School Environmental Intervention to Reduce Particulate Pollutant Exposures for Children with Asthma

Abstract

Background: Home-based interventions to improve indoor air quality have demonstrated benefits for asthma morbidity, yet little is known about the effect of environmental interventions in the school setting.

Objective: We piloted the feasibility and effectiveness of a classroom-based air cleaner intervention to reduce particulate pollutants in classrooms of children with asthma.

Methods: In this pilot randomized controlled trial, we assessed the effect of air cleaners on indoor air particulate pollutant concentrations in 18 classrooms (9 control, 9 intervention) in 3 urban elementary schools. We enrolled 25 children with asthma (13 control, 12 intervention) aged 6 to 10 years. Classroom air pollutant measurements and spirometry were completed once before and twice after randomization. Asthma symptoms were surveyed every 3 months.

Results: Baseline classroom levels of fine particulate matter (particulate matter with diameter of <2.5 μm [PM_2.5]) and black carbon (BC) were 6.3 and 0.41 μg/m³, respectively. When comparing the intervention to the control group, classroom PM_2.5 levels were reduced by 49% and 42% and BC levels were reduced by 58% and 55% in the first and second follow-up periods, respectively (P < .05 for all comparisons). When comparing the children randomized to intervention and control classrooms, there was a modest improvement in peak flow, but no significant changes in forced expiratory volume in 1 second (FEV₁) and asthma symptoms.

Conclusions: In this pilot study, a classroom-based air cleaner intervention led to significant reductions in PM_2.5 and BC. Future large-scale studies should comprehensively evaluate the effect of school-based environmental interventions on pediatric asthma morbidity.

Keywords: Air cleaner; Asthma; Environmental intervention; Indoor air quality.

Figure 1. Study design schema

18 classrooms (25 students) in 3 schools were randomized to an air cleaner intervention or a sham filter control. 6 classrooms from 1 school also received IPM in the fall. Baseline study visits were completed prior to the start of school. Baseline classroom pollutant levels were measured during the fall semester prior to randomization.

Figure 2. Classroom particulate pollutant levels

Classroom PM_2.5 (μg/m³) and BC (μg/m³) levels at baseline and follow-up visits in the intervention and control groups. Mean and standard errors shown.