BMJ 1995;311:1053-1056 (21 October)

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Home environment and severe asthma in adolescence: a population based case-control study

David P Strachan, senior lecturer in epidemiology,a Iain M Carey, statistician a

a Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE

Correspondence to: Dr Strachan.

Abstract

Objective: To investigate the effects of the home environment on the risk of severe asthma during adolescence.
Design: A questionnaire based case-control study drawn from a cross sectional survey of allergic diseases among secondary school pupils in Sheffield in 1991.
Subjects: 763 children whose parents had reported that over the previous 12 months they had suffered either 12 or more wheezing attacks or a speech limiting attack of wheeze. A further 763 children were frequency matched for age and school class to act as controls. Analysis was restricted to 486 affected children and 475 others born between 1975 and 1980 who had lived at their present address for more than three years.
Results: Independent associations with severe wheeze were seen for non-feather bedding, especially foam pillows (odds ratio 2.78; 95% confidence interval 1.89 to 4.17), and the ownership of furry pets now (1.51; 1.04 to 2.20) and at birth (1.70; 1.20 to 2.40). These estimates were derived from subjects whose parents denied making changes in the bedroom or avoiding having a pet because of allergy. Parental smoking, use of gas for cooking, age of mattress, and mould growth in the child's bedroom were not significantly associated with wheezing.
Conclusions: Either our study questionnaire failed to detect the avoidance or removal of feather bedding by allergic families or there is some undetermined hazard related to foam pillows. Synthetic bedding and furry pets were both widespread in this population and may represent remediable causes of childhood asthma.

Key messages

  • Key messages

  • The bedroom arrangements of one quarter of teenagers with troublesome asthma in Sheffield had been altered because of the child's allergy or chest problem. One quarter of these families had avoided pets or removed them from the home because of allergy

  • Nevertheless, about two thirds of asthmatic children were exposed to furry pets in their home, an exposure which almost doubled their risk of troublesome symptoms

  • Alterations to the bedroom commonly entailed use of non-feather bedding, used by 95% of severely wheezy children. Exposure to synthetic pillows was associated with a two to threefold increase in risk of severe wheezing, even after allowance for selective avoidance of allergens by the families of allergic or asthmatic children

  • Avoidance of feather bedding is unlikely to benefit children with asthma, and there may be a hitherto unidentified hazard associated with use of synthetic pillows


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