| dc.description.abstract | This thesis utilizes systematic review and cross-sectional analyses to evaluate the impact of the indoor environment at an individual, household and area level on asthma outcomes, for a sub-population of social housing tenants in Cornwall, UK. Asthma is a chronic and complex disease which can develop or be exacerbated by exposure to air pollution and is responsible for 1400 deaths each year in England and Wales. Whilst much research has examined the health impacts of outdoor air pollution, which is regulated and declining, little has explored the indoor home environment. As a modifiable micro-environment, heavily influenced by individual action, a better understanding of the indoor environment and its components can help both individuals and policymakers to better plan and manage health and homes. As such, identifying the pollutants and allergens in the home which are responsible for the development of, and or exacerbation of asthma, and understanding the relationship with both other exposures, and the resultant asthma related health impacts, is critical to enable better mitigation, regulation, population health, healthier environments and better patient care. Using a pre published protocol, this thesis provides collective new evidence through the systematic synthesis of 14 studies meeting the inclusion criteria, that exposure to volatile organic compounds such as aromatic and aliphatic compounds in the home, is associated with an increased risk of asthma development and/or exacerbation. Exposure to VOCs in the home are also associated with an increased risk of asthma symptoms such as a wheeze, even for individuals without a diagnosis of asthma. Further, using a series of univariate and multiple regression modelling a cross sectional analysis identified that increased time spent in homes with fungal contamination elicit worse asthma symptoms in asthmatic individuals, with noticeable differences in symptom severity between summer and winter. A protocol is demonstrated to model the indoor as a composite measure when examining dose response in relation to indoor air pollution. These findings indicate the need for improved links between health and home providers as well as individuals and pave the way for future research. Key implications for future health and home management, mitigation and education are discussed. | en_GB |
