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Asthma and respiratory symptoms related to the housing environment
Örebro University, Department of Health Sciences.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this dissertation was to study the housing environment with a focus on indoor climate factors which may maintain or worsen respiratory symptoms among persons with asthma.

Quasi-experimental and cross-sectional designs and a case-control approach were used. In Study I data was collected from a consecutive series of patients with asthma (n=21) and in the three other studies from a randomly selected sample, representative of the general population (n=6732). This sample was classified into subgroups (Study II): persons with asthma (n=261), healthy persons (n=5266) and persons with symptoms (n=1205). In Study III persons with asthma (n=49) were compared to persons without asthma (n=48), and the same group, persons with asthma (n=49) was also included in Study IV. Data were gathered using subjective information from diaries and questionnaires as well as objective measurements of medical and environmental factors.

Lung function was improved and there was a tendency for the indoor climate to improve after the removal of textile wall-to-wall carpets or the increase of air exchange rate. No statistically significant differences were found in the housing environment when persons with and without asthma were compared. However in some individual homes, environmental factors at levels that could increase symptoms were identified. In single-family houses higher levels of humidity, insufficient ventilation and the occurrence of house dust mites indicated a less favorable indoor climate compared to multi-family houses. Respiratory symptoms attributed to specific environmental exposures increased in both healthy and unhealthy persons when they reported occurrence of indoor climate risk indicators. No statistically significant associations were found between separate risk indicators, identified by a ‘Housing Environmental-index’, or the frequency of indicators and clinical tests. The lack of significant associations may show that the chosen cut-off levels in the index were too high in reference to persons with asthma and further research is needed to establish relevant cut-off levels.

In some of the investigated houses there was a need for secondary preventive interventions to improve the indoor climate in order to decrease the exposure of allergens and airway irritants. In this dissertation one aspect of the complex relationship between the person and the environment, i.e. accessibility, has been studied. Further research is needed to address the aspect of usability, i.e. the person’s own evaluation of the degree to which they can be in and use the environment.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2007. , p. 63
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 15
Keywords [en]
Accessibility, adaptation, asthma, housing environment, risk indicators, index, occupational therapy, prevention, respiratory symptoms.
National Category
Nursing
Research subject
Nursing Science; Nursing Science w. Occupational Therapy Focus
Identifiers
URN: urn:nbn:se:oru:diva-1195ISBN: 978-91-7668-540-2 (print)OAI: oai:DiVA.org:oru-1195DiVA, id: diva2:134760
Public defence
2007-05-25, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2007-05-03 Created: 2007-05-02 Last updated: 2017-10-18Bibliographically approved
List of papers
1. Occupational therapy adaptation of the home environment in Sweden for people with asthma
Open this publication in new window or tab >>Occupational therapy adaptation of the home environment in Sweden for people with asthma
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2002 (English)In: Occupational Therapy International, ISSN 0966-7903, Vol. 9, no 4, p. 294-311Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to evaluate changes of lung function, respiratory symptoms and indoor air quality after reducing allergens and indoor pollutants in the home environment of people with asthma (n = 21). A quasi-experimental pre-/post-test design with one group of participants was implemented. The interventions included removal of wall-to-wall carpets (n = 14) or improvement of indoor air exchange (n = 7). Participants' lung function, symptoms, medication and type-1 allergy were recorded before and after the intervention. The indoor environment was monitored at house calls by an occupational therapist using conventional physical, biological and chemical methods. There was an improvement of lung function evidenced by an increased mean Forced Expiratory Volume (FEV(1) %) and a reduction of airway obstruction (reversibility, % of baseline value), which indicate an improved asthmatic condition. Lung function assessed by vital capacity, bronchial hyper-responsiveness, mean of Peak Expiratory Flow, symptom score and medicine consumption did not change significantly. There was a tendency that the amount of airborne dust (p=0.06) was reduced in the indoor environment. Relative humidity, carbon dioxide, formaldehyde and house dust mite levels had decreased after the intervention, but not significantly. Asthma symptoms related to the home environment are probably caused by several factors. When people with asthma suffer from increased symptoms in the home, house calls should be performed routinely. Dust samples from beds and carpets for analysis of allergens give information about exposure, and environmental assessments should be performed before interventions. Occupational therapists can make a valuable contribution in evaluating the home environment and suggesting ergonomic adaptations for individuals with asthma.

National Category
Nursing
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-2831 (URN)10.1002/oti.170 (DOI)
Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2017-10-18Bibliographically approved
2. Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population
Open this publication in new window or tab >>Increased occurrence of respiratory symptoms is associated with indoor climate risk indicators: a cross-sectional study in a Swedish population
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2007 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 9, p. 2031-2035Article in journal (Refereed) Published
Abstract [en]

A basic assumption was that exposure to the indoor environment would increase the manifestation of respiratory symptoms in predisposed individuals. The aim was to investigate the proportion of perceived respiratory symptoms attributed to specific environmental exposures, and associations related to indoor climate risk indicators, i.e. occurrence of damp or mould, insufficient ventilation and condensation on windows.

Method

A questionnaire was mailed to a random sample of 8008 individuals, stratified for gender and age. The response rate was 84% (n=6732). Established criteria for current asthma were used to classify subjects into three subgroups: asthmatics, healthy and symptomatics (but without current asthma).

Results

The proportion of symptoms attributed to specific environmental exposures increased in the total sample and in the three subgroups when indoor climate risk indicators, particularly damp or mould, were reported. Generally, the lowest proportions were found for healthy and the highest for asthmatics. Univariate analyses presented as relative risks (RR) (95% CI) showed significantly increased risks for perceived overall influence on airways for all groups, with RR ranging from 4.3 to 6.8. Although respiratory symptoms attributed to dust, environmental tobacco smoke (ETS) and strong scents increased when risk indicators were reported, RR were generally lower in all groups.

Conclusion

The high frequency of respiratory symptoms among asthmatics increased when occurrences of risk indicators were reported. Similarly, increased symptoms were found for healthy indicating that indoor climate risk indicators may affect both healthy and unhealthy individuals.

Keywords
asthma, airway symptoms, housing environment, risk indicators
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-2832 (URN)10.1016/j.rmed.2007.05.002 (DOI)
Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2017-12-14Bibliographically approved
3. An investigation of the housing environment for persons with asthma and persons without asthma
Open this publication in new window or tab >>An investigation of the housing environment for persons with asthma and persons without asthma
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2006 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, no 1, p. 4-12Article in journal (Refereed) Published
Abstract [en]

Asthma is a chronic disease affected by environmental factors that may increase symptoms that impact on a persons' well-being. An important issue in occupational therapy is to improve the relationship between a person's functional capacity and the physical environment. The aim of the study was to compare the housing environment of persons with asthma (cases, n=49) and persons without asthma (controls, n=48), with regard to building construction and condition, physical, chemical and biological factors, and cleaning routines. A secondary aim was to compare different types of accommodation within cases and controls. A specialist team, including a construction engineer, a biological scientist, and an occupational therapist, conducted the study. Data were collected using protocols, as well as a number of established technical methods from the field of occupational and environmentsl medicine. The primary results showed no major differences in the housing environment between the two groups. However, in individual homes environmental factors at levels that could increase symptoms were identified. When single-familyhouses were compared with multi-family houses, significant differences were found indicating that preventive interventions may be needed in some single-family houses. Further studies are needed to clarify the person-environment relationship for persons with asthma, focusing on their ability to perform daily activities.

Keywords
environmental factors, housing, occupational therapy, respiratory symptoms
National Category
Social Sciences Interdisciplinary Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-2833 (URN)10.1080/11038120510031824 (DOI)
Projects
FinEsS-studies
Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2018-01-13Bibliographically approved
4. Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?
Open this publication in new window or tab >>Are there associations between indoor climate risk indicators, identified by a Housing Environmental index (HE-index), and clinical tests of lung function, allergy and bronchial hyper-responsiveness in persons with asthma?
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(English)Manuscript (preprint) (Other academic)
National Category
Nursing Occupational Therapy
Research subject
Nursing Science w. Occupational Therapy Focus
Identifiers
urn:nbn:se:oru:diva-2834 (URN)
Available from: 2007-05-03 Created: 2007-05-03 Last updated: 2017-10-18Bibliographically approved

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Frisk, Margot L. A.

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