Home Air in Agriculture: Pediatric Intervention Trial

Study Overview
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Brief Summary
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This study seeks to reduce exposure to asthmagens in the homes of a community of Latino children residing in an area of intense agricultural production in Eastern Washington by testing the effectiveness of an intervention (high efficiency particulate air filter- HEPA portable room air cleaners) plus asthma education to reduce indoor measures of particulate matter, ammonia, improve clinically relevant measures of asthma health, and reduce biomarkers of inflammation.

Detailed Description
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Over the course of five years, this project's specific aims are as follows: Build on a well-established community based participatory research program to engage community partners in the design, implementation and evaluation of this asthma intervention study. Conduct a year-long intervention study with longitudinal measurement of key asthmagen exposures and health outcome indicators with minimal participant burden. Develop and characterize evaluation metrics for the process, impact and outcomes of this project in achievement of the aims. Promote sustainable public health action via positive and transparent communications about the project to participants, local stakeholders, and state level policy makers through broad-based community outreach.

Official Title
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Home Air in Agriculture: Pediatric Intervention Trial

Conditions
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Asthma in Children

Intervention / Treatment
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* Device: HEPA air cleaner


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eligibility criteria include male and female, poorly controlled asthma, likely to stay in the area over the course of the study, having only one residence, no smokers in the household and residential proximity to dairy operations/crop production (<400 meters) determined by the telephone screening questionnaire. Exclusion Criteria: Prior participation in the Asthma Home Visiting Program, not from the northern third of the lower Yakima Valley, well controlled asthma, unlikely to stay in the are over the course of the study, smokers in the household, no residential proximity to dairy operations or crop production, having more than one residence and inability to communicate over the phone.

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Intervention group<br>Households are randomly assigned to the intervention group with asthma education and received two HEPA air cleaners designed to reduce PM and NH3. | Device: HEPA air cleaner<br>* Participants in the intervention group received two HEPA air cleaners per household. They were informed to place the HEPA air cleaners in the child's bedroom and the living room. Field staff provided and discuss how to use the air cleaner which promoted continuous operation of both air cleaners, keeping the child's bedroom door closed, and selected the highest fan speed. Typical use of the HEPA cleaners were questioned during the mid-study and final visits.<br>|
| No Intervention: Control group<br>Households are randomly assigned to the control group. They only received the asthma education during the study period. These households receive a HEPA air cleaner at the end of the study. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in particulate matter 2.5 (PM2.5) concentration | Indoor air sampling for PM2.5 collected over a 14-day period. MicroPEM (RTI International, Research Triangle Park, NC, USA) is turn on and left on for 14 days. Measurements collected at beginning and at 1 year after enrollment. | 1 year (study period) | 
| Change in ammonia (NH3) concentration | Indoor air sampling for NH3 collected over a 14-day period. Ogawa passive sampler (Ogawa USA, Pompano Beach, Fl, USA) is left open for 14 days. Measurements collected at beginning and at 1 year after enrollment. | 1 year (study period) | 
| Asthma Control Test | ACT score using the ACT questionnaire | At study enrollment | 
| Clinical utilization | Caregivers were asked if child had a scheduled or unscheduled (urgent) clinical visit with a doctor or health care provider, emergency department, or overnight hospitalization for asthma symptoms. Number and types of visits are reported. | One year (study period) | 
| Inflammatory markers of asthma: Urinary leukotriene | Measured urinary leukotriene concentration and specific gravity in child urine sample. Measurements collected at enrollment, mid-study (4-6 months after enrollment), and end of study (1 year after enrollment) | 1 year (study period) | 
| Inflammatory markers of asthma: Fractional exhaled nitric oxide | Portable NIOX VERO (Aerocrine Inc, Stockholm, Sweden) for direct measurement of fractional exhaled nitric oxide. | At study enrollment | 
| Asthma exacerbation | Reviewed participant medical records for receipt of prescription for a course of oral corticosteroid. | One year (study period) | 
| Lung function | Measured lung fuction using EasyOne spirometer (NDD Technologies, Andover, MA). Minimum of three exhalations with acceptable starts, complete exhalation, and no coughs until two exhalations with acceptable repeatability was achieved. | At study enrollment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Latinx children, fine particulate matter, endotoxins, antigens, spirometry, exhaled nitric oxide, agriculture, HEPA air cleaner, home indoor/outdoor sampling, coarse particulate matter