A touch-screen display that controls all of the energy-related functions in the "Effizienzhaus Plus“ energy-efficient house hangs on a wall on December 7, 2011 in Berlin, Germany.

(Sean Gallup/Getty Images)

The first winter after Danielle Smith bought her house in North Baltimore, the 35-year-old schoolteacher wondered if it even had a furnace, it was so cold and drafty.

Now, with almost all new windows and several other energy-efficiency retrofits, Smith said, her four-bedroom single-story home in the mid-Govans neighborhood is cozier, less costly to heat -- and apparently healthier for her 8-year-old son, Akil.

"You can feel the difference," she said, as her son played on the carpeted living room floor at her feet. She can see the difference as well. Her utility bills are more than $100 a month lower this time of year, she explained, and the last time Akil had an asthma attack that sent him to the emergency room was sometime in 2011.

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The cost savings and health benefits that Smith has experienced are byproducts of a "green and healthy homes" initiative for low- and moderate-income property owners in Baltimore and 15 other cities around the country.

Directed by the Baltimore-based Coalition to End Childhood Lead Poisoning, the program uses federal and state funding, and grants from local and national foundations, to help homeowners of limited means upgrade residences in ways that not only cut energy expenses but create healthier places to live. Each affects the other, said Ruth Ann Norton, the coalition's executive director.

"If you're paying three times what you should in energy costs, you're less likely to fix the water leak," she said. At the same time, she added, "You can't do a proper weatherization of a home if it has lead or mold hazards."

The effort has targeted homes where children suffer from asthma and other respiratory problems.Asthma is the most common chronic health disorder in childhood, affecting about 6.2 million children, or 1 in 12, with inner-city youths particularly afflicted, according to the National Institutes of Health.

Though the condition runs in families, research has shown that the environment also plays a role.Housing conditions have a lot to do with asthma, according to Dr. Donald K. Milton, director of the Maryland Institute for Environmental Health at College Park. Studies show that dust mites, cockroaches, dogs and cats, rodents, molds and fungi often found in homes can trigger allergies and respiratory attacks.

"With water leaks, with plumbing leaks, water accumulation can certainly result in mold indoors," Milton said.

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In homes with such conditions, weatherization can actually worsen health and safety issues, he and other experts say.

"It's a double-edged sword," said Dr. Nathan Rabinovich, an asthma specialist at the National Jewish Health Center in Denver, Colo. While energy-efficiency retrofits might succeed in keeping a home's heat inside, he said, they can also trap the mold, smoke or pet dander that can trigger or aggravate asthma attacks.

To get around that dilemma, the coalition's initiative takes a more holistic approach, offering help with weatherization and health and safety at the same time. Upgrades include adding insulation, wrapping water heaters and pipes, and sealing cracks and crevices to make houses "tighter" and prevent heat loss. But they also include replacing hazardous lead-painted windows, fixing leaky roofs and helping homeowners deal with pest infestations and other maintenance issues that may contribute to respiratory problems.

The initiative recently launched a pilot project to quantify the benefits of its work, partnering with a Boston-based software company, WegoWise, which crunches utility data to analyze buildings' energy performance.

Drawing on 24 months' worth of utility bills from 31 single-family homes in the Baltimore area, WegoWise figures the effort has saved low-income owners $400 a year on average.

After homes were upgraded and maintenance guidance was provided to owners, families in the program also saw an average 67 percent reduction in visits to the emergency room for treatment of asthma attacks, the coalition reported.

By compiling data on cost savings, Norton hopes to convince government and charities to expand funding for such efforts to even more cities.

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Upgrades provided under the program cost from $3,000 to $6,000, she said, but the health savings alone were greater than that. Emergency-room visits typically cost more than $6,000, she said, while hospitalization averaged $53,000 a year for children suffering multiple attacks in a year. Those costs were largely borne by the government through medical assistance for the poor, but families still paid a price, she said, including lost time from work to look after a sick child.

For program participants, the energy and health upgrades are a "triple win," Norton said.

"You lower energy costs because you're lowering consumption," she explained. "You are lowering the incidence of asthma, lead poisoning and trip-and-fall injuries and the related costs." Finally, she said the effort is "making that house more affordable so people are more likely to stay in the home, and that leads to greater neighborhood stabilization."

In Smith's home, replacing most of the windows not only helped her save money on heat but improved ventilation and health, because the old wooden windows in her 1920s-era home had lead paint on them and were painted shut when she bought the place eight years ago. She couldn't afford to replace them all at once, so she had planned to swap out two at a time.

She said the inability to open windows in warm weather made the house hotter, and might have aggravated her son's asthma. When they first lived there, she recalled, he had severe wheezing episodes about every six months, including one that required a hospital stay.

Smith said she found the lead coalition's Green and Healthy Home Initiative while searching for help on the Internet. Besides replacing her windows, the program repainted a lead-painted porch and helped her identify a roof leak that was causing water damage inside the house. The staff also assessed her home for potentially unhealthy conditions and gave her and other program participants tips on what they might do in terms of housekeeping and minor fixes to minimize those hazards.

The home still could use more insulation and leak-plugging, she said, and then she might be able to do away with the portable space heater that's still being used. But her heating bills have dropped from more than $300 a month to less than $200, she said, and her son's condition, though still a problem -- he broke out in hives during a recent holiday visit to a household with a dog -- is more "manageable" now.

"I feel really blessed," she concluded.

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