A Randomized Trial of Air Cleaners and a Health Coach to Improve Indoor Air Quality for Inner-City Children With Asthma and Secondhand Smoke Exposure

Butz, Arlene; Matsui, Elizabeth C.; Breysse, Patrick N.; Curtin-Brosnan, Jean; Eggleston, Peyton A.; Diette, Gregory B.; Williams, D'Ann; Yuan, Jie; Bernert, John T.; Rańd, Cynthia S.

doi:10.1001/archpediatrics.2011.111

Cited by 142 publications

(179 citation statements)

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“…However, our findings are likely independent of SHS exposure, and there are other important modifiable sources of indoor PM and NO 2 (20,40). Future studies investigating the effectiveness of environmental interventions aimed at reducing indoor pollutant concentrations in homes of patients with COPD, such air cleaner intervention trials that have shown reduction in indoor PM and improved symptoms in asthma (10), are warranted as potential nonpharmacologic approaches to improving COPD health. They may represent more cost-effective and novel therapeutic arenas for a disease with limited treatment options.…”

Section: Discussionmentioning

confidence: 74%

“…feasible interventions, such as the placement of high-efficiency particulate air cleaners (10), could be used to improve in-home air quality.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

“…NO 2 was measured using a passive sampler (Ogawa badge) (21) and the limit of detection was 0.52 ppb. Secondhand smoke (SHS) exposure was assessed by air nicotine at baseline and hair nicotine at all visits (10,22), with a limit of detection of 0.02 mg/m 3 and 0.025 ng/mg, respectively. Any sample with detectable nicotine was considered evidence of SHS exposure.…”

Section: Air Quality Assessmentmentioning

confidence: 99%

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In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

Hansel¹,

McCormack²,

Belli³

et al. 2013

Am J Respir Crit Care Med

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Rationale: The effect of indoor air pollutants on respiratory morbidity among patients with chronic obstructive pulmonary disease (COPD) in developed countries is uncertain. Objectives: The first longitudinal study to investigate the independent effects of indoor particulate matter (PM) and nitrogen dioxide (NO 2 ) concentrations on COPD morbidity in a periurban community. Methods: Former smokers with COPD were recruited and indoor air was monitored over a 1-week period in the participant's bedroom and main living area at baseline, 3 months, and 6 months. At each visit, participants completed spirometry and questionnaires assessing respiratory symptoms. Exacerbations were assessed by questionnaires administered at clinic visits and monthly telephone calls. Measurements and Main Results: Participants (n ¼ 84) had moderate or severe COPD with a mean FEV 1 of 48.6% predicted. The mean (6 SD) indoor PM 2.5 and NO 2 concentrations were 11.4 6 13.3 µg/m 3 and 10.8 6 10.6 ppb in the bedroom, and 12.2 6 12.2 µg/m 3 and 12.2 6 11.8 ppb in the main living area. Increases in PM 2.5 concentrations in the main living area were associated with increases in respiratory symptoms, rescue medication use, and risk of severe COPD exacerbations. Increases in NO 2 concentrations in the main living area were independently associated with worse dyspnea. Increases in bedroom NO 2 concentrations were associated with increases in nocturnal symptoms and risk of severe COPD exacerbations. Conclusions: Indoor pollutant exposure, including PM 2.5 and NO 2 , was associated with increased respiratory symptoms and risk of COPD exacerbation. Future investigations should include intervention studies that optimize indoor air quality as a novel therapeutic approach to improving COPD health outcomes.Keywords: indoor air; chronic obstructive pulmonary disease; particulate matter; nitrogen dioxide; exacerbations Chronic obstructive pulmonary disease (COPD), the third leading cause of death in the United States and the fifth leading cause worldwide, is expected to become increasingly prevalent in upcoming decades (1, 2). Most COPD is caused by environmental exposures; in developed countries, this exposure is primarily cigarette smoke. After COPD begins, evidence indicates that it can be worsened by other environmental exposures. For example, outdoor particulate matter (PM) concentrations have been associated with an increase in COPD hospitalizations and mortality (3, 4). Similarly, outdoor nitrogen dioxide (NO 2 ) exposure has been linked to worse COPD morbidity, including higher rates of exacerbations (4-6).Although substantial evidence shows that outdoor air pollutants impact COPD, there is much less evidence for the impact of indoor air on COPD, especially in developed countries. Although the Global Initiative for Chronic Obstructive Lung Disease guidelines identify indoor air pollution resulting from burning wood and other biomass fuels as a major risk factor for COPD (7), exposures under these conditions are two to three orders of magnitude higher ...

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Section: Discussionmentioning

confidence: 74%

“…feasible interventions, such as the placement of high-efficiency particulate air cleaners (10), could be used to improve in-home air quality.…”

Section: What This Study Adds To the Fieldmentioning

confidence: 99%

Section: Air Quality Assessmentmentioning

confidence: 99%

See 1 more Smart Citation

In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

Hansel¹,

McCormack²,

Belli³

et al. 2013

Am J Respir Crit Care Med

View full text Add to dashboard Cite

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“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] The trials were published between 1994 and 2013. A flowchart describing the identification process is presented in Fig 1. Study characteristics of included trials are presented in Tables 1 and 2. …”

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confidence: 99%

“…21,22,25,27,33,34,84,85,[87][88][89][90]93,97 Biomarkers Of the 13 studies presenting biomarker information at follow-up, 9 presented urinary cotinine or urinary CCR 20,[23][24][25][31][32][33]93,96 ; 2 presented salivary cotinine 22,26 ; 1 presented serum cotinine 27 ; and 1 presented hair nicotine and cotinine. 21 …”

mentioning

confidence: 99%

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Rosen¹,

Myers²,

Hovell

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P , .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD 20.05, CI 20.13 to 0.03, P = .20).CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement. KEY WORDS secondhand smoke exposure, tobacco smoke exposure, metaanalysis, systematic review, child ABBREVIATIONS CCR-cotinine/creatinine ratio CI-confidence interval CT-controlled trial PREP-parentally reported exposure or protection RCT-randomized controlled trial RD-relative difference RR-relative risk SHS-secondhand smoke THS-thirdhand smoke TSE-tobacco smoke exposure Dr Rosen conceptualized and designed the study, oversaw all aspects of the research, performed the systematic review of the literature, extracted data from the original studies, contributed to the statistical analysis, wrote sections of the manuscript, and edited the entire manuscript; Ms Myers contributed to systematically reviewing the literature, extracted data from the original articles, contributed to the data analysis, and contributed to the writing of the manuscript; Dr Hovell contributed to the design of the meta-analysis and interpretation of the data and edited the manuscript for scientific content; Dr Zucker assisted with various statistical issues in the analysis of the manuscript and edited the manuscript; Ms Ben Noach contributed to the design of the study, the systematic review of the literature, data extraction, data analysis, data interpretation, and writing of the m...

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Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations

Pollack,

Roberts,

Peng

et al. 2023

JAMA

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ImportanceStructural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact.ObjectiveTo examine whether participation in a housing mobility program that provided housing vouchers and assistance moving to low-poverty neighborhoods was associated with reduced asthma morbidity among children and to explore potential mediating factors.Design, Setting, and ParticipantsCohort study of 123 children aged 5 to 17 years with persistent asthma whose families participated in the Baltimore Regional Housing Partnership housing mobility program from 2016 to 2020. Children were matched to 115 children enrolled in the Urban Environment and Childhood Asthma (URECA) birth cohort using propensity scores.ExposureMoving to a low-poverty neighborhood.Main OutcomesCaregiver-reported asthma exacerbations and symptoms.ResultsAmong 123 children enrolled in the program, median age was 8.4 years, 58 (47.2%) were female, and 120 (97.6%) were Black. Prior to moving, 89 of 110 children (81%) lived in a high-poverty census tract (&gt;20% of families below the poverty line); after moving, only 1 of 106 children with after-move data (0.9%) lived in a high-poverty tract. Among this cohort, 15.1% (SD, 35.8) had at least 1 exacerbation per 3-month period prior to moving vs 8.5% (SD, 28.0) after moving, an adjusted difference of −6.8 percentage points (95% CI, −11.9% to −1.7%; P = .009). Maximum symptom days in the past 2 weeks were 5.1 (SD, 5.0) before moving and 2.7 (SD, 3.8) after moving, an adjusted difference of −2.37 days (95% CI, −3.14 to −1.59; P &lt; .001). Results remained significant in propensity score–matched analyses with URECA data. Measures of stress, including social cohesion, neighborhood safety, and urban stress, all improved with moving and were estimated to mediate between 29% and 35% of the association between moving and asthma exacerbations.Conclusions and RelevanceChildren with asthma whose families participated in a program that helped them move into low-poverty neighborhoods experienced significant improvements in asthma symptom days and exacerbations. This study adds to the limited evidence suggesting that programs to counter housing discrimination can reduce childhood asthma morbidity.

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A Randomized Trial of Air Cleaners and a Health Coach to Improve Indoor Air Quality for Inner-City Children With Asthma and Secondhand Smoke Exposure

Cited by 142 publications

References 52 publications

In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

In-Home Air Pollution Is Linked to Respiratory Morbidity in Former Smokers with Chronic Obstructive Pulmonary Disease

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Association of a Housing Mobility Program With Childhood Asthma Symptoms and Exacerbations

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