A Randomized Trial of Air Cleaners and a Health Coach to Improve Indoor Air Quality for Inner-City Children With Asthma and Secondhand Smoke Exposure

Objective: To test an air cleaner and health coach intervention to reduce secondhand smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter (PM), air nicotine, and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker. Design: Randomized controlled trial, with randomization embedded in study database. Settings: The Johns Hopkins Hospital Children's Center and homes of children. Participants: Children with asthma, residing with a smoker, randomly assigned to interventions consisting of air cleaners only (n=41), air cleaners plus a health coach (n=41), or delayed air cleaner (control) (n=44). Main Outcome Measures: Changes in PM, air nicotine, and urine cotinine concentrations and symptom-free days during the 6-month study. Results: The overall follow-up rate was high (91.3%). Changes in mean fine and coarse PM (PM2.5 and PM2.5-10) concentrations (baseline to 6 months) were significantly lower in both air cleaner groups compared with the control group (mean differences for PM2.5 concentrations: control, 3.5 mu g/m(3); air cleaner only, -19.9 mu g/m(3); and air cleaner plus health coach, -16.1 mu g/m(3); P=.003; and PM2.5-10 concentrations: control, 2.4 mu g/m(3); air cleaner only, -8.7 mu g/m(3); and air cleaner plus health coach, -10.6 mu g/m(3); P=.02). No differences were noted in air nicotine or urine cotinine concentrations. The health coach provided no additional reduction in PM concentrations. Symptom-free days were significantly reduced in both air cleaner groups compared with the control group (P=.03). Conclusion: Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke.