Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Get just this article for as long as you need it


Prices may be subject to local taxes which are calculated during checkout


  1. Klauss AK, Tull RH, Roots LM, Pafafflin JR. History of changing concepts in ventilation requirements. ASHrAE J. 1970;12:51.

    Google Scholar 

  2. Nazaroff WW. Four principles for achieving good indoor air quality. Indoor Air. 2013;23:353–6.

    Article  Google Scholar 

  3. Fisk WJ. How home ventilation rates affect health: a literature review. Indoor Air. 2018;28:473–87.

    Article  CAS  Google Scholar 

  4. Sundell J, Levin H, Nazaroff WW, Cain WS, Fisk WJ, Grimsrud DT, et al. Ventilation rates and health: multidisciplinary review of the scientific literature. Indoor Air. 2011;21:191–204.

    Article  CAS  Google Scholar 

  5. Wargocki P. The effects of ventilation in homes on health. Int J Vent. 2013;12:101–18.

    Google Scholar 

  6. Hodas N, Meng Q, Lunden MM, Rich DQ, Ozkaynak H, et al. Variability in the fraction of ambient fine particulate matter found indoors and observed heterogeneity in health effect estimates. J Expo Sci Environ Epidemiol. 2012;22:448–54.

    Article  CAS  Google Scholar 

  7. Carlton EJ, Barton K, Shrestha PM, Humphrey J, Newman LS, Adgate JL, et al. Relationships between home ventilation rates and respiratory health in the Colorado Home Energy Efficiency and Respiratory Health (CHEER) study. Environ Res. 2018;169:297–307.

    Article  Google Scholar 

  8. Wang J, Engvall K, Smedje G, Nilsson H, Norback D. Current wheeze, asthma, respiratory infections, and rhinitis among adults in relation to inspection data and indoor measurements in single-family houses in Sweden-The BETSI study. Indoor Air. 2017;27:725–36.

    Article  CAS  Google Scholar 

  9. Francisco PW, Jacobs DE, Targos L, Dixon SL, Breysse J, Rose W, et al. Ventilation, indoor air quality, and health in homes undergoing weatherization. Indoor Air. 2017;27:463–77.

    Article  CAS  Google Scholar 

  10. Oie L, Nafstad P, Botten G, Magnus P, Jaakkola JJK. Ventilation in homes and bronchial obstruction in young children. Epidemiology. 1999;10:249–99.

    Article  Google Scholar 

  11. Wilson J, Dixon SL, Jacobs DE, Breysse J, Akoto J, Tohn E, et al. Watts-to-Wellbeing: does residential energy conservation improve health? Energy Efficiency. 2014;7:151–60.

    Article  Google Scholar 

  12. Bornehag CG, Sundell J, Hagerhed-Engman L, Sigsgaard T. Association between ventilation rates in 390 Swedish homes and allergic symptoms in children. Indoor Air. 2005;15:275–80.

    Article  CAS  Google Scholar 

  13. Emenius G, Svartengren M, Korsgaard J, Nordvall L, Pershagen G, Wickman M. Building characteristics, indoor air quality and recurrent wheezing in very young children (BAMSE). Indoor Air. 2004;14:34–42.

    Article  CAS  Google Scholar 

  14. Isaacs K, Burke J, Smith L, Williams R. Identifying housing and meteorological conditions influencing residential air exchange rates in the DEARS and RIOPA studies: development of distributions for human exposure modeling. J Expo Sci Environ Epidemiol. 2013;23:248–58.

    Article  CAS  Google Scholar 

  15. Lajoie P, Aubin D, Gingras V, Daigneault P, Ducharme F, Gauvin D, et al. The IVAIRE project-a randomized controlled study of the impact of ventilation on indoor air quality and the respiratory symptoms of asthmatic children in single family homes. Indoor Air. 2015;25:582–97.

    Article  CAS  Google Scholar 

  16. Wright GR, Howieson S, McSharry C, McMahon AD, Chaudhuri R, Thompson J, et al. Effect of improved home ventilation on asthma control and house dust mite allergen levels. Allergy. 2009;64:1671–80.

    Article  CAS  Google Scholar 

  17. Warner JA, Frederick JM, Bryant TN, Weich C, Raw GJ, Hunter C, et al. Mechanical ventilation and high-efficiency vacuum cleaning: a combined strategy of mite and mite allergen reduction in the control of mite-sensitive asthma. J Allergy Clin Immunol. 2000;105:75–82.

    Article  CAS  Google Scholar 

  18. U.S. Environmental Protection Agency. Report to Congress on indoor air quality: volume 2. Washington, DC: U.S. Environmental Protection Agency; 1989.

  19. U.S. Department of Housing and Urban Development (HUD). Glossary of CPD terms - low income. Washington, D.C., U.S: U.S. Department of Housing and Urban Development; 2016.

  20. Sherman MH, Grimsrud DT. Measurement of infiltration using fan pressurization and weather data. Washington, D.C., U.S: Lawrence Berkeley National Laboratory; 1980.

  21. The Energy Conservatory. Minneapolis Blower Door System with DG-1000. Washington, D.C., U.S: The Energy Conservatory; 2015.

  22. Canadian General Standards Board. Determination of the airtightness of building envelopes by the fan depressurization method. Ottawa, CA: Canadian General Standards Board; 1986.

  23. Palmiter L, Bond T. Interaction of mechanical systems and natural infiltration. In: AIVC Conference On Air Movement and Ventilation Control Within Buildings; Ottawa, Canada; 1991.

  24. Shrestha PM, Humphrey JL, Barton KE, Carlton EJ, Adgate JL, Root ED, et al. Impact of low-income home energy-efficiency retrofits on building air tightness and healthy home indicators. Sustainability. 2019;11:2667–89.

  25. The National Institue for Occupational Safety and Health (NIOSH). Spirometry Training Program. Washington, D.C., U.S: The National Institue for Occupational Safety and Health; 2017.

  26. NDD Medical Technologies Inc. EasyOne Plus Spirometer. Andover, MA, USA: NDD Medical Technologies Inc; 2017.

  27. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.

    Article  CAS  Google Scholar 

  28. Eisen EA, Robins JM, Greaves IA, Wegman DH. Selection effects of repeatability criteria applied to lung spirometry. Am J Epidemiol 1984;120:734–42.

    Article  CAS  Google Scholar 

  29. Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J. 2012;40:1324–43.

    Article  Google Scholar 

  30. Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey Questionnaire, 2011–2012. Washington, D.C., U.S: Centers for Disease Control and Prevention; 2012.

  31. Eisner MD, Blanc PD, Omachi TA, Yelin EH, Sidney S, Katz PP, et al. Socioeconomic status, race and COPD health outcomes. J Epidemiol Community Health. 2011;65:26–34.

    Article  CAS  Google Scholar 

  32. Garrett MH, Hooper MA, Hooper BM, Abramson MJ. Respiratory symptoms in children and indoor exposure to nitrogen dioxide and gas stoves. Am J Respir Crit Care Med. 1998;158:891–5.

    Article  CAS  Google Scholar 

  33. Jenkins CR, Celli B, Anderson JA, Ferguson GT, Jones PW, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J. 2012;39:38–45.

    Article  CAS  Google Scholar 

  34. Carlsen HK, Modig L, Levinsson A, Kim JL, Toren K, Nyberg F, et al. Exposure to traffic and lung function in adults: a general population cohort study. BMJ Open. 2015;5:e007624.

    Article  Google Scholar 

  35. Zeger S, Kung-Yee L, Albert P. Models for longitudinal data: a generalized estimating equation approach. Biometrics. 1988;44:1049–60.

    Article  CAS  Google Scholar 

  36. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383:1581–92.

    Article  CAS  Google Scholar 

  37. Lewis SA, Weiss ST, Platts-Mills TAE, Burge H, Gold DR. The rold of indoor allergen sensitization and exposure in causing morbidity in women with asthma. Am J Respir Crit Care Med. 2002;165:961–6.

  38. Maçãira EdF, Algranti E, Stelmach R, Ribeiro M, Nunes MdPT, Mendonça EMC, et al. Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos. Jornal Brasileiro de. Pneumologia. 2005;31:477–85.

    Google Scholar 

  39. SAS Institute Inc. SAS Version 9.4. Cary, NC: SAS Institute Inc; 2014.

  40. Pellegrino R, Viegi G, Brusasco V, Crapo R, Burgos F, Casaburi R, et al. Interpretave strategies for lung function tests. Eur Respir J. 2005;26:948–68.

    Article  CAS  Google Scholar 

  41. Hegewald MJ, Crapo RO. Socioeconomic status and lung function. Chest. 2007;132:1608–14.

    Article  Google Scholar 

  42. Sherman MH, WIlson DJ, Kiel DE. Variability in residential air leakage. Measured air leakage of buildings. Washington, D.C., U.S: ASTM International; 1986.

Download references


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.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Shelly L. Miller.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


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


Quick links