Randomized trial of a portable HEPA air cleaner intervention to reduce asthma morbidity among Latino children in an agricultural community

Environmental Health

Jennifer E. Krenz¹  Karen L. Jansen¹  Rebecca L. Drieling¹  Lisa R. Younglove¹  Maria I. Tchong French¹  Esther Min¹  Anne M. Riederer¹  Stephanie A. Farquhar²  Catherine J. Karr³  Syam S. Andra⁴  Anne E. Massey⁵  Paul D. Sampson⁶  Seunghee Kim-Schulze⁷  Elizabeth Torres⁸  Eugene Aisenberg⁹  Adriana Perez^1,10 

[1] Department of Environmental & Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, 98105, Seattle, WA, USA;Department of Environmental & Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, 98105, Seattle, WA, USA;Department of Health Services, University of Washington, Seattle, WA, USA;Department of Environmental & Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Suite 100, 98105, Seattle, WA, USA;Department of Pediatrics, University of Washington, Seattle, WA, USA;Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA;Department of Epidemiology, University of Washington, Seattle, WA, USA;Department of Statistics, University of Washington, Seattle, WA, USA;Human Immune Monitoring Center, Department of Oncological Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA;Northwest Communities Education Center, Radio KDNA, Granger, WA, USA;School of Social Work, University of Washington, Seattle, WA, USA;Yakima Valley Farm Workers Clinic, Toppenish, WA, USA;

关键词: Air pollution;    Childhood asthma;    HEPA air cleaner;    Randomized controlled trial;   

DOI  :  10.1186/s12940-021-00816-w

来源: Springer

【 摘 要 】

BackgroundData on pediatric asthma morbidity and effective environmental interventions in U.S. agricultural settings are few. We evaluated the effectiveness of HEPA air cleaners on asthma morbidity among a cohort of rural Latino children.MethodsSeventy-five children with poorly controlled asthma and living in non-smoking homes were randomly assigned to asthma education alone or along with HEPA air cleaners placed in their sleeping area and home living room. The Asthma Control Test (ACT) score, asthma symptoms in prior 2 weeks, unplanned clinical utilization, creatinine-adjusted urinary leukotriene E4 (uLTE4 [ng/mg]), and additional secondary outcomes were evaluated at baseline, six, and 12 months. Group differences were assessed using multivariable-adjusted generalized estimating equations. Incident rate ratios of ever experiencing the metrics of poorer asthma health during follow-up (suboptimal asthma management) were estimated using Poisson regression models in secondary analysis.ResultsMean child age was 9.2 and 8.6 years in intervention and control groups, respectively, and two-thirds of participants were male. Primary analysis of repeated measures of ACT score did not differ between groups (HEPA group mean change compared to controls 10% [95% CI: − 12-39%]). A suggestion of greater decrease in uLTE4 (ng/mg creatinine) was observed (− 10% [95% CI: − 20 -1%]). Secondary analysis showed children with HEPAs were less likely to have an ACT score meeting a clinically defined cutoff for poorly controlled asthma using repeated measures (IRR: 0.45 [95% CI: 0.21–0.97]). In Poisson models, intervention participants had reduced risk of ever meeting this cutoff (IRR: 0.43 [95% CI: 0.21–0.89]), ever having symptoms in the past 2 weeks (IRR: 0.71 [95% CI: 0.52–0.98]), and lower risk of any unplanned clinical utilization (IRR: 0.35 [95% CI: 0.13–0.94]) compared to control participants.DiscussionThe HAPI study showed generally improved outcomes among children in the HEPA air cleaner group. However, primary analyses did not meet statistical significance and many outcomes were subjective (self-report) in this unblinded study, so findings must be interpreted cautiously. HEPA air cleaners may provide additional benefit for child asthma health where traditional asthmagens (traffic, tobacco smoke) are not prominent factors, but larger studies with more statistical power and blinded designs are needed.Trial registrationClinicalTrials.gov Identifier: NCT04919915. Date of retrospective registration: May 19, 2021.

【 授权许可】

CC BY