group (33 children) indicated
that the number of days lost per month from school/nursery due to
asthma reduced (median number of days lost before = 3, after = 0;
p = 0.03) as did the number of visits made to a GP (median number of
GP visits before = 1, after = 0; p = 0.04).
5. Discussions
The results from the Breath of Fresh Air Project indicated a reduction
in asthma symptoms from the installation of MVHR systems. There were
limitations to the study. The small sample size reduced the sensitivity of
the analysis, only allowing the detection of large changes in the
environmental and health data. The assessors were aware of becoming
an intervention, through their own actions or in conversations with the
participants. Other factors such as: type of house, position of house,
social status (income, psychological welfare etc.), GP's choice of patients,
poor memory of guardian, and biased responses by the guardian to the
assessors, may have inuenced the results. No measurements of outside
of own house inuences were accounted for, such as day-care nurseries,
friends at day-care, school environments, and after school activities, all
possibly inuencing the recorded symptoms. A major consideration was
the variation in the lifestyle and habits of the participants. This may have
had an inuence on the outcomes of the assessments. There were no
changes in smoking or cat ownership, both of which are known asthma
triggers.
There was no parallel control group to compare the main study
results to in 2004, therefore factors such as being involved in a study,
extra attention, and someone taking the participant's opinions seriously
cannot be discounted from inuencing the results. If a Hawthorne or
similar effect (Gillespie, 1991) was the dominant reason for improved
health, it could be expected that all the participants in the pilot study,
including the control households, would have improved in a similar
fashion, since all homes received the same attention. However, the
control and Surfaces group showed no signicant changes.
The symptom questions used in this study have been previously
demonstrated to correlate well with the clinical severity of an adult's
asthma (Steen et al., 1994). Without clinical outcomes it cannot be
conrmed whether or not the reduction in symptom scores really
represent a change in asthma for the participating children. The World
Health Organisation has suggested that despite the subjectivity of the
type of questionnaire used in this study, the measurement of perceived
health is still useful in measuring public health status (WHO, 2001).
When the questionnaires were implemented (each year in April),
the preceding months were not in the high pollen count season. The

Table 7
Symptom scores: combined MVHR group (n = 33).
Symptom

Before After p value

Breathless during the day when not exercising

1
Breathless on exercise
0
Wheezy during the day
1
Wheezy during the night
1
Cough during the day
2
Cough during the night
2
Runny nose
2
Blocked nose
1
Hay fever
0
Total symptom score
11
Total asthma symptom score (minus non-asthma scores)
8

0
0
0
0
0
1
0
0
0
3
3

0.07
0.01
0.01
0.01
b0.01
b0.01
b0.01
0.04
0.6
b0.01
b0.01

results, as expected, reected this with little or no incidence of hay

fever. Hay fever (rhinitis) is an allergic disorder associated with pollen
and is seasonal. Blocked or runny noses are symptomatic of upper
respiratory tract infections and allergies. Although these symptoms
are not necessarily related to asthma, an improvement could be
expected in scores for these symptoms because of reductions in
allergens (pets, pollen, mould) through the introduction of ltered,
continuous, low-level ventilation in the MVHR homes.
The only large, signicant change in this study in medical events
was the reduction of the number of school days lost due to asthma for
children in the combined MVHR group. Some of the participants
highlighted that their children's medication patterns had changed,
with reduced inhaler usage (non-recorded).
The MVHR systems met the original remit of the study that the
chosen intervention would provide a reduction in Der p 1 concentrations and asthma symptom scores. The most notable trend seen in the
analysis of homes with MVHR systems, were the large reductions of
Der p 1 concentrations in sampled mattresses. A reduction of Der p 1
concentrations is normally associated with reduced indoor humidity
(Stephen et al., 1997; Warner et al., 2000). However, this was not the
case. When the MVHR homes from the pilot study were analysed
(n = 8 homes) there was a signicant change in relative humidity in
the living room, however, these changes reected similar changes
outdoors. There was a strong probability that the reduced concentrations of Der p 1 in homes with MVHR systems were due to the
intervention, not to changes in outdoor humidity, as the downward
trend was repeated in the main study, despite increased humidity
outdoors. It could be expected that in homes where MVHR systems
are installed there would be little or no difference in temperatures, as
was the case in this study.
Few studies have been conducted that have determined the health
and environmental effects of installing MVHR systems as a single
intervention. Warner et al. (2000) investigated the installation of MVHR
systems in ten dust mite sensitive asthmatics' homes (ten further with
MVHR and high efciency vacuum cleaners). The study did not provide
evidence of clinical improvements in asthma symptoms but indicated
non-signicant reductions in Der p 1 concentrations, similar to this
study. A study of 54 asthmatics who had single-room MVHR systems
installed in their bedrooms and living rooms provided evidence of large
reductions in dust mite concentrations and an improvement in self
reported health status (Howieson et al., 2003). A study by Fletcher et al.
(1996), where 18 homes were provided with MVHR systems,
demonstrated that MVHR was associated with a reduction in humidity
but concluded that this would not be enough to reduce mite populations
(and their allergens). The UK Building Research Establishment installed
MVHR systems in 146 homes and found non-signicant reductions in
Der p 1 concentrations and non-signicant improvements in health
(Aizlewood et al., 2004), reecting the results of this study. A study by
Takaro et al. (2011), has also conrmed that installing a system that
provides fresh, ltered outdoor air as part of an overall low allergen
strategy and energy efcient housing scheme, can increase the number
of days occupants are free from asthma symptoms. Exposure to mould
and other allergen sources, such as rodents and cockroaches was also
reduced.
6. Anecdotal evidence
The participants freely discussed their perceptions of their health
and the interventions with the researchers after the assessments.
People's perceptions of their indoor environment are important in their
sense of well-being (Adan et al., 2007). Some participants perceived a
difference in the air in their homes after the installation of MVHR, more
specically a noticeable difference in odours, particularly tobacco
smoke. Many participants wanted to actively take part in controlling
their child's asthma symptoms and were keen to understand the results
from the investigations. The participants appreciated the presence of

S.A. Eick, G. Richardson / Science of the Total Environment 409 (2011) 36283633

health professionals and environmental scientists in their homes to

explain some of their indoor environmental problems (post intervention). Participants commented on the difference a change in their child's
health had made to the whole family's well-being. This can be associated
with the results where night time symptoms were reduced, allowing the
whole family to gain a full night's sleep.
Complaints were made about the Surfaces intervention, particularly
the central vacuum cleaning system. This would suggest that negative
health perceptions in those homes might be linked to the participants'
acceptance of the interventions. There were also complaints made about
the MVHR systems, particularly about aesthetics, noise, and draughts,
however, the participants still perceived an improvement in their
children's health. The participants did highlight specic benets of
the MVHR systems other than ventilation, including solving issues
associated with ventilating through open windows, such as noise,
security, and heat loss. No participants discussed the continuous
running costs of the MVHR systems.
Education about maintaining a healthy indoor environment is
important and the participants requested more information during
the study about what actions they could take. This led to a successful
follow-on project where simple advice booklets were produced by the
Breath of Fresh Air Project (AC & T Ltd., 2007) and 5000 copies
distributed to participating families and to non-participants through
children's centres, medical centres, and health visitors.
7. Conclusions
The study indicated that installing mechanical ventilation with
heat recovery (MVHR) led to a decrease in asthma symptoms. The
results from the study reect that of other studies involving the
installation of MVHR systems with health improvements in the form
of reduced asthma symptoms and the reduction of house dust mite
allergen.
Acknowledgements
The Breath of Fresh Air Project was funded by the Cornwall and
Isles of Scilly Health Action Zone. Many thanks to Nicky Houghton
(project manager) and other members of the steering committee for
their input into this article.
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