In January, the National Institute for Health and Care Excellence (NICE, 2020) published a new guideline aimed at improving air quality in the home to improve health outcomes in vulnerable groups. The guidance states: ‘Good evidence showed that exposure to poor indoor air quality is linked to a range of health problems. This includes respiratory conditions such as a cough, wheezing or asthma, and allergic symptoms such as a runny nose or eye irritation. Certain groups are more vulnerable, either because of their personal circumstances or because of where they live. Because poor indoor air quality at home is a hidden health threat, raising awareness is a first step in reducing the risk of long-term health issues, especially for vulnerable groups.’
The guidance is aimed at public health professionals and its committee noted local authorities' duty of care.
This publication was followed more recently by a report on indoor air pollution published by The Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Physicians (RCP) (2020), which presents evidence linking poor indoor air quality to respiratory problems among children.
Commenting on both publications, Joe Farrington-Douglas, Head of Policy and External Affairs at Asthma UK, said:
‘We cannot ignore the damaging impact of indoor air pollution any longer. Living in poor quality housing when you have asthma can be toxic for the 1.1 million children living with the condition, blighting the health of future generations.
‘The NICE guidelines are a major step in the right direction, but without legally binding performance standards for indoor air pollution, national and local government cannot be held to account. Making children feel safe in their schools and homes must be a priority.’
‘Our children should not grow up in homes that put them at risk of an asthma attack. It is unacceptable that people in living in more deprived areas are more likely to have asthma and more likely to go to hospital with asthma attacks. The NICE guidelines are a major step in the right direction, but without legally binding performance standards for indoor air pollution, national and local government cannot be held to account. Making children feel safe in their schools and homes must be a priority.’
Findings
Common sources of indoor air pollutants include (RCPCH and RCP, 2020):
- Particulate matter—Particulate matter of varying sizes, environmental tobacco smoke, asbestos
- Inorganic air pollutants—Nitrogen dioxide, nitrogen oxide, carbon monoxide, carbon dioxide, ozone
- Chemicals—Volatile organic compounds (e.g. benzene, octane, acetaldehyde, d-limonene), semi-volatile organic compounds (e.g. pesticides, plasticisers, flame retardants), formaldehyde, polycyclic aromatic hydrocarbons
- Airborne radiation—Radon
- Biological pollutants—House dust mites, moulds and fungi, endotoxin, pollen, pet hair and dander.
The following housing conditions can put people at increased risk of exposure to indoor air pollutants (NICE, 2020):
- Location (e.g. they are located in areas where there are high levels of outdoor air pollution, or where noise or security risks mean residents do not open windows)
- Physical infrastructure (e.g. small room sizes, inadequate ventilation, building's layout and orientation)
- Standards of housing (e.g. damp and mould or physical disrepair including flood damage or with unflued or poorly maintained fuel-burning appliances)
- Overcrowding.
Evidence from both reports shows that disadvantaged communities are at greater risk of being exposed to indoor air pollutants due to poor housing conditions. This echoes findings from an Asthma UK (2018) report that looked at how inequality affects people with asthma and found that:
- ‘Asthma is more prevalent within more deprived communities, and those living in more deprived areas of England are more likely to go to hospital for their asthma
- Those from disadvantaged socio-economic groups are more likely to be exposed to the causes and triggers of asthma, such as smoking and air pollution
- There is significant variation in access to basic care for asthma across geography, age group and ethnicity
- Asthma requires self-management, which is harder to embed in groups with lower health literacy.’
Recommendations
The RCPCH and RCP report suggests that a number of areas need to be addressed to improve indoor air quality in homes and schools, including better building and chemicals regulation, as well as their enforcement and compliance. A concerted effort from all key players is needed to improve conditions, including health and social care professionals, schools, local authorities, building owners and landlords, occupants and users.
NICE (2020) also offers some practical recommendations for the general public on improving indoor air quality (see Table 1).
Table 1. Improving air quality
| Reducing damp and condensation and preventing mould |
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| Reducing the following activities, which may lead to poor indoor air quality |
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Poor indoor air quality is a considerable source of health inequality and poses a substantial risk to children and young people with health conditions, in particular those with asthma.
Asthma UK's 2018 report said that ‘to reduce health inequality in asthma and enable people to better adhere to self-managed treatment, there must be preventative action on causes and triggers, improved access to basic care, and digital innovation to improve engagement in healthcare and health literacy’.
FURTHER INFORMATION
NICE
Indoor air quality at home. NICE guideline 149: www.nice.org.uk/guidance/ng149
The Royal College of Paediatrics and Child Health and Royal College of Physicians
The inside story: Health effects of indoor air quality on children and young people: https://bit.ly/3b043WQ