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Bronchiolitis recovery and the use of High Efficiency Particulate Air (HEPA) Filters (The BREATHE Study): study
Kelly Cowan1, Erin O Semmens2, Jeannette Y Lee3
1Department of Pediatrics, Larner College of Medicine at the University of Vermont, 111 Colchester Ave, Smith 5, Burlington, VT, 05403, USA. kelly.cowan@uvmhealth.org.
Insights
This study investigated if high efficiency particulate air (HEPA) filters reduce respiratory symptoms in infants after bronchiolitis hospitalization. Results will inform strategies for improving indoor air quality and reducing infant respiratory illness.
Area of Science:
- Pediatric Respiratory Medicine
- Environmental Health
- Clinical Trials
Background:
- Acute viral bronchiolitis is a leading cause of infant hospitalization in the USA.
- Hospitalized infants face risks of recurrent respiratory symptoms, wheeze, and childhood asthma.
- Indoor air quality, specifically particulate matter ≤2.5 µm (PM2.5), is a contributing factor to adverse respiratory outcomes.
Purpose of the Study:
- To evaluate the efficacy of high efficiency particulate air (HEPA) filtration units in reducing respiratory symptom burden in infants post-bronchiolitis hospitalization.
- To assess the impact of HEPA filtration on unscheduled healthcare visits, child quality of life, and indoor PM2.5 levels.
Main Methods:
- A multi-center, double-blind, randomized controlled trial (BREATHE study) involving 228 infants hospitalized for bronchiolitis.
- Participants were randomized to a 24-week home intervention with HEPA and carbon filters or a control group with non-filtering units.
- Primary endpoint: reduction in respiratory symptom burden over 24 weeks.
Main Results:
- The study aims to determine if HEPA filtration significantly reduces respiratory symptom burden compared to control.
- Secondary analyses will examine effects on healthcare utilization, quality of life, and indoor air quality (PM2.5).
Conclusions:
- HEPA filtration is proposed as a strategy to improve indoor air quality and reduce respiratory symptom burden in infants following severe bronchiolitis.
- Successful trial outcomes would support the use of HEPA filtration for managing post-bronchiolitis respiratory symptoms in infants.
Background:
Acute viral bronchiolitis is the most common reason for hospitalization of infants in the USA. Infants hospitalized for bronchiolitis are at high risk for recurrent respiratory symptoms and wheeze in the subsequent year, and longer-term adverse respiratory outcomes such as persistent childhood asthma. There are no effective secondary prevention strategies. Multiple factors, including air pollutant exposure, contribute to risk of adverse respiratory outcomes in these infants. Improvement in indoor air quality following hospitalization for bronchiolitis may be a prevention opportunity to reduce symptom burden. Use of stand-alone high efficiency particulate air (HEPA) filtration units is a simple method to reduce particulate matter ≤ 2.5 µm in diameter (PM2.5), a common component of household air pollution that is strongly linked to health effects.
Methods:
BREATHE is a multi-center, parallel, double-blind, randomized controlled clinical trial. Two hundred twenty-eight children < 12 months of age hospitalized for the first time with bronchiolitis will participate. Children will be randomized 1:1 to receive a 24-week home intervention with filtration units containing HEPA and carbon filters (in the child's sleep space and a common room) or to a control group with units that do not contain HEPA and carbon filters. The primary objective is to determine if use of HEPA filtration units reduces respiratory symptom burden for 24 weeks compared to use of control units. Secondary objectives are to assess the efficacy of the HEPA intervention relative to control on (1) number of unscheduled healthcare visits for respiratory complaints, (2) child quality of life, and (3) average PM2.5 levels in the home.
Discussion:
We propose to test the use of HEPA filtration to improve indoor air quality as a strategy to reduce post-bronchiolitis respiratory symptom burden in at-risk infants with severe bronchiolitis. If the intervention proves successful, this trial will support use of HEPA filtration for children with bronchiolitis to reduce respiratory symptom burden following hospitalization.
Trial Registration:
NCT05615870. Registered on November 14, 2022.
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