AQI and Childhood Asthma: an Intervention
Condition: Asthma; Asthma in Children
MeSH terms: Asthma
Study type: Interventional

Summary: 
      This is a small pilot prospective intervention trial in children with asthma who will be
      randomized to receive either (A) Air Quality Index (AQI) education + an asthma action plan
      (control) or (B) AQI education + an asthma action plan which contains AQI behavioral
      recommendations + demonstrate ability to navigate to AirNow either online or on smartphone
      app (intervention).
    

Detailed description: 
      Over 3 million US children with asthma reported at least one attack in the prior year. Poorly
      controlled asthma is a major cause of suffering, school absences, loss of caregiver
      productivity, and healthcare costs (estimated as ~$80 billion/year). Over half of children on
      controller medication are not well controlled, due to environmental exposures, non-adherence,
      or true non-response to treatment. Outdoor air pollution is a known trigger of asthma.
      Although sound health policies are the best long-term approaches to reduce the harmful
      effects of air pollution, exposure avoidance is needed until "clean air" is ensured through
      effective legislation. Despite this, healthcare providers infrequently provide pollution
      exposure advice to children with asthma. The Environmental Protection Agency (EPA) monitors
      air pollution and reports a daily Air Quality Index (AQI) that is easy to use and available
      in most metropolitan areas. Practical recommendations regarding outdoor activity can be based
      on AQI levels. Despite this, AQI-based recommendations are rarely addressed in asthma action
      plans (AAP). No pediatric study has assessed the addition of the AQI to AAP to reduce asthma
      morbidity. This proposal seeks to recruit a pilot cohort of 40 children with asthma. Using
      this cohort, the investigators will test the hypotheses that (1) the addition of the AQI to
      AAP will reduce asthma exacerbations and (2) the addition of the AQI to AAP will improve
      asthma symptom control & quality of life in children with asthma. The inclusion of the AQI
      onto asthma action plans is novel in clinical asthma care; its wide availability would make
      large-scale implementation feasible. The investigators expect this low-cost and low-tech
      intervention will have a positive impact in reducing asthma morbidity. Given that 1 out of
      every 12 children in the U.S. has asthma, this is relevant to health care professionals,
      parents, and public health practitioners.

      Optional, the investigators will collect nasal epithelial cells for use in future
      genomic/epigenetic studies.

      Additionally, 40 parents/guardians of the children were also recruited to complete a baseline
      parental knowledge and usage of the AQI questionnaire administered at the randomization
      visit. This was originally listed as a secondary outcome however was removed during reporting
      of results as parental knowledge is not a true clinical trial outcome. Also, the secondary
      outcome of baseline child AQI usage (checking AQI) was changed to reflect this was a measure
      collected at all study visits and the secondary measure of physical activity was added.
    

Intervention name(s): AQI intervention; Routine care
Intervention type(s): Behavioral; Other
Intervention description(s): The intervention arm will receive AQI education, an asthma action plan containing AQI information and recommendations, and will be required to demonstrate ability to check AQI (either via airnow.gov website or downloaded AirNow smartphone app).; The routine care arm will be provided with general AQI education and an asthma action plan not containing AQI information.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 40 child will be 1:1 randomization by age groups 8-12 years, 13-17 years.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Air Quality Index (AQI); Childhood asthma exacerbations