To reduce air pollution exposure, the U.S. asthma guidelines recommend that children
check the Air Quality Index before outdoor activity. Whether adding the Air Quality
Index and recommendations to asthma action plans reduces exacerbations and improves
control and quality of life in children with asthma is unknown.
A pilot, unblinded, randomized clinical trial of 40 children with persistent asthma,
stratified by age and randomized 1:1, recruited from the University of Pittsburgh
Medical Center Children's Hospital of Pittsburgh (Pittsburgh, PA) was conducted. All
participants received asthma action plans and Air Quality Index education. The intervention
group received printed Air Quality Index information and showed the ability to use
AirNow. Asthma exacerbations were assessed through a questionnaire, asthma control
was assessed with the Asthma Control Test and Childhood Asthma Control Test, and quality
of life was assessed with the Pediatric Asthma Quality of Life Questionnaire. After
randomization (July–October 2020), participants were followed monthly for 6 months
(exit January–March 2021). Outcome differences between groups were evaluated at the
exit visit and over time (analysis was in 2021).
At randomization, there were no significant differences in age, sex, race, or asthma
severity. At exit, more intervention participants checked the Air Quality Index (63%
vs 15%) with no differences in the proportion of asthma exacerbations or mean Childhood
Asthma Control Test or Pediatric Asthma Quality of Life Questionnaire scores. The
mean change in Asthma Control Test score was higher in the intervention group (change
in Asthma Control Test=2.00 vs 0.15 for the control), which was modified by time (=1.85, CI=0.09, 3.61). Physical activity was decreased overall and showed modification
by treatment and time.
Addition of the Air Quality Index to asthma action plans led to improved asthma control
by Asthma Control Test scores but may decrease outdoor activity.