Chronic obstructive pulmonary disease (COPD) is a significant cause of ill health, hospitalisation and death in England and Wales. It is known that damp conditions in housing aggravate the symptoms of asthma sufferers owing to a greater volume of inhaled airborne allergens, but while the pathology of COPD is also largely concerned with disrupted lung function, it has a number of different underlying traits. It is known that the symptoms are worse the lower external and internal temperatures become.
It cannot be assumed, therefore, that lessons learned from asthma are automatically transferable to COPD, and robust data are needed to understand what interactions exist between poor housing and this condition.
Key research Question
The study aimed to determine whether housing conditions affected the health of patients diagnosed with COPD and to identify how this is manifested.
Summary of activity
Quantitative measurements were collected at the homes of 80 patients with moderate or severe COPD predominantly living in east London with an average age of 66. Technical measurements (e.g. the temperature and humidity of the living room and bedroom) were taken alongside medical tests (e.g. lung function), quality of life questionnaires and diary cards recording COPD symptoms.
Structured interviews using closed questions collected quantitative data from residents. These included personal data (e.g. age), as well as practical details of their property, such as the extent of insulation, number of rooms and heating system, subjective perceptions of damp and their expenditure on fuel. The severity of damp was calculated by combining humidity measurements with patients’ own subjective judgements.
Data from the study were then compared with existing figures for seasonal mortality and ongoing information on quality of life and health collected from the patients involved in the research.
Statistical analysis was undertaken using STATA software.
Certain housing conditions were found to be linked to an exacerbation of particular COPD symptoms. Increases in humidity in the living room and the coldest room within a property (often the bedroom), a lack of central heating and the presence/location of additional heaters (in bedrooms) were associated with a worsening of symptoms. Older properties also demonstrated this, but symptoms were less severe in the cases of patients living in homes with more than one floor and those with loft and cavity wall insulation. However, the number of floors may be a misleading proxy, as patients with the most severe symptoms were more likely to be rehoused in single-storey properties because of their health condition.
There was no correlation between the number of contacts per day and symptoms, which suggests that higher exposure to person-to-person infection is not a factor.
The author proposes that dry, well-ventilated and centrally heated homes represent the most appropriate option for individuals with moderate and severe COPD.
If services or providers are involved in rehousing patients with COPD, they must consider how the new property can offer conditions suited to their needs. Improvements to retrofit properties with technology that can reduce risk factors (e.g. extractor fans to lower humidity and modern heating systems) should be considered. The design of new builds ought to take account of the issues that exacerbate COPD patients.
Further studies that recruit larger samples and test other measures of damp would be valuable to assess the relationship between damp and COPD symptoms in greater depth.