Air Quality Index and Childhood Asthma: A Pilot Randomized Clinical Trial Intervention
Franziska J Rosser1, Scott D Rothenberger2, Yueh-Ying Han1
1Division of Pulmonary Medicine, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Adding Air Quality Index (AQI) information to asthma action plans improved asthma control in children. However, this intervention may also lead to reduced outdoor activity for children with asthma.
Area of Science:
- Environmental Health
- Pediatric Pulmonology
- Clinical Trial Research
Background:
- U.S. asthma guidelines recommend checking the Air Quality Index (AQI) for children's outdoor activities.
- The impact of integrating AQI information into asthma action plans on pediatric asthma outcomes is not well understood.
Purpose of the Study:
- To evaluate whether adding AQI recommendations to asthma action plans improves asthma control and quality of life in children.
- To assess the effect of AQI integration on asthma exacerbations and physical activity levels.
Main Methods:
- A pilot, unblinded, randomized clinical trial involving 40 children with persistent asthma.
- Participants received asthma action plans; the intervention group also received AQI information and AirNow training.
- Outcomes including asthma exacerbations, control (Asthma Control Test, Childhood Asthma Control Test), and quality of life (Pediatric Asthma Quality of Life Questionnaire) were assessed over 6 months.
Main Results:
- More intervention participants checked the AQI (63% vs. 15%) at study exit.
- No significant differences were observed in asthma exacerbations or quality of life scores between groups.
- The intervention group showed a greater improvement in Asthma Control Test scores (2.00 vs. 0.15).
Conclusions:
- Integrating AQI information into asthma action plans improved asthma control as measured by the Asthma Control Test.
- The intervention may lead to decreased outdoor physical activity in children with asthma.
Introduction:
To reduce air pollution exposure, the U.S. asthma guidelines recommend that children check the Air Quality Index before outdoor activity. Whether adding the Air Quality Index and recommendations to asthma action plans reduces exacerbations and improves control and quality of life in children with asthma is unknown.
Methods:
A pilot, unblinded, randomized clinical trial of 40 children with persistent asthma, stratified by age and randomized 1:1, recruited from the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh (Pittsburgh, PA) was conducted. All participants received asthma action plans and Air Quality Index education. The intervention group received printed Air Quality Index information and showed the ability to use AirNow. Asthma exacerbations were assessed through a questionnaire, asthma control was assessed with the Asthma Control Test and Childhood Asthma Control Test, and quality of life was assessed with the Pediatric Asthma Quality of Life Questionnaire. After randomization (July-October 2020), participants were followed monthly for 6 months (exit January-March 2021). Outcome differences between groups were evaluated at the exit visit and over time (analysis was in 2021).
Results:
At randomization, there were no significant differences in age, sex, race, or asthma severity. At exit, more intervention participants checked the Air Quality Index (63% vs 15%) with no differences in the proportion of asthma exacerbations or mean Childhood Asthma Control Test or Pediatric Asthma Quality of Life Questionnaire scores. The mean change in Asthma Control Test score was higher in the intervention group (change in Asthma Control Test=2.00 vs 0.15 for the control), which was modified by time (β=1.85, CI=0.09, 3.61). Physical activity was decreased overall and showed modification by treatment and time.
Conclusions:
Addition of the Air Quality Index to asthma action plans led to improved asthma control by Asthma Control Test scores but may decrease outdoor activity.
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