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CO2 concentration in day care centres is related to wheezing in attending children

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Abstract

Poor ventilation at day care centres (DCCs) was already reported, although its effects on attending children are not clear. This study aimed to evaluate the association between wheezing in children and indoor CO2 (a ventilation surrogate marker) in DCC and to identify behaviours and building characteristics potentially related to CO2. In phase I, 45 DCCs from Lisbon and Oporto (Portugal) were selected through a proportional stratified random sampling. In phase II, 3 months later, 19 DCCs were further reassessed after cluster analysis for the greatest difference comparison. In both phases, children’s respiratory health was assessed by ISAAC-derived questionnaires. Indoor CO2 concentrations and building characteristics of the DCC were evaluated in both phases, using complementary methods. Mixed effect models were used to analyze the data. In phase I, which included 3,186 children (mean age 3.1 ± 1.5 years), indoor CO2 concentration in the DCC rooms was associated with reported wheezing in the past 12 months (27.5 %) (adjusted odds ratio (OR) for each increase of 200 ppm 1.04, 95 % CI 1:01 to 1:07). In phase II, the association in the subsample of 1,196 children seen in 19 out of the initial 45 DCCs was not significant (adjusted OR 1.02, 95 % CI 0.96 to 1.08). Indoor CO2 concentration was inversely associated with the practices of opening windows and internal doors and with higher wind velocity. A positive trend was observed between CO2 and prevalence of reported asthma (4.7 %). Conclusion: Improved ventilation is needed to achieve a healthier indoor environment in DCC.

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Abbreviations

CI:

Confidence interval

CO2 :

Carbon dioxide

DCC:

Day care centre

ENVIRH:

Environment and Health in children day care centres

IAQ:

Indoor air quality

OR:

Odds ratio

SD:

Standard deviation

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Acknowledgments

The authors would like to express their deepest gratitude to the parents and to the children as well as to the caregivers for their important contribution. The authors also thank the DCC staff and all the authorities involved in the study. We would especially like to thank architect Susana Azevedo (from Laboratório Nacional de Engenharia Civil) and Dr. Catarina Pedro (from Faculdade de Ciências Médicas).

Grant

Fundação para a Ciência e Tecnologia—ENVIRH Project PTDC/SAU-ESA/100275/2008 and PEst-OE/MAT/UI0006/2014.

Author information

Authors and Affiliations

  1. CEDOC, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal

    Pedro Carreiro-Martins, Iolanda Caires, José Araújo-Martins, João Gaspar-Marques, Paula Leiria-Pinto & Nuno Neuparth

  2. Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045, Lisbon, Portugal

    Pedro Carreiro-Martins, João Gaspar-Marques, Paula Leiria-Pinto & Nuno Neuparth

  3. Laboratório Nacional de Engenharia Civil, Avenida Brasil, 101, 1700-066, Lisbon, Portugal

    João Viegas

  4. Departamento de Bioestatística e Informática, CEAUL, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal

    Ana Luisa Papoila

  5. Epidemiology and Statistics Analysis Unit, Research Centre, Centro Hospitalar de Lisboa Central, EPE, Rua Jacinta Marto, 1169-045, Lisbon, Portugal

    Pedro Carreiro-Martins, Ana Luisa Papoila & Daniel Virella

  6. Faculdade de Ciências e Tecnologia (FCT), Universidade Nova de Lisboa, Campus da Caparica, 2829-516, Caparica, Portugal

    Daniel Aelenei

  7. Instituto Nacional de Saúde Dr. Ricardo Jorge, Avenida Padre Cruz, 1649-016, Lisbon, Portugal

    Maria Manuela Cano

  8. Instituto Nacional de Saúde Dr. Ricardo Jorge, Rua Alexandre Herculano, 321, 4000-055, Oporto, Portugal

    Ana Sofia Mendes

  9. Hospital da Luz, Avenida Lusíada, 100, 1500-650, Lisbon, Portugal

    José Rosado-Pinto

  10. INSERM, UMR S 707: EPAR, Paris, F-75012, France

    Isabella Annesi-Maesano

  11. Université Pierre et Marie Curie—UMR S 707: EPAR, Paris, F-75012, France

    Isabella Annesi-Maesano

Authors
  1. Pedro Carreiro-Martins
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  2. João Viegas
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  3. Ana Luisa Papoila
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  4. Daniel Aelenei
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  5. Iolanda Caires
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  6. José Araújo-Martins
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  7. João Gaspar-Marques
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  8. Maria Manuela Cano
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  9. Ana Sofia Mendes
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  10. Daniel Virella
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  11. José Rosado-Pinto
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  12. Paula Leiria-Pinto
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  13. Isabella Annesi-Maesano
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  14. Nuno Neuparth
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Corresponding author

Correspondence to Pedro Carreiro-Martins.

Additional information

Communicated by David Nadal

What is known–what is new:

Poor ventilation at day care centres (DCC) was already reported. The results of the present study suggest that poor ventilation in DCC could be related to wheezing in children. Even though natural actions could not be sufficient to provide ventilation and reduce CO2 to acceptable levels, the increment of natural ventilation through effective open window practices and adjusting the number of children in each classroom may be considered.

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Carreiro-Martins, P., Viegas, J., Papoila, A.L. et al. CO2 concentration in day care centres is related to wheezing in attending children. Eur J Pediatr 173, 1041–1049 (2014). https://doi.org/10.1007/s00431-014-2288-4

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  • DOI: https://doi.org/10.1007/s00431-014-2288-4

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