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Singh-Smith K, Sprague Martinez L, Eliasziw M, Lerman Ginzburg S, Hudda N, Betz GM, Gurcan A, Vazquez-Dodero T, Mertl A, Goldstein-Gelb W, Zamore W, Brugge D. Reaction to at-home air purifiers installed to reduce traffic-related air pollution in near-highway residences. Trials 2024; 25:551. [PMID: 39160612 PMCID: PMC11331753 DOI: 10.1186/s13063-024-08388-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/07/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND AND AIM Traffic-related ultrafine particle pollution near highways is associated with adverse health. Reducing exposure by use of portable air purifiers in homes is one approach to reducing this risk. However, the reaction of residents to having air purifiers in homes is not well studied. METHODS Within the framework of our randomized crossover trial of air purifiers in homes near a major highway, we collected data about participants' use and reactions to air purifiers using questionnaires at their 30-day and 90-day home visits, recorded electricity consumption using HOBO monitors, and conducted structured interviews with participants. RESULTS Nearly all 150 participants reported running the air purifiers virtually 24 h every day in both their living room and their bedroom in the prior month. The units' HOBO electricity use, from a subset of 45 participants, supported the participants' responses from the questionnaire. Approximately 80% of participants reported setting their air purifier on the medium setting. Tolerance to air purifier noise increased significantly between the 30-day and 90-day home visits, with approximately two thirds reporting not being bothered at all by the noise. The qualitative interviews in a subset of 26 participants yielded consistent responses to those from the questionnaires. Size of unit, airflow, and energy consumption were additional concerns that emerged during the interviews. CONCLUSIONS Results from the questionnaires, HOBO data, and structured interviews all suggest participants had positive reactions towards the presence of in-home APs, and therefore may be receptive to using air purifiers in their homes on a regular basis. TRIAL REGISTRATION ClinicalTrials.gov, NCT04279249 . Registered 09 October 2019.
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Affiliation(s)
- K Singh-Smith
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - L Sprague Martinez
- Health Disparities Institute UConn Health, 241 Main Street, Hartford, CT, 06106, USA
| | - M Eliasziw
- Department of Public Health and Community Medicine, Tufts University, 136 Harrison Ave, Boston, MA, 02111, USA
| | - S Lerman Ginzburg
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
- Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Ave, Boston, MA, 02115, USA
| | - N Hudda
- Department of Civil and Environmental Engineering, Tufts University, 200 College Avenue, Medford, MA, 02155, USA
| | - G M Betz
- Health Disparities Institute UConn Health, 241 Main Street, Hartford, CT, 06106, USA
| | - A Gurcan
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - T Vazquez-Dodero
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | - A Mertl
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
| | | | - W Zamore
- Somerville Transportation Equity Partnership, 51 Mount Vernon St, Somerville, MA, 02145, USA
| | - D Brugge
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA
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2
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Kouis P, Galanakis E, Michaelidou E, Kinni P, Michanikou A, Pitsios C, Perez J, Achilleos S, Middleton N, Anagnostopoulou P, Dimitriou H, Revvas E, Stamatelatos G, Zacharatos H, Savvides C, Vasiliadou E, Kalivitis N, Chrysanthou A, Tymvios F, Papatheodorou SI, Koutrakis P, Yiallouros PK. Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial. Thorax 2024; 79:495-507. [PMID: 38388489 DOI: 10.1136/thorax-2023-220877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma. OBJECTIVE The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece. DESIGN, PARTICIPANTS, INTERVENTIONS AND SETTING Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children's homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO). RESULTS In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls. CONCLUSION Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma. TRIAL REGISTRATION NUMBER NCT03503812.
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Affiliation(s)
- Panayiotis Kouis
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | | | - Paraskevi Kinni
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Antonis Michanikou
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Constantinos Pitsios
- Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
| | | | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Nicos Middleton
- Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | | | | | | | | | - Chrysanthos Savvides
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
| | - Emily Vasiliadou
- Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
| | - Nikos Kalivitis
- Department of Chemistry, University of Crete, Heraklion, Greece
| | - Andreas Chrysanthou
- Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Nicosia, Cyprus
| | - Filippos Tymvios
- Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Heraklion, Cyprus
| | - Stefania I Papatheodorou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
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3
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Ebrahimifakhar A, Poursadegh M, Hu Y, Yuill DP, Luo Y. A systematic review and meta-analysis of field studies of portable air cleaners: Performance, user behavior, and by-product emissions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:168786. [PMID: 38008326 DOI: 10.1016/j.scitotenv.2023.168786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Indoor air quality is important for the health of building occupants, and public interest in controlling indoor airborne pathogens increased dramatically with the COVID-19 pandemic. Pollutant concentrations can be controlled locally using portable air cleaners (sometimes called air purifiers), which allow occupants to apply air cleaning technology to meet their needs in the location and times that they find appropriate. This paper provides a systematic review of scientific literature that describes field studies of the effectiveness of portable air cleaners. Over 500 papers were considered, and 148 were reviewed in detail, to extract 35 specific research results (e.g., particulate removal performance) or characteristics (e.g., type of building). These were aggregated to provide an overview of results and approaches to this type of research, and to provide meta-analyses of the results. The review includes: descriptions of the geographical location of the research; rate of publications over time; types of buildings and occupants in the field study; types of air cleaner technology being tested; pollutants being measured; resulting pollutant removal effectiveness; patterns of usage and potential barriers to usage by occupants; and the potential for by-product emissions in some air cleaner technologies. An example result is that 83 of the 148 papers measured reductions in fine particulates (PM2.5) and found a mean reduction of 49 % with standard deviation of 20 %. The aggregated results were approximately normally distributed, ranging from finding no significant reduction up to a maximum above 90 % reduction. Sixteen of the 148 papers considered gaseous pollutants, such as volatile organic compounds, nitrogen dioxide, and ozone; 36 papers considered biological pollutants, such as bacteria, viruses, pollen, fungi, etc. An important challenge, common to several studies, is that occupants run the air cleaners for shorter periods and on low airflow rate settings, because of concerns about noise, drafts, and electricity cost, which significantly reduces air cleaning effectiveness.
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Affiliation(s)
- Amir Ebrahimifakhar
- Delos Labs, Delos, New York, NY 10014, USA; Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Mehrdad Poursadegh
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yifeng Hu
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA; Buildings and Transportation Science Division, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA.
| | - David P Yuill
- Durham School of Architectural Engineering and Construction, University of Nebraska - Lincoln, 1110 S. 67th Street, Omaha, NE 68182, USA.
| | - Yu Luo
- Department of Applied Physics and Applied Mathematics, Columbia University, 500 W. 120th Street, New York, NY 10027, USA.
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4
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Adibi A, Barn P, Shellington EM, Harvard S, Johnson KM, Carlsten C. High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study. Am J Respir Crit Care Med 2024; 209:175-184. [PMID: 37917367 DOI: 10.1164/rccm.202307-1205oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023] Open
Abstract
Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 μm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.
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Affiliation(s)
- Amin Adibi
- Climate Change Health Effects, Adaptation, and ResiLience Research Cluster
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, and
| | - Prabjit Barn
- Fraser Health Authority, Surrey, British Columbia, Canada; and
| | - Erin M Shellington
- Climate Change Health Effects, Adaptation, and ResiLience Research Cluster
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Legacy for Airway Health and
| | - Stephanie Harvard
- Climate Change Health Effects, Adaptation, and ResiLience Research Cluster
- Legacy for Airway Health and
| | - Kate M Johnson
- Climate Change Health Effects, Adaptation, and ResiLience Research Cluster
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, and
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Legacy for Airway Health and
| | - Christopher Carlsten
- Climate Change Health Effects, Adaptation, and ResiLience Research Cluster
- Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Legacy for Airway Health and
- Air Pollution Exposure Lab, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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5
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Simoneau T, Gaffin JM. Socioeconomic determinants of asthma health. Curr Opin Pediatr 2023; 35:337-343. [PMID: 36861771 PMCID: PMC10160003 DOI: 10.1097/mop.0000000000001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism. RECENT FINDINGS Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community - via telehealth, school-based health centers, or peer mentors - are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist 'redlining' policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes. SUMMARY Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.
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Affiliation(s)
- Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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6
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Holder AL, Halliday HS, Virtaranta L. Impact of do-it-yourself air cleaner design on the reduction of simulated wildfire smoke in a controlled chamber environment. INDOOR AIR 2022; 32:e13163. [PMID: 36437679 PMCID: PMC9828579 DOI: 10.1111/ina.13163] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
During wildfire smoke events public health agencies release advisories to stay indoors, close doors and windows, and operate a portable air cleaner (PAC). The do-it-yourself (DIY) air cleaner consisting of a box fan and a furnace filter is a widely used low-cost alternative to commercial PACs because of its increased accessibility. In this study, we evaluate the clean air delivery rate (CADR) of different DIY air cleaner designs for reducing simulated wildfire smoke and identify operating parameters that may impact their performance and use. The simplest formulation of a DIY air cleaner (box fan with taped on minimum effectiveness reporting value - [MERV] 13 furnace filter) had a CADR of 111.2 ± 1.3 ft3 /min (CFM). Increasing the fan flow by changing the fan type, increasing the fan setting, or reducing the pressure drop across the filtering surface increased the CADR. Large increases in CADR could be obtained by using a shroud (40%), using a 4″ thick filter (123%) using two filters in a wedge shape (137%), or using four filters in a Corsi-Rosenthal (CR) box design (261%). The CADR was greatly reduced with filters heavily loaded with smoke, pointing to the need for frequent filter changes during smoke events.
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Affiliation(s)
- Amara L. Holder
- Office of Research and DevelopmentU.S. Environmental Protection AgencyResearch Triangle ParkNorth CarolinaUSA
| | - Hannah S. Halliday
- Office of Research and DevelopmentU.S. Environmental Protection AgencyResearch Triangle ParkNorth CarolinaUSA
| | - Larry Virtaranta
- Jacobs Technology InternationalResearch Triangle ParkNorth CarolinaUSA
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7
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Lorizio W, Woo H, McCormack MC, Liu C, Putcha N, Wood M, Green T, Kaviany P, Belz D, Fawzy A, Carson S, Eakin MN, Koehler K, Hansel NN. Patterns and Predictors of Air Cleaner Adherence Among Adults with COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:366-376. [PMID: 35731929 PMCID: PMC9448002 DOI: 10.15326/jcopdf.2022.0309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
Rational Poor indoor air quality has been associated with worse chronic obstructive pulmonary disease (COPD) morbidity. In-home portable air cleaners reduce indoor pollutants and could improve respiratory health. Factors associated with air cleaner adherence among adults with COPD remains unknown. Methods In a 6-month trial of former smokers with COPD, participants (n=116) received active or sham portable air cleaners. Air cleaner adherence was measured by electronic monitors. Potential baseline predictors of adherence included individual factors (demographics, socioeconomic status, smoking history, psychological well-being), COPD disease severity, and housing characteristics. Time and season were also considered. Stepwise logistic regression and longitudinal fixed effect analysis were performed to assess independent predictors of adherence. Results A total of 109 participants had an objective measure of adherence, and 76.1% used at least 1 air cleaner 80% of the time (defined a priori as adherent). Higher annual household income ≥$35,000 (odds ratio [OR]=4.4, 95% confidence interval [CI], 1.1-18.0) and use of heat pump/electricity (versus gas) for heating (OR=6.1, 95%CI, 1.7-22.4) were associated with higher odds of adherence. Further, poor quality of life (St George's Respiratory Questionnaire, per 10-point increase) and prior year exacerbations were associated with lower odds of adherence (OR=0.65, 95%CI, 0.4-1.0) and (OR=0.26, 95%CI, 0.1-0.9), respectively. Adherence was highest during the first month and lower during winter compared to other seasons. Conclusion These findings suggest that cold weather season, use of gas for home heating, and lower annual income negatively impact adherence. Poor quality of life and worse disease control may also decrease adherence. Addressing factors associated with air cleaner adherence should be considered when designing future environmental studies.
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Affiliation(s)
- Wendy Lorizio
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Han Woo
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Meredith C. McCormack
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Chen Liu
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Megan Wood
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Timothy Green
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Parisa Kaviany
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States
| | - Daniel Belz
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Ashraf Fawzy
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sara Carson
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Michelle N. Eakin
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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