PARTICULATE REDUCTION EDUCATION IN CITY HOMES (PREACH)

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In studies of persons with asthma, particulate matter (PM) in ambient air has been associated with respiratory morbidity (Romieu 1995). In many urban households, the leading modifiable source of particulate matter (PM) is environmental tobacco smoke (ETS). In our previous study 60% of households reported at least one smoker and some households with multiple smokers. In this study a single air cleaner was able to reduce indoor PM concentrations by 43% and the proportion of systematic children by 35%. (Eggleston 2005). We hypothesize that air cleaners in combination with reduced ETS will result in decreased PM10 levels in the home and subsequently reduce symptom days in children with persistent asthma. We plan to recruit 150 asthmatic children aged 6-12 years who reside in Baltimore and have a smoker in the household. All children will be randomized into three groups: HEPA air cleaners plus ETS/Indoor particulate behavior management, HEPA air cleaners and a standard asthma education and a standard asthma education group with delayed HEPA filter use. The HEPA air cleaners and ETS reduction Training Group will receive two HEPA air cleaners and four home visits by a health coach to assist the parent in reducing their child's exposure to ETS. Families in the HEPA air cleaners and Standard Asthma Education will receive two HEPA air cleaners and three home visits for standard asthma education. Use of air cleaners will be electronically monitored to determine level or "dose" of air cleaning used by families. All children will receive a home inspection, PM exposure monitoring, home dust allergen collection at baseline and at the end of the 6 month intervention. At baseline children will provide skin testing, urine cotinine, spirometry, blood for eosinophil counts and exhaled NO testing. Caregivers of each child will be interviewed at baseline and at 6 month follow-up regarding ETS reduction behaviors in the home, symptom frequency, asthma control, other environmental exposures and health care utilization outcomes. The primary outcome for this study is reduction in PM 10 and PM 2.5 over the 6 month follow-up. Secondary outcomes includes ETS reduction behavior change (i.e. smoker is smoking outside of home, child not sitting with smoker, reduction in number of household smokers), symptom free days and health care utilization measures.