Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial

Panayiotis Kouis; Emmanouil Galanakis; Eleni Michaelidou; Paraskevi Kinni; Antonis Michanikou; Constantinos Pitsios; Julietta Perez; Souzana Achilleos; Nicos Middleton; Pinelopi Anagnostopoulou; Helen Dimitriou; Efstathios Revvas; Gerasimos Stamatelatos; Haris Zacharatos; Chrysanthos Savvides; Emily Vasiliadou; Nikos Kalivitis; Andreas Chrysanthou; Filippos Tymvios; Stefania I Papatheodorou; Petros Koutrakis; Panayiotis K Yiallouros

doi:10.1136/thorax-2023-220877

Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial

Thorax. 2024 Feb 22:thorax-2023-220877. doi: 10.1136/thorax-2023-220877. Online ahead of print.

Authors

Panayiotis Kouis¹, Emmanouil Galanakis², Eleni Michaelidou², Paraskevi Kinni¹, Antonis Michanikou¹, Constantinos Pitsios¹, Julietta Perez², Souzana Achilleos^{3

4}, Nicos Middleton⁵, Pinelopi Anagnostopoulou¹, Helen Dimitriou², Efstathios Revvas⁶, Gerasimos Stamatelatos⁶, Haris Zacharatos⁷, Chrysanthos Savvides⁸, Emily Vasiliadou⁸, Nikos Kalivitis⁹, Andreas Chrysanthou¹⁰, Filippos Tymvios¹¹, Stefania I Papatheodorou^{12

13}, Petros Koutrakis¹⁴, Panayiotis K Yiallouros¹⁵

Affiliations

¹ Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus.
² Medical School, University of Crete, Heraklion, Greece.
³ Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus.
⁴ Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
⁵ Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
⁶ E.n.A Consulting LP, Arachova, Greece.
⁷ Cellock LTD, Nicosia, Cyprus.
⁸ Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus.
⁹ Department of Chemistry, University of Crete, Heraklion, Greece.
¹⁰ Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Nicosia, Cyprus.
¹¹ Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Heraklion, Cyprus.
¹² Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA.
¹³ Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, New Jersey, USA.
¹⁴ Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA.
¹⁵ Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus yiallouros.panayiotis@ucy.ac.cy.

PMID: 38388489
DOI: 10.1136/thorax-2023-220877

Abstract

Introduction: Elevated particulate matter (PM) concentrations of anthropogenic and/or desert dust origin are associated with increased morbidity among children with asthma.

Objective: The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches randomised controlled trial assessed the impact of exposure reduction recommendations, including indoor air filtration, on childhood asthma control during high desert dust storms (DDS) season in Cyprus and Greece.

Design, participants, interventions and setting: Primary school children with asthma were randomised into three parallel groups: (a) no intervention (controls); (b) outdoor intervention (early alerts notifications, recommendations to stay indoors and limit outdoor physical activity during DDS) and (c) combined intervention (same as (b) combined with indoor air purification with high efficiency particulate air filters in children's homes and school classrooms. Asthma symptom control was assessed using the childhood Asthma Control Test (c-ACT), spirometry (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC)) and fractional exhaled nitric oxide (FeNO).

Results: In total, 182 children with asthma (age; mean=9.5, SD=1.63) were evaluated during 2019 and 2021. After three follow-up months, the combined intervention group demonstrated a significant improvement in c-ACT in comparison to controls (β=2.63, 95% CI 0.72 to 4.54, p=0.007), which was more profound among atopic children (β=3.56, 95% CI 0.04 to 7.07, p=0.047). Similarly, FEV1% predicted (β=4.26, 95% CI 0.54 to 7.99, p=0.025), the need for any asthma medication and unscheduled clinician visits, but not FVC% and FeNO, were significantly improved in the combined intervention compared with controls.

Conclusion: Recommendations to reduce exposure and use of indoor air filtration in areas with high PM pollution may improve symptom control and lung function in children with asthma.

Trial registration number: NCT03503812.

Keywords: paediatric asthma.

Associated data

ClinicalTrials.gov/NCT03503812