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Apr 26, 2023 · Scope of the problem. Breathlessness is a subjective, distressing sensation of awareness of difficulty in breathing. Breathlessness is associated with high healthcare use, accounting for 5% of presentations to the emergency department (1, 2), approximately 4% of GP consultations (3) and reported by patients in 12% of medical admissions (4).
a chest infection. being overweight. smoking. a panic attack. But sometimes shortness of breath could be a sign of something more serious, such as: a lung condition called chronic obstructive pulmonary disease (COPD) scarring of the lungs known as idiopathic pulmonary fibrosis. heart failure. lung cancer.
- Ministerial foreword
- Key messages
- Who the guidance is for
- Introduction
- Health effects of damp and mould
- People at increased risk from damp and mould
- Legal standards on damp and mould in rented homes
- Identifying and addressing damp and mould in your property
Every person across this country deserves to live in a home that is safe, warm and dry.
The tragic death of 2-year-old Awaab Ishak in 2020, due to mould in his family home, should never happen to another family.
The Coroner’s report into Awaab’s death describes a catalogue of failures, and a housing provider that abdicated its responsibilities to his family and hid behind legal processes.
This guidance is a direct response to the Coroner’s report, and has been developed with a multidisciplinary group of experts in housing and health. Members of the government’s expert Committee on the Medical Effects of Air Pollutants were also consulted. It makes sure that social and private sector landlords have a thorough understanding of their legal responsibilities, and of the serious health risks that damp and mould pose.
Landlords must ensure that the accommodation they provide is free from serious hazards, including damp and mould, and that homes are fit for habitation. They must treat cases of damp and mould with the utmost seriousness and act promptly to protect their tenants’ health.
As this guidance also makes clear, tenants should not be blamed for damp and mould. Damp and mould in the home are not the result of ‘lifestyle choices’, and it is the responsibility of landlords to identify and address the underlying causes of the problem, such as structural issues or inadequate ventilation.
Health risks
Damp and mould primarily affect the airways and lungs, but they can also affect the eyes and skin. The respiratory effects of damp and mould can cause serious illness and, in the most severe cases, death (see ‘Health effects of damp and mould’). The tragic death of Awaab Ishak was the result of a severe respiratory condition due to prolonged exposure to mould in a home with inadequate ventilation. The presence of damp and mould can also affect tenants’ mental health. This could be due to worries about the health impacts of damp and mould, unpleasant living conditions, and destruction of property and belongings, among other concerns. Everyone is vulnerable to the health impacts of damp and mould, but people with certain health conditions, children and older adults are at greater risk of more severe health impacts (see ‘People at increased risk from damp and mould’).
Regulation on damp and mould in social and private rented properties
Private and social landlords must adhere to a number of regulations related to damp and mould (see ‘Legal standards on damp and mould in rented homes’). A lack of compliance can place a landlord at risk of prosecution or financial penalties. The legislation and standards are sometimes different for social and private rented landlords, but include: Housing Act 2004 Environmental Protection Act 1990 Homes (Fitness for Human Habitation) Act 2018 Landlord and Tenant Act 1985 Decent Homes Standard Minimum Level of Energy Efficiency standard Works to the heating and ventilation systems and replacement of windows are all controlled work. When undertaking controlled work, landlords must comply with the Building Regulations 2010.
Responding to reports of damp and mould
When responding to reports of damp and mould landlords should: respond sensitively and assess the issue with urgency to identify the severity of the damp and mould and potential risks to tenants always tackle the underlying issue promptly, and act with urgency when concerns have been raised about tenant health. Landlords should not delay action to await medical evidence or opinion - medical evidence is not a requirement for action ensure tenants are informed about the steps that will be taken to remove mould and address any underlying issues and the timeframes for the work prior to the removal of the mould, photograph and document the location of the mould, to help identify the source remove the mould, to address the health risk to tenants, using a qualified professional when appropriate identify and tackle the underlying causes of damp and mould, including building deficiencies, inadequate ventilation and condensation. Simply removing surface mould will not prevent the damp and mould from reappearing inspect the home at least 6 weeks after remedial work has been carried out, to ensure that the issue has been fixed and damp and mould have not reappeared. If damp and mould have reappeared, further investigation and intervention should be pursued See ‘Identifying and addressing damp and mould in your property’.
This guidance is primarily aimed at social and private rented housing providers in England and, where applicable, their workforce.
This guidance applies to all types of accommodation providers, including:
•social landlords registered with the Regulator of Social Housing (RSH)
•private landlords and managing agents
•temporary accommodation providers
•providers of asylum support accommodation
Everyone has the right to a warm, secure and decent home and to be treated with dignity and fairness. Yet many people in England are living in a home with damp and mould, which may put their health at risk. Estimates of the number of homes in England with damp and mould range from 4% to 27% of homes, or 962,000 to 6.5 million households.[footnote 1] [footnote 2] The reported figure varies due to differences in how damp and mould is measured and how it is reported. People living in private or social rented housing are more likely to live in a home with damp and mould than are owner occupiers.[footnote 1] [footnote 2]
In December 2020, 2-year-old Awaab Ishak died from a severe respiratory infection caused by prolonged exposure to damp and mould in his home. This guidance has been produced in response to concerns raised by the Coroner following an inquest into Awaab’s death. In particular, it addresses the concern that ‘there was no evidence that up-to-date relevant health information pertaining to the risks of damp and mould was easily accessible to the housing sector’.
This guidance highlights the serious risks that damp and mould can pose to tenants’ health, the imperative to respond quickly, and the practical steps that should be taken both to address damp and mould and prevent them.
More specifically, the guidance:
•provides an overview of the potential physical and mental health effects of living in a home with damp and mould
•summarises the groups that are particularly vulnerable to more severe health impacts
Damp and mould within the home can produce allergens, irritants, mould spores and other toxins that are harmful to health.[footnote 3] Even if visible mould is not present, dampness alone can increase the risk of health problems. Excessive moisture can promote the growth of microorganisms such as mould and other fungi, certain species of house dust mites, bacteria or viruses.[footnote 4] The more serious the damp and mould problem and the longer it is left untreated, the worse the health impacts and risks are likely to be.
Most people come into contact with the substances produced by damp and mould by breathing them in. This means they predominantly affect the airways and lungs.[footnote 5] [footnote 6] [footnote 7] [footnote 8] [footnote 9] [footnote 10] [footnote 11] [footnote 12]
Damp and mould can cause disease and ill health in anyone, but people with underlying health conditions, weakened immune systems, and some other groups of people are at greater risk of ill-health from damp and mould (see ‘People at increased risk from damp and mould’).
During the inquest into the death of Awaab Ishak, the Coroner concluded that Awaab’s death was a result of a severe respiratory condition due to prolonged exposure to mould. Awaab’s death highlights just how crucial it is for landlords to understand the health risks of damp and mould and respond with urgency when cases are reported.
Certain individuals may be at increased risk of the health impacts of damp and mould exposure. This could be due to health-related or age-related vulnerabilities, or because they are less able to report and act on guidance related to damp and mould, or simply because they are more likely to live in a home with damp and mould.
Legal standards for housing providers
There are 5 main legal standards that relate to damp and mould in rented homes. All homes must be free from hazards at the most dangerous ‘category 1’ level The Housing Act 2004 states that properties must be free from hazards at the most dangerous ‘category 1’ level, as assessed using the Housing Health and Safety Rating System (HHSRS), a risk-based evaluation tool. This includes mould and all types of dampness. See below ‘Understanding damp and mould’. Generally, a ‘category 1’ hazard means that an occupier of or visitor to the property may require some form of medical attention over the course of a year. Local councils also have a power to take action when they identify hazards at the ‘category 2’ level. All homes must not contain conditions that are prejudicial to health The Environmental Protection Act 1990 gives tenants and local councils powers to take legal action where homes contain a ‘statutory nuisance’, which includes where they are in such a state as to be prejudicial to health. To be a statutory nuisance, the damp and mould must be harmful to the health of the tenant or a nuisance. Homes must be fit to live in New provisions in the Landlord and Tenant Act 1985 added by the Homes (Fitness for Human Habitation) Act 2018 require that properties are free of hazards, including damp and mould, which are so serious that the dwelling is not reasonably suitable for occupation in that condition. The current occupier may be taken into consideration when determining whether the property is suitable. A home that is fit for human habitation is safe and healthy, which would mean free from damp and mould that could cause significant harm. Tenants may wish to take action if their property is unfit for human habitation or the landlord has failed to keep it in repair, under defined circumstances, under Section 9A and Section 11 of the Landlord and Tenant Act 1985. While there is currently no legal requirement to undertake remedial work within a specific period of time, landlords should nonetheless respond to complaints about repairs promptly. Social housing specifically must meet the Decent Homes Standard (DHS) To meet the Decent Homes Standard, social housing must be free from dangerous ‘category 1’ hazards. But the DHS also states that social housing must be in a reasonable state of repair and provide a reasonable degree of thermal comfort. Either disrepair or inadequate thermal comfort, or both, may result in damp and mould. Where the Regulator of Social Housing (RSH) determines a provider has breached standards, it has a range of legal powers it can use, including enforcement powers. We will legislate to introduce a Decent Homes Standard in the private rented sector at the earliest opportunity. Privately rented homes must meet minimum energy efficiency standards The Energy Efficiency (Private Rented Property) (England and Wales) Regulations 2015 require that privately rented homes must meet the Minimum Level of Energy Efficiency standard of Energy Performance Certificate (EPC) band E (unless exempt). The regulations do not make reference to damp and mould, but an energy efficient property is less likely to be affected by condensation, one cause of damp and mould, provided it is adequately ventilated.[footnote 2] [footnote 50] The government has committed to consult on the energy efficiency of social housing.
Complying with the standards
As a first step, landlords of all types of tenure must ensure that their homes have all the measures in place to ensure that damp and mould have been minimised. Landlords should regularly inspect their properties, remedy deficiencies promptly and ensure that they have a regular programme of maintenance and management. Landlords have a right to enter their properties, with reasonable notice, but only in specific circumstances which may include: to inspect the conditions of the premises to perform repairs access to provide services If a tenant reports damp and mould, landlords should establish the source of the damp, whether there is any defect to the property that is causing it, and then carry out the appropriate remedial work. While there is currently no specific timeframe within which remedial work to address damp and mould must be undertaken, landlords should always respond promptly and address this issue as a matter of urgency when there is significant damp and mould and/or when there is a significant concern for tenant health. See ‘Identifying and addressing damp and mould in your property’ and ‘Reducing the risk of damp and mould developing’ for further guidance. If all possible remedial action has been taken, landlords may be able to appeal or defend formal action taken under the legislation set out above, even if damp and mould persists. Note: works to the heating and ventilation systems and replacement of windows are all controlled work. When undertaking controlled work, there is a legal duty to comply with the Building Regulations. If the work requires approval but landlords would rather not apply themselves, they can hire a tradesperson registered with a competent person scheme instead. Landlords or agents undertaking any work to remedy damp and mould should check the guidance on Building Regulations Approval. Landlords or agents may also wish to speak to their local council building control department.
Enforcing the standards
Local councils enforce standards in the private rented sector and social housing owned by housing associations and other private registered providers. They have a duty to take enforcement action under the Housing Act 2004 if they identify category 1 damp and mould hazards and have the power to take action for category 2 hazards. They can also take action under the Environmental Protection Act 1990 if they identify damp and mould that is a statutory nuisance. Within many local councils, Environmental Health Practitioners will play an important role in the identification of hazards and supporting enforcement of standards. The Regulator of Social Housing (RSH) enforces the Decent Homes Standard in the social rented sector. In addition, the Housing Ombudsman can investigate and determine individual complaints from residents against their landlord which cannot be resolved locally. Tenants can take their own action under the Landlord and Tenant Act 1985. Guidance for tenants on the amendments to the Homes (Fitness for Human Habitation) 2018 Act made to the Landlord and Tenant Act 1985 explains their rights and how to represent themselves. Local councils and other agencies may also help tenants through the process. Tenants can also take action under the Environmental Protection Act 1990 if they consider that a ‘statutory nuisance’ that is prejudicial to health is present. Legal aid is available for tenants who are eligible. See below for the specific regulation, how it is enforced and links to any relevant guidance.
This guidance provides an overview of what landlords should consider when addressing reports of damp and mould. This section provides some examples of best practice which will help reduce the health risks to the tenants and potential damage to the property, as well as supporting landlords to demonstrate to the relevant regulators that they are seek...
Managing Author: Respiratory and Home Oxygen Services, Oxford Health NHS Foundation Trust. Please send any questions or comments about this leaflet to: Respiratory and Home Oxygen Service 63 Blackbird Leys Rd Oxford. OX4 6HJ Tel: 01865 904418 If you would like to have information translated into a different language, please contact the Equality ...
What is a BPD? BPD most commonly known as DB refers to a group of breathing disorders where there is an alteration in the normal patterns of breathing that can result in intermittent or chronic (long-term) respiratory and non-respiratory symptoms. Breathing should change, based on what we challenge ourselves with: for example, exercising.
Sep 19, 2017 · There are risks associated with having dysphagia including, aspiration (food going down into your lungs), choking, poor nutrition and reduced quality of life. It is common for individuals with breathing difficulties to have problems eating and drinking. 27% of people who suffer from COPD (Chronic Obstructive Pulmonary Disease) have a dysphagia ...
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breathing does not suddenly ‘increase in size’, for example through sighing, yawning or coughing. During breathing control you may find that you feel ‘hungry’ for air. This sensation is perfectly normal and may be a result of the levels of carbon dioxide increasing to a more normal level. Try to ‘swallow away’ the urge to gasp for air.
