Cardiovascular benefits of air purifier in patients with stable coronary artery disease: A randomized single-blind crossover study

Background

Exposure to PM_2.5 will accelerate the progression of cardiovascular diseases. Air purifier can reduce the PM_2.5 exposure and theoretically alleviate the influence of PM_2.5 on patients with stable coronary artery disease (SCAD). However, few studies of the protective effect showed significant results because the interferent effects of routine medication had not been taken into account. In order to explore the actual effect on patients with SCAD, we conducted a randomized single-blind crossover air purifier intervention trial.

Method

Levels of PM_2.5 exposure during intervention and cardiovascular indicators (inflammation, coagulation, plaque stability, and blood lipids) after intervention were detected, meanwhile the information of drug use was obtained by questionnaire. The kinds of drug used by more than 20% of the subjects were sorted out. And the influence of these drugs on cardiovascular indicators was summarized through literature review. Based on that, the drug use was included as a variable in linear mixed effects models that used to analyze the associations between PM_2.5 exposure reduction by air purifier and cardiovascular indicators.

Results

The result revealed that the interpretation contribution rate of drug use was more than that of PM_2.5 exposure. The level of C-reactive protein significantly decreased by 20.93% (95%CI: 6.56%, 33.10%), 23.44% (95%CI: 2.77%, 39.39%) and 24.11% (95%CI: 4.21%, 39.69%) on lag1, lag01 and lag02 respectively, while the level of high-density lipoprotein cholesterol significantly increased by 5.10% (95%CI: 0.69%, 9.05%), 3.71% (95%CI: 0.92%, 6.60%) and 6.48% (95%CI: 2.58%, 10.24%) respectively on lag0, lag1 and lag01 associated with an interquartile range decrease of 22.51 μg/m³ in PM_2.5 exposure.

Conclusion

The study shows positive effects of air purifier on SCAD, and also provides methodological reference for future related research.

Association between the infection probability of COVID-19 and ventilation rates: An update for SARS-CoV-2 variants

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the current coronavirus disease 2019 (COVID-19) pandemic, is evolving. Thus, the risk of airborne transmission in confined spaces may be higher, and corresponding precautions should be re-appraised. Here, we obtained the quantum generation rate (q) value of three SARS-CoV-2 variants (Alpha, Delta, and Omicron) for the Wells-Riley equation with a reproductive number-based fitted approach and estimated the association between the infection probability and ventilation rates. The q value was 89-165 h^-1 for Alpha variant, 312-935 h^-1 for Delta variant, and 725-2,345 h^-1 for Omicron variant. The ventilation rates increased to ensure an infection probability of less than 1%, and were 8,000-14,000 m³ h^-1, 26,000-80,000 m³ h^-1, and 64,000-250,000 m³ h^-1 per infector for the Alpha, Delta, and Omicron variants, respectively. If the infector and susceptible person wore N95 masks, the required ventilation rates decreased to about 1/100 of the values required without masks, which can be achieved in most typical scenarios. An air purifier was ineffective for reducing transmission when used in scenarios without masks. Preventing prolonged exposure time in confined spaces remains critical in reducing the risk of airborne transmission for highly contagious SARS-CoV-2 variants.

Impact of do-it-yourself air cleaner design on the reduction of simulated wildfire smoke in a controlled chamber environment

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.

Prediction of indoor PM2.5 concentrations and reduction strategies for cooking events through various IAQ management methods in an apartment of South Korea

Indoor PM_2.5 in apartments must be effectively managed to minimize adverse impacts on human health. Cooking is the one of the main PM_2.5 sources in apartments, and indoor air quality (IAQ) management methods (natural ventilation, mechanical ventilations, range hoods, and air purifiers) are typically used to reduce PM_2.5 generated during cooking. For effective control of indoor PM_2.5 , prediction of PM_2.5 reduction for various IAQ management methods is necessary. This study carefully predicted indoor PM_2.5 concentrations in an apartment when IAQ management methods were applied separately and/or in combination during cooking. The infiltration and exfiltration were verified by comparing the experimental results of CO₂ concentration with those predicted with or without mechanical ventilation. The deposition rate for PM_2.5 generated by cooking was also derived by comparing the experimental PM_2.5 changes with the predicted values for PM_2.5 natural decay. Through this method, effective PM_2.5 control ways during cooking in apartments can be proposed, such as natural ventilation with a range hood for 30 min and then the operation of an air purifier for 30 min. Additionally, if this prediction is combined with energy consumption, it will be possible to propose the most energy-efficient indoor PM_2.5 control methods for various seasons and outdoor conditions.

The Actual Efficacy of an Air Purifier at Different Outdoor PM2.5 Concentrations in Residential Houses with Different Airtightness

It is important to control airborne particles in residential houses for protecting human health. Indoor particulate matter of <2.5 μm (PM2.5) can be effectively monitored and managed using an air purifier. In this study, the actual clean air delivery rates in residential houses (CADRActual) were acquired by comparing decay rates of fine particles with and without operations of the air purifier under actual conditions, following the standard CADR of an air purifier obtained in a closed test chamber. The measurements of CADRActual at different outdoor PM2.5 concentrations over a month in two residential houses revealed different airtightness levels, compared to the standardized clean air delivery rate of the air purifier (CADRAP). Air changes per hour at 50 Pa (ACH50) was 4.8 h−1 for “house A” (built in 2007) and 2.1 h−1 for “house B” (built in 2018). The CADR of the air purifier used in this study was 10.6 m3/min, while the averaged CADRActual at the “house A” was 7.2 m3/min (approximately 66% of the CADR of the air purifier) and 9.5 m3/min at “house B” (approximately 90% of the CADR of the air purifier). Under the outdoor PM2.5 concentrations of <35 μg/m3, the averaged CADRActual of house A and house B were 7.8 ± 0.3 and 9.7 ± 0.4 m3/min, respectively. However, under the outdoor PM2.5 concentrations of >35 μg/m3, the analogous averaged concentrations were 6.8 ± 0.6 and 9.6 ± 0.3 m3/min for houses A and B, respectively. The measured CADRActual agreed well with the theoretical estimates of CADRActual acquired by the mass balance equation using the infiltration rate of ACH50/20. We also estimated CADRActual/CADRAP for house C built in 2017, where the ACH50 was 1.8 h−1. Overall, this study demonstrated how CADRActual/CADRAP of an air purifier at residential houses can be predicted according to outdoor PM2.5 concentration and airtightness of the house. As shown, it can be closer to 1 at lower ACH50 houses and at lower outdoor PM2.5 concentrations.

Efficient Energy Saving Scenarios for Indoor PM2.5 Management in an Apartment of South Korea

Indoor PM_2.5 must be effectively controlled to minimize adverse impacts on public health. Cooking is one of the main sources of PM_2.5 in residential areas, and indoor air quality (IAQ) management methods such as natural and mechanical ventilation, range hood, and air purifier are typically used to reduce cooking-generated PM_2.5 concentrations. However, studies on the combined effects of various IAQ management methods on indoor PM_2.5 reduction and energy consumption are limited. In this study, a theoretical model was established to estimate the performance of various IAQ management methods for controlling indoor PM_2.5 concentrations and energy consumption. The model was verified by comparative experiments in which, various IAQ management methods were operated individually or combined. Seasonal energy consumption was calculated through the verified model, and energy consumption saving scenarios were derived for maintaining indoor PM_2.5 concentrations less than 10 μg/m³, a World Health Organization annual guideline, under fair and poor outdoor PM_2.5 concentrations of 15 and 50 μg/m³, respectively. Based on our results, we found that energy consumption could be reduced significantly by applying natural ventilation in spring, autumn, and summer and mechanical ventilation in winter. Our study identified efficient energy saving PM_2.5 management scenarios using various IAQ management methods by predicting indoor PM_2.5 concentration and energy consumption according to the annual life patterns of typical residents in South Korea.

Natural Ventilation and Air Purification for Effective Removal of Airborne Virus in Classrooms with Heater Operation

Mass COVID-19 infection cases in indoor spaces have been continuously reported since its global outbreak, generating increasing public interest in reducing the spread of the virus. This study considered a situation in which an infected individual continuously releases the virus into the air in a classroom, simulated by continuous injection of NaCl particles ≤ 5 μm, with heater operation during winter. The effects of applying natural ventilation and operating one or two air purifiers on the removal of virus-containing aerosols were experimentally compared and analyzed based on the spatiotemporal changes in NaCl concentration within the classroom. When a heater was operated with all windows shut, operating one and two air purifiers reduced the amount of the aerosol in indoor air by approximately 50 and 60%, respectively, compared to the case with no air purifier. Additionally, when the heater was operated with one or two air purifiers under natural ventilation, the amount of virus-containing aerosol in the air was reduced by 86-88% compared to the case with neither natural ventilation nor air purifier. Because natural ventilation significantly varies with weather conditions and particulate matter concentrations, combining natural ventilation with air purifiers in classrooms during winter needs to be adjusted appropriately.

Reducing the Effectiveness of Ward Particulate Matter, Bacteria and Influenza Virus by Combining Two Complementary Air Purifiers

Air purifiers should pay much attention to hospital-associated infections, but the role of a single air purifier is limited. The goal of this study was to evaluate the effectiveness of the combined application of the nonequilibrium positive and negative oxygen ion purifier (PNOI) and the high-efficiency particulate air filter (HEPA) on a complex, polluted environment. Two of the better performing purifiers were selected before the study. The efficacy of their use alone and in combination for purification of cigarette particulate matter (PM), Staphylococcus albicans, and influenza virus were then evaluated under a simulated contaminated ward. PNAI and HEPA alone are deficient. However, when they were combined, they achieved 98.44%, 99.75%, and 100% 30 min purification rates for cigarette PM, S. albus, and influenza virus, respectively. The purification of pollution of various particle sizes and positions was optimized and reduced differentials, and a subset of airborne influenza viruses is inactivated. Furthermore, they were superior to ultraviolet disinfection for microbial purification in air. This work demonstrates the strong purification capability of the combined application of these two air purifiers for complex air pollution, which provides a new idea for infection control in medical institutions.

Positive Effect of Air Purifier Intervention on Baroreflex Sensitivity and Biomarkers of Oxidative Stress in Patients with Coronary Artery Disease: A Randomized Crossover Intervention Trial

Exposure to fine particulate matter increases the risk of cardiovascular morbidity and mortality. Few studies have tested the beneficial effect of indoor air filtration intervention in patients with cardiovascular disease. The aim of this study is to investigate the effect of air filtration on mitigating cardiovascular health in patients with coronary artery disease. This randomized, double-blind, crossover study is conducted with 38 coronary artery disease patients. The intervention consists of the following three periods: two-week active and sham air filtration interventions, with a two-week washout period. The indoor PM_2.5 concentration is continuously monitored during the entire study period. We measure the blood pressure, heart rate variability, baroreflex sensitivity, autonomic function test results, and endothelial function. The two-week active air filtration intervention for two weeks reduces the average indoor concentration of PM_2.5 by 33.9%. The indoor PM_2.5 concentration is significantly correlated to cross-correlation baroreflex sensitivity. Active air filtration is significantly associated with a decrease in the indicator of oxidative stress represented as 8-hydroxy-2′-deoxyguanosine. This study shows that a short-term air filtration intervention improved baroreflex sensitivity and might reduce oxidative stress in coronary artery disease patients. These findings suggest that the use of an air purifier could mitigate the recurrence of cardiovascular disease events in patients with coronary artery disease.

The effect of an air purifier on aerosol generation measurements during clinical motility testing

BACKGROUND

Aerosol spread is key to interpret the risk of viral contamination during clinical procedures such as esophageal high-resolution manometry (HRM). Installing an air purifier seems a legitimate strategy, but this has recently been questioned.

METHODS

Patients undergoing an HRM procedure at the Leuven University Hospital were included in this clinical study. All subjects had to wear a surgical mask which was only lowered beneath the nose during the placement and removal of the nasogastric catheter. The number of aerosol particles was measured by a Lasair^® II Particle Counter to obtain data about different particles sizes: 0.3; 0.5; 1.0; 3.0; 5.0; and 10.0 µm. Measurements were done immediately before the placement and the removal of the HRM catheter, and one and 5 min after. A portable air purifier with high-efficiency particle air filters was installed in the hospital room.

KEY RESULTS

Thirteen patients underwent a manometry examination. The amount of 0.3 µm-sized particles was unaffected during the whole procedure. The larger particle sizes (1.0; 3.0; 5.0; and 10.0 µm) decreased when the catheter was positioned, but not 0.5 µm. During the HRM measurements itself, these numbers decreased further. Yet, 1 min after catheter removal a significant elevation of particles was seen, which did not recover within 5 min.

CONCLUSIONS & INTERFERENCES

Based on this study, there is no evidence that filtration systems reduce aerosol particles properly during a clinical investigation.

Low-Cost Air Purifier Prototype Using a Ventilating Fan and Pump Against Haze Pollution

This study aimed to focus on the design and development of low-cost do-it-yourself (DIY) air purifiers, using a ventilating fan, air pump, water pump, and an ultrasonic generator that can be used during the haze pollution. Six types of household air purifiers were fabricated. The amount of particulate matter (PM) and carbon dioxide (CO2) levels were recorded at 0, 10, 20, 30, and 60 min (min), then, repeated 3 times. After 10 min of the 3rd experiment of each study, the last measurement of air pollution would be recorded. The results showed at 60 min, the high-efficiency particulate air (HEPA) filter and electrostatic fiber was the best technique regarding reduction of PM and CO2 levels. The highest PM reduction rate had occurred at 30 min using an air pump procedure (99.330 to 100%). The CO2 levels of all experiments had fluctuated at different times. After 10 min of a closed machine, PM levels of all air purifier systems were decreased, except HEPA filter and electrostatic fiber types. In conclusion, the best method for reducing particulate matter and cost without taking humidity into account is an air pump technique, whereas the HEPA filter and electrostatic fiber method is the best choice for lowering PM levels without increasing humidity and vapor production.

Removal of chemical hazardous compounds using CATACOAT, a nano-platinum thermal catalyst system

The performance of CATACOAT, a nano-platinum thermal catalyst system, was evaluated for the removal of chemical hazardous compounds from air. Xylene, benzene, styrene, and toluene were selected as standard volatile organic compounds (VOCs) in this study. In addition, formaldehyde was tested as a chemical hazardous compound. Each VOC, or formaldehyde, was evaporated in a 4,000 L chamber under controlled environments. At the maximum concentration point, CATACOAT was turned on and the concentrations of the chemical hazardous compounds were recorded for 5 h. The air purifier based on H-13-grade high-efficiency particulate air (HEPA) filter was tested in the same way to compare the effects of CATACOAT. Compared with the HEPA filter system, every VOC concentration was significantly decreased with the CATACOAT system only 0.025 h after turning on the air purifier (P values for xylene, benzene, styrene, and toluene are 0.00488, 0.01508, 0.00014, and 0.04690, respectively). After running the air cleaners for 5 h, every VOC and formaldehyde demonstrated significantly decreased concentrations with the CATACOAT system, compared with HEPA filter system (P values for xylene, benzene, styrene, toluene, and formaldehyde are 0.00034, 0.00009, 0.00008, 0.00001, and 0.00571, respectively). In conclusion, the CATACOAT may be a viable solution to control indoor air pollution.

Improving the Indoor Air Quality in Nursery Buildings in United Arab Emirates

Children inhale indoor air at 400 mL/min∙kg per body weight, 2.76 times more than adults. They have weaker immunity than adults and are more exposed to asthma, allergies, and atopic diseases. The objective of this paper is to suggest effective management and improvement measures for indoor air quality for nurseries. As a methodology, 16 nurseries (total of 35 classrooms) were selected to measure the indoor air quality compared with WHO IAQ Standard, and identify the daily concentration change of the pollutants. Based on the measurements, IAQ improvements for selected facilities are carried out to compare the results before and after improvement. The result has shown that the concentration of Carbon Dioxide (CO₂), Total Volatile Organic Compounds (TVOC), Total Suspended Particles (TSP) and formaldehyde (CH₂O) exceeds WHO IAQ standards. The concentration of CO₂ and TSP is changed mainly by physical activity of children and that of CH₂O and TVOC is changed mainly by ventilation after school start. TVOC decreased by 46.4% and the TSP decreased by 21.7% after air purifier, but CH₂O and TVOC increased 1.8–3.8 times after interior renovation with low-emission finishing materials. After new ventilation installation, the CH₂O and TVOC reduced half and the TSP reduced one third. It is proven that the most effective way to reduce the concentration of air pollutants in nurseries is the installation of a new ventilation system, followed by an air purifier. The renovation with low-emission finishing materials cannot improve IAQ in a short period of time.

Wind tunnel-based testing of a photoelectrochemical oxidative filter-based air purification unit in coronavirus and influenza aerosol removal and inactivation

Recirculating air purification technologies are employed as potential means of reducing exposure to aerosol particles and airborne viruses. Toward improved testing of recirculating air purification units, we developed and applied a medium-scale single-pass wind tunnel test to examine the size-dependent collection of particles and the collection and inactivation of viable bovine coronavirus (BCoV, a betacoronavirus), porcine respiratory coronavirus (PRCV, an alphacoronavirus), and influenza A virus (IAV), by a commercial air purification unit. The tested unit, the Molekule Air Mini, incorporates a MERV 16 filter as well as a photoelectrochemical oxidating layer. It was found to have a collection efficiency above 95.8% for all tested particle diameters and flow rates, with collection efficiencies above 99% for supermicrometer particles with the minimum collection efficiency for particles smaller than 100 nm. For all three tested viruses, the physical tracer-based log reduction was near 2.0 (99% removal). Conversely, the viable virus log reductions were found to be near 4.0 for IAV, 3.0 for BCoV, and 2.5 for PRCV, suggesting additional inactivation in a virus family- and genus-specific manner. In total, this work describes a suite of test methods which can be used to rigorously evaluate the efficacy of recirculating air purification technologies.

Efficacy of air purifier therapy for patients with allergic asthma

OBJECTIVES

This study aimed to evaluate the efficacy of air purifier therapy for patients with allergic asthma.

METHODS

Thirty-eight subjects were categorized under two groups namely treatment group and control group. All subjects were under 18 years of age and they had been clinically diagnosed with allergic asthma. The treatment group used high efficiency particulate air (HEPA) purifiers for six consecutive months, and the control group did not use the air filters. Particulate matter (PM) data and dust samples (from bedding and a static point) were collected from the subjects' bedrooms before they started using the air purifiers and each month thereafter. Simultaneously, the subjects were asked to complete a questionnaire for the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Fractional exhaled nitric oxide (FENO) tests were performed at the start and end of the study. The concentrations of Der p1 and Der f1 were measured in the dust samples.

RESULTS

(1) After utilizing the air purifier, the concentrations of house dust mite (HDM) allergens (Der p1+ Der f1) in the dust samples decreased. In addition, the PM_{indoor/outdoor} values significantly decreased. (2) The ACT and C-ACT scores in the treatment group maintained a steady significant upward trend. (3) At the end of the study, the FENO levels in both groups were lower, although the differences were not significant.

CONCLUSIONS

It is witnessed that HEPA air purifiers can decrease indoor HDM allergen and PM levels and improve the quality of life for allergic asthma patients.

Effects of Air Purifiers on the Spread of Simulated Respiratory Droplet Nuclei and Virus Aggregates

The present study was performed to quantitatively evaluate the effects of air purifiers on the spread of COVID-19 and to suggest guidelines for their safe use. To simulate respiratory droplet nuclei and nano-sized virus aggregates, deionized water containing 100 nm of polystyrene latex (PSL) particles was sprayed using a vibrating mesh nebulizer, and the changes in the particle number concentration were measured for various locations of the particle source and air purifier in a standard 30 m³ test chamber. The spread of the simulated respiratory droplet nuclei by the air purifier was not significant, but the nano-sized aggregates were significantly affected by the airflow generated by the air purifier. However, due to the removal of the airborne particles by the HEPA filter contained in the air purifier, continuous operation of the air purifier reduced the number concentration of both the simulated respiratory droplet nuclei and nano-sized aggregates in comparison to the experiment without operation of the air purifier. The effect of the airflow generated by the air purifier on the spread of simulated respiratory droplet nuclei and nano-sized aggregates was negligible when the distance between the air purifier and the nebulizer exceeded 1 m.

The Efficacy of the Dyson Air Purifier in Improving Asthma Control: Protocol for a Single-Center, Investigator-Led, Randomized, Double-Blind, Placebo-Controlled Trial

Background

Indoor air quality has been shown to influence asthma control and outcomes. Air purifiers and high-efficiency particulate air filtration devices can improve indoor air quality by reducing the indoor levels of air pollution and allergens. However, the influence of this improved indoor air quality on asthma control remains unclear; hence, randomized controlled trials are needed to further elucidate this phenomenon.

Objective

This study aims to investigate the effect of reducing the levels of allergens and pollutants in the bedroom and living room through the use of Dyson air purifiers (Dyson Pure Cool) on asthma control.

Methods

This is an 18-month long, investigator-led, randomized, double-blinded, placebo-controlled, single-center trial. Subjects will be randomized in a 1:1 ratio to active or placebo Dyson filters. The primary outcome is the change in the scores of Asthma Control Questionnaire 6 and Asthma-specific Quality of Life Questionnaire from baseline. Secondary outcomes include changes in lung function (forced expiratory volume in one second, forced expiratory volume in one second/forced vital capacity ratio, and midexpiratory flows), peak expiratory flow measurements, airway hyperresponsiveness (assessed by methacholine bronchial challenge), fractional exhaled nitric oxide, and indoor air pollutant levels. The sample size will be 50 subjects, and all subjects will have a confirmed diagnosis of mild persistent to moderate persistent asthma along with an Asthma Control Questionnaire 6 score of >1.5.

Results

This study was approved by the West Midlands Research Ethics Committee (18/WM/0277). The study results will be published in peer-reviewed scientific journals; presented at relevant scientific conferences; and shared in plain English with participants in our newsletters, in our clinics, and via the David Hide Asthma and Allergy Research Centre website. Our trial began in September 2019 and is expected to end in August 2021.

Conclusions

This is a double-blinded, placebo-controlled, randomized, investigator-led study to investigate the efficacy of a novel air purifier in improving asthma control in adults. The trial period of 18 months will facilitate the collection of robust data and will therefore generate clear signals. However, this extended trial duration may lead to patient withdrawal. Furthermore, this trial is conducted at a single center and in a location with a homogenous cohort of people, which may affect translatability. Nonetheless, it is hoped that the findings of this trial may help further inform clinicians regarding the utility of this novel device as an adjunct in asthma care.

Trial Registration

ClinicalTrials.gov NCT04729530; https://clinicaltrials.gov/ct2/show/NCT04729530

International Registered Report Identifier (IRRID)

DERR1-10.2196/28624

Portable HEPA Purifiers to Eliminate Airborne SARS-CoV-2: A Systematic Review

OBJECTIVE

Current epidemiologic predictions of COVID-19 suggest that SARS-CoV-2 mitigation strategies must be implemented long-term. In-office aerosol-generating procedures pose a risk to staff and patients while necessitating examination room shutdown to allow aerosol decontamination by indwelling ventilation. This review summarizes the current state of knowledge on portable high-efficiency particulate air (HEPA) purifiers' effectiveness in eliminating airborne SARS-CoV-2 from indoor environments.

DATA SOURCES

Medline, Embase, Cochrane Databases, and the World Health Organization's COVID-19 Global Literature on Coronavirus Disease.

REVIEW METHODS

Data sources were systematically searched for original English-language published studies indexed up to January 14, 2021 per the following search strategy: ("HEPA" OR "High-efficiency" OR "High-efficiency particulate air" OR "Efficiency particulate" OR "Purifier" OR "Filter" OR "Cleaner" OR "Filtration") AND ("COVID" OR "COVID-19" OR "SARS-CoV-2" OR "Coronavirus"). Additional relevant studies were identified by searching the reference lists of included articles.

RESULTS

Eleven published studies have evaluated the effectiveness of portable HEPA purifiers in eliminating airborne SARS-CoV-2 with relevantly sized surrogate particles. Ten studies evaluated aerosols and submicron particles similar in size to SARS-CoV-2 virions. In all studies, portable HEPA purifiers were able to significantly reduce airborne SARS-CoV-2-surrogate particles. The addition of portable HEPA purifiers augmented other decontamination strategies such as ventilation.

CONCLUSION

Experimental studies provide evidence for portable HEPA purifiers' potential to eliminate airborne SARS-CoV-2 and augment primary decontamination strategies such as ventilation. Based on filtration rates, additional air exchanges provided by portable HEPA purifiers may be calculated and room shutdown times potentially reduced after aerosol-generating procedures.

Association between Peak Expiratory Flow Rate and Exposure Level to Indoor PM2.5 in Asthmatic Children, Using Data from the Escort Intervention Study

Various studies have indicated that particulate matter <2.5 μm (PM2.5) could cause adverse health effects on pulmonary functions in susceptible groups, especially asthmatic children. Although the impact of ambient PM2.5 on children’s lower respiratory health has been well-established, information regarding the associations between indoor PM2.5 levels and respiratory symptoms in asthmatic children is relatively limited. This randomized, crossover intervention study was conducted among 26 asthmatic children’s homes located in Incheon metropolitan city, Korea. We aimed to evaluate the effects of indoor PM2.5 on children’s peak expiratory flow rate (PEFR), with a daily intervention of air purifiers with filter on, compared with those groups with filter off. Children aged between 6–12 years diagnosed with asthma were enrolled and randomly allocated into two groups. During a crossover intervention period of seven weeks, we observed that, in the filter-on group, indoor PM2.5 levels significantly decreased by up to 43%. (p < 0.001). We also found that the daily or weekly unit (1 μg/m³) increase in indoor PM2.5 levels could significantly decrease PEFR by 0.2% (95% confidence interval (CI) = 0.1 to 0.5) or PEFR by 1.2% (95% CI = 0.1 to 2.7) in asthmatic children, respectively. The use of in-home air filtration could be considered as an intervention strategy for indoor air quality control in asthmatic children’s homes.

Evaluation on Air Purifier's Performance in Reducing the Concentration of Fine Particulate Matter for Occupants according to its Operation Methods

Fine particulate matter entering the body through breathing cause serious damage to humans. In South Korea, filter-type air purifiers are used to eliminate indoor fine particulate matter, and there has been a broad range of studies on the spread of fine particulate matter and air purifiers. However, earlier studies have not evaluated an operating method of air purifiers considering the inflow of fine particulate matter into the body or reduction performance of the concentration of fine particulate matter. There is a limit to controlling the concentration of fine particulate matter of the overall space where an air purifier is fixed in one spot as the source of indoor fine particulate matter is varied. Accordingly, this study analyzed changes in the concentration of indoor fine particulate matter through an experiment according to the discharging method and location of a fixed air purifier considering the inflow route of fine particulate matter into the body and their harmfulness. The study evaluated the purifiers' performance in reducing the concentration of fine particulate matter in the occupants' breathing zone according to the operation method in which a movable air purifier responds to the movement of occupants. The results showed the concentration of fine particulate matter around the breathing zone of the occupants had decreased by about 51 μg/m³ compared to the surrounding concentration in terms of the operating method in which an air purifier tracks occupants in real-time, and a decrease of about 68 μg/m³ in terms of the operating method in which an air purifier controls the zone. On the other hand, a real-time occupant tracking method may face a threshold due to the moving path of an air purifier and changes in the number of occupants. A zone controlling method is deemed suitable as an operating method of a movable air purifier to reduce the concentration of fine particulate matter in the breathing zone of occupants.

Prospective Association of Air-Purifier Usage during Pregnancy with Infant Neurodevelopment: A Nationwide Longitudinal Study-Japan Environment and Children's Study (JECS)

Fetal exposure to particulate matter (PM) is associated with infant developmental delay likely via neuroinflammation and prefrontal cortex lesions; however, whether air-purifier usage, which can reduce indoor PM levels, is related to infant developmental delay remains unknown. We therefore examined the prospective relationship between air-purifier usage during pregnancy and infant developmental delay by analyzing 82,441 mother-infant pairs using a simple yes/no questionnaire. Developmental delays at 6 and 12 months were assessed in five areas using the Ages and Stages Questionnaire, Third Edition. A generalized linear mixed model analysis was used to derive adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) while controlling for 20 covariates. The analysis revealed that air-purifier usage was associated with developmental delays in fine motor (AOR: 0.91, 95% CI: 0.83-0.99) and problem solving (AOR: 0.83, 95% CI: 0.77-0.90) at 6 months and in communication (AOR: 0.86, 95% CI: 0.79-0.93), fine motor (AOR: 0.87, 95% CI: 0.82-0.92), problem solving (AOR: 0.83, 95% CI: 0.77-0.88), and personal-social (AOR: 0.79, 95% CI: 0.72-0.86) at 12 months. In conclusion, a negative association exists between air-purifier usage during pregnancy and infant neurodevelopmental delay that strengthens with time. Our results outline the potential role of air purifiers in inhibiting infant neurodevelopmental delay.

Effects of the Use of Air Purifier on Indoor Environment and Respiratory System among Healthy Adults

Air purifiers have become popular among ordinary families. However, it remains controversial whether indoor air purification improves the respiratory health of healthy adults. A randomized crossover intervention study was conducted with 32 healthy individuals. The subjects were categorized into two groups. One group continuously used true air purifiers, and the other followed with sham air purifiers for 4 weeks. Following this first intervention, all the subjects underwent a 4-week washout period and continued with the second 4-week intervention with the alternate air purifiers. We collected fine particulate matter (PM) ≤ 2.5 µm in aerodynamic diameter (PM2.5), coarse particulate matter between 2.5 and 10 µm in aerodynamic diameter (PM10–2.5) and ozone (O₃). The subjects’ pulmonary function and fractional exhaled nitric oxide (FeNO) were measured during the study period. The indoor PM2.5 concentrations decreased by 11% with the true air purifiers compared to those with sham air purifiers. However, this decrease was not significant (p = 0.08). The air purification did not significantly improve the pulmonary function of the study subjects. In contrast, an increase in the indoor PM10–2.5 and O₃ concentration led to a significant decrease in the forced expiratory volume in one second (FEV_1.0)/forced vital capacity (FVC) and maximal mid-expiratory flow (MMEF), respectively. In conclusion, air purification slightly improved the indoor PM2.5 concentrations in ordinary homes but had no demonstrable impact on improving health.

Effects of Indoor Air Purifiers on Children with Asthma

PURPOSE

To evaluate the effects of air purifiers on the concentrations of indoor air pollutants and on asthma control in children.

MATERIALS AND METHODS

In this randomized crossover trial, daily use of an air purifier filter was compared with a matched placebo with the filter off. Thirty elementary school students who had asthma were enrolled and randomly allocated to one of two groups. The primary endpoints were changes in indoor air quality, asthma severity, lung function, airway inflammatory, urine microbiome, and phthalate after the installation of air purifiers. PM_2.5 and CO₂ were measured as indoor air pollutants. Asthma severity was assessed in terms of both symptom and medication scores acquired using a daily questionnaire. The higher the score, the better the symptom or the less frequent the use of medication. Peak expiratory flow rate and fractional exhaled nitric oxide were also measured.

RESULTS

The mean age of the enrolled patients was 9.2±1.98 years. The mean concentration of PM_2.5 was 17.0 μg/m³ in the filter-off condition, but significantly lower at 9.26 μg/m³ in the filter-on condition. Medication scores were 6.9 for the filter-off and 7.12 for the filter-on conditions, reflecting a statistically significant decrease in the frequency of medications used during air purifier operation. Bacterial richness, as determined using the Chao 1 index, was markedly lower in the filter-on than the filter-off condition.

CONCLUSION

This study suggests that air purifiers benefit medication burden in children with asthma by reducing PM_2.5 levels.

Effect of a Novel Photoelectrochemical Oxidation Air Purifier on Nasal and Ocular Allergy Symptoms

Background

Photoelectrochemical oxidation (PECO) is a new air purification technology developed to reduce circulating indoor allergens. PECO removes particles as small as 0.1 nm with the destruction of organic matter otherwise not trapped by a traditional filter and removes volatile organic compounds.

Objective

We hypothesized that with daily use, the device would reduce user nasal and ocular allergy total symptom scores (TSS) within 4 weeks.

Methods

The study was performed among 46 individuals with self-reported allergies using a portable PECO air purifier. Self-reported TSS were calculated at baseline and weekly for 4 weeks following initiation of continuous use of the system. TSS was the sum of total nasal symptom scores (TNSS) and total ocular symptom scores (TOSS) for the week.

Results

There was a statistically significant change in overall TSS from baseline to 4 weeks (10.1 at baseline and 4.35 postintervention) resulting in a mean difference of 5.75 (95% confidence interval [CI] 4.32-7.18; P < .0001). There was a statistically significant change in TNSS from baseline to 4 weeks (6.3 at baseline and 3.04 postintervention) resulting in a mean difference of 3.26 (95% CI 2.33-3.19; P < .0001). There was a statistically significant change in TOSS from baseline to 4 weeks (3.82 at baseline and 1.3 postintervention) resulting in a mean difference of 2.52 (95% CI 1.74-3.3; P < .0001).

Conclusion

With the use of PECO air purification technology, TSS, TNSS, and TOSS decreased significantly. These improvements were consistent over the 4-week course of device use.