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 | Asthma | JAMA Pediatrics | JAMA Network
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Article
Aug 2011

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

Author Affiliations

Author Affiliations: Divisions of General Pediatrics (Dr Butz) and Allergy and Immunology (Drs Matsui and Eggleston and Ms Curtin-Brosnan), Department of Pediatrics, and Department of Pulmonary and Critical Care (Drs Diette and Rand), The Johns Hopkins University School of Medicine, and Department of Environmental Health Sciences, The Johns Hopkins University Bloomberg School of Public Health (Drs Breysse and Williams and Mr Yuan), Baltimore, Maryland; and Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Bernert).

Arch Pediatr Adolesc Med. 2011;165(8):741-748. doi:10.1001/archpediatrics.2011.111
Abstract

Objective To test an air cleaner and health coach intervention to reduce secondhand smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter (PM), air nicotine, and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker.

Design Randomized controlled trial, with randomization embedded in study database.

Settings The Johns Hopkins Hospital Children's Center and homes of children.

Participants Children with asthma, residing with a smoker, randomly assigned to interventions consisting of air cleaners only (n = 41), air cleaners plus a health coach (n = 41), or delayed air cleaner (control) (n = 44).

Main Outcome Measures Changes in PM, air nicotine, and urine cotinine concentrations and symptom-free days during the 6-month study.

Results The overall follow-up rate was high (91.3%). Changes in mean fine and coarse PM (PM2.5 and PM2.5-10) concentrations (baseline to 6 months) were significantly lower in both air cleaner groups compared with the control group (mean differences for PM2.5 concentrations: control, 3.5 μg/m3; air cleaner only, −19.9 μg/m3; and air cleaner plus health coach, −16.1 μg/m3; P = .003; and PM2.5-10 concentrations: control, 2.4 μg/m3; air cleaner only, −8.7 μg/m3; and air cleaner plus health coach, −10.6 μg/m3; P = .02). No differences were noted in air nicotine or urine cotinine concentrations. The health coach provided no additional reduction in PM concentrations. Symptom-free days were significantly increased in both air cleaner groups compared with the control group (P = .03).

Conclusion Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke.

Trial Registration clinicaltrials.gov Identifier: NCT00466024

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