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Air infiltration in low-income, urban homes and its relationship to lung function


Previous research has found increased home ventilation, which may affect health by altering the composition of indoor air, is associated with improvement of respiratory health, but evidence linking home ventilation to objectively measured lung function is sparse. The Colorado Home Energy Efficiency and Respiratory health (CHEER) study, a cross-sectional study of low-income, urban, nonsmoking homes across the Northern Front Range of Colorado, USA, focused on elucidating this link. We used a multipoint depressurization blower door test to measure the air tightness of the homes and calculate the annual average infiltration rate (AAIR). Lung function tests were administered to eligible participants. We analyzed data from 253 participants in 187 homes with two or more acceptable spirometry tests. We used generalized estimating equations to model forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC z-scores as a function of AAIR. AAIRs ranged from 0.10 to 1.98 air changes per hour. Mean z-scores for FEV1, FVC, and FEV1/FVC were −0.57, 0.32, and −0.43, respectively. AAIR was positively associated with increased FEV1/FVC z-scores, such that a 1-unit change in AAIR corresponded to a half of a standard deviation in lung function (β = 0.51, CI: 0.02–0.99). These associations were strongest for healthy populations and weaker for those with asthma and asthma-like symptoms. AAIR was not associated with FEV1 or FVC. Our study is the first in the United States to link home ventilation by infiltration to objectively measured lung function in low-income, urban households.

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This research was developed under Assistance Agreement No. RD 83575201 awarded by the U.S. Environmental Protection Agency to SLM. It has not been formally reviewed by EPA. The views expressed in this document are solely those of the authors and do not necessarily reflect those of the Agency. EPA does not endorse any products or commercial services mentioned in this publication. We thank Xcel Energy, Boulder Housing Partners, and Loveland Habitat for Humanity with their assistance in recruiting study participants. We also thank Megan Lindstrom, Sam Rock, Adam Pittman, Ethan Zerpa, Adam Hahn, Hanadi Salamah, Tess Bloom, Ryan Hourigan, Mohamad Eltarkawe, Olivia Cecil, Jonathan Kohlenberg, Alisen Bol, Adam Hester, Sarah Hong, Alex Mass, and Stefano Brunelli for their assistance with field data collection.

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Correspondence to Shelly L. Miller.

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Humphrey, J.L., Barton, K.E., Man Shrestha, P. et al. Air infiltration in low-income, urban homes and its relationship to lung function. J Expo Sci Environ Epidemiol 30, 262–270 (2020).

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  • Lung function
  • FEV1
  • FVC
  • Home ventilation
  • Infiltration rate
  • Indoor air


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