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Asthma
Original research
Improved childhood asthma control after exposure reduction interventions for desert dust and anthropogenic air pollution: the MEDEA randomised controlled trial
  1. Panayiotis Kouis1,
  2. Emmanouil Galanakis2,
  3. Eleni Michaelidou2,
  4. Paraskevi Kinni1,
  5. Antonis Michanikou1,
  6. Constantinos Pitsios1,
  7. Julietta Perez2,
  8. Souzana Achilleos3,4,
  9. Nicos Middleton5,
  10. Pinelopi Anagnostopoulou1,
  11. Helen Dimitriou2,
  12. Efstathios Revvas6,
  13. Gerasimos Stamatelatos6,
  14. Haris Zacharatos7,
  15. Chrysanthos Savvides8,
  16. Emily Vasiliadou8,
  17. Nikos Kalivitis9,
  18. Andreas Chrysanthou10,
  19. Filippos Tymvios11,
  20. Stefania I Papatheodorou12,13,
  21. Petros Koutrakis14,
  22. Panayiotis K Yiallouros1
  1. 1Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus
  2. 2Medical School, University of Crete, Heraklion, Greece
  3. 3Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
  4. 4Cyprus International Institute for Environmental and Public Health, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
  5. 5Department of Nursing, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
  6. 6E.n.A Consulting LP, Arachova, Greece
  7. 7Cellock LTD, Nicosia, Cyprus
  8. 8Air Quality and Strategic Planning Section, Department of Labour Inspection, Ministry of Labour, Welfare and Social Insurance, Nicosia, Cyprus
  9. 9Department of Chemistry, University of Crete, Heraklion, Greece
  10. 10Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Nicosia, Cyprus
  11. 11Department of Meteorology, Ministry of Agriculture, Rural Development and Environment, Heraklion, Cyprus
  12. 12Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  13. 13Department of Biostatistics and Epidemiology, Rutgers School of Public Health, New Brunswick, New Jersey, USA
  14. 14Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
  1. Correspondence to Professor Panayiotis K Yiallouros, Respiratory Physiology Laboratory, Medical School, University of Cyprus, Nicosia, Cyprus; yiallouros.panayiotis{at}ucy.ac.cy

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.

  • paediatric asthma

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/thorax-2023-220877

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Contributors PKouis: project administration, methodology, investigation, software, data curation, visualisation, formal analysis, writing—original draft preparation; EG: methodology, writing—review and editing, supervision; EM: investigation, data curation, writing—review and editing; PKinni: investigation, data curation, software, visualisation, writing—review and editing; AM: investigation, methodology, software, data curation, writing—review and editing; CP: investigation, methodology, data collection, JP: investigation, software, data curation; SA: investigation, data curation, writing—review and editing; NM: methodology, data curation, formal analysis, writing—review and editing; PA: data curation, software, visualisation, writing—review and editing; HD: Project administration, data curation, writing—review and editing; ER: software, writing—review and editing; GS: software, writing—review and editing; HZ: software, data duration, writing—review and editing; CS: investigation, resources, methodology, data curation, writing—review and editing; EV: investigation, resources, project administration, data curation, writing—review and editing; NK: investigation, resources, methodology, data curation, writing—review and editing; AC: investigation, resources, data curation, writing—review and editing; FT: investigation, resources, data curation, writing—review and editing; SIP: methodology, formal analysis, writing—review and editing; PKoutrakis: conceptualisation, methodology, formal analysis, writing—review and editing; PY: conceptualisation, methodology, formal analysis, writing—original draft preparation, funding acquisition, supervision. PY (content guarantor) accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The study was financed by the European Union LIFE Project MEDEA (LIFE16 CCA/CY/000041).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.