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The Effect of the Affordable Warmth Programme on Internal Environmental Variables and Respiratory Health in a Vulnerable Group: A Randomised Trial

University of Aberdeen
Aberdeen City Council
Aberdeen Royal Infirmary
Castlehill Housing Association
Date: 2007


Living in a poorly heated, damp home is known to place householders at risk of developing ill health. Those with pre-existing conditions, particularly respiratory illnesses, can experience aggravations of their symptoms and an increased likelihood of mortality. However, there is a paucity of information on the energy performance of the homes of such people and the exact relationship between their heating arrangements, health status and other variables. 

Key research Question

Whether the referral of patients with chronic obstructive pulmonary disease (COPD) to energy efficiency schemes had a positive impact on their health and home climate. 

Summary of activity

The project involved Aberdeen University and Aberdeen City Council carrying out a randomised controlled trial among homeowners and housing association and council tenants in Scotland who experienced fuel poverty. The research assessed the impact of participation in a unique programme developed by Aberdeen City Council to improve the energy efficiency of homes to bring them up to the Affordable Warmth standard. The trial evaluated the health benefits of the scheme for patients with COPD and the effect of the home improvements on indoor environmental variables likely to affect respiratory health.  

A randomised controlled trial on 178 patients with COPD was carried out from 2004 to 2007. Home visits were made to record energy ratings, complete baseline environmental measurements and identify possible energy efficiency improvements. Participants were assigned to either ‘intervention’ or ‘waiting list control’ groups. This was followed by a consultation on potential energy efficiency options. Monitoring of air quality and temperature alongside monitoring of respiratory clinical data and general health status was undertaken.  



Households that failed to meet the World Health Organisation recommended number of hours of warmth (9 hours at 21 degrees C) per day were more likely to experience negative respiratory symptoms. However, even homes that met higher efficiency standards did not always attain this standard of warmth, and the study concluded this was related to personal behaviours and choice. 

The study noted a general reluctance to participate in energy efficiency improvements among the target group. Taken together, these points may indicate that current targets will be insufficient to deliver meaningful improvements for householders with COPD. 

While significant improvements in respiratory symptom indicators were recorded among participants who had energy efficiency measures installed (as well as notable cost savings), a commensurate drop in hospital admissions was not observed, nor were there any changes in warmth or humidity in living or bedroom environments. 

Where very poor air quality was recorded, this was strongly correlated with adverse respiratory presentation. Tobacco smoke was the most significant contributor to lower air quality, and smokers in the study experienced more serious effects from lower temperatures. 


Housing and other relevant policies must take account of the motives that encourage and/or discourage the uptake of energy efficiency schemes among householders with COPD. 

Air quality must be taken into account when designing domestic energy improvement schemes 

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