The best medicine for asthma sufferers may well be home renovations.
New Canadian research shows that living in a home designed to minimize asthma triggers can reduce the suffering of asthmatic children as much as - if not more than - prescription drugs such as those in inhalers.
"Housing is a very important determinant in the health of asthmatics," said Tim Takaro, an associate professor of health sciences at Simon Fraser University in Burnaby, B.C., in an interview.
"The magnitude of the impact we saw with this intervention was similar to inhaled steroids. It was significant."
The research team, led by Dr. Takaro, examined the health of asthmatic children in housing projects in Seattle, then compared those findings with the outcomes after they moved into so-called Breathe Easy homes in a new development.
Of the 1,600 homes in the new development, 35 were built to the specifications set out by Dr. Takaro, an expert on the effects of environmental hazards on human health. The Breathe Easy homes (of which 25 more are under construction) were designed to minimize exposure to common asthma triggers such as dust, mould, mites and rodents.
The comparative data, presented recently at the annual conference of the American Public Health Association, were compelling. They showed, for example:
In a typical two-week period, asthmatic children had an average 12.4 symptom-free days in Breathe Easy homes, compared with 7.1 days in their old homes;
The average number of visits to doctors and emergency rooms over a year dropped to 20.6 days in the new homes from 60 days in the old homes;
Parents and children reported that their quality of life improved significantly, with fewer sleepless nights, fewer missed days of work and school, and a lot fewer frantic visits to emergency.
Maria Pryor, whose 18-year-old son John-David has suffered from asthma for more than a decade, said moving into a Breathe Easy home has been a blessing for her entire family.
"It just feels like cleaner air, it feels like we finally have the freedom to breathe," she said in an interview.
In their previous home, she said, her son used his inhaler to treat asthma symptoms almost every day.
"We still have the inhalers, but he hardly uses them at all," Ms. Pryor said. "He doesn't walk around with a heavy chest any more. He doesn't do all that wheezing."
Ms. Pryor, a preschool teacher in Seattle, has been in the new house for almost two years and said it's been a welcome change from the "long, difficult journey" of caring for a child with asthma.
She said she is aware that the house is designed to reduce asthma symptoms but is not sure precisely what is different, aside from the almost complete lack of carpeting.
"I know it's different, but it looks the same as the other houses," Ms. Pryor said.
Dr. Takaro said that is deliberate, because researchers did not want to stigmatize asthmatics kids.
In the High Point housing development where the study was conducted, the Breathe Easy homes are interspersed with others randomly and "you can't tell one from another."
However, the asthmatic-friendly homes have a number of significant design features to ensure better air quality, including:
Hard flooring surfaces such as linoleum instead of carpeting, which can trap dust and allergens;
Window blinds instead of curtains, again to reduce trapped dust;
Airtight construction, insulated windows and an insulating foundation to minimize contaminants from the outside and reduce moisture build-up;
Hydronic (warm-water) instead of forced-air heating to reduce airborne particles and organisms;
Positive ventilation to remove stale air and filter incoming air, as well as reduce moisture;
Paints and cabinetry materials that emit low levels of volatile organic compounds (VOC);
A HEPA filter vacuum that efficiently removes dust and other toxins;
Landscaping designed to reduce seasonal pollens.
Dr. Takaro said these modifications cost between $5,000 (U.S.) and $7,000. While the changes were made to new homes in this study, he said houses could also be upgraded for about the same cost.
"In the grand scheme of things, it's not very expensive," he said. "You probably save at least that much money in ER visits for one kid in a year."
An estimated 500,000 Canadian children suffer from asthma, and it is particularly prevalent in low-income communities where housing is poor. Asthma is one of the leading causes of emergency room visits and hospitalization in children.
Dr. Takaro said that his research has been very well received in the academic community - including winning the Urban Land Institute Global Award for Excellence in 2007.
The Breathe Easy project in Seattle received $1.8-million in grants from the U.S. Department of Housing and Urban Development and the U.S. National Institute of Environmental Health Sciences.
Unfortunately, this type of project is the exception rather than the rule. Such projects are seldom embraced by government agencies that could make this type of investment work.
"The problem is that there is a total disconnect between housing and health in government," he said.
"Building healthier homes is a really good investment of health dollars but the system doesn't really support that kind of tradeoff."
