Disclosure - Portable air cleaners 

Hansel reported receiving grants from Boehringer Ingelheim, COPD Foundation and NIH; personal expenses from AstraZeneca and Mylan; and grants and personal expenses from GlaxoSmithKline. 

Please see the research for all other relevant author financial disclosures.

Portable air cleaners improved respiratory outcomes among former smokers with COPD

with the greatest benefit found in those with greater adherence and those who spent more time indoors, according to the CLEAN AIR STUDY results.

Although outdoor air pollution has been aware of the adverse respiratory effects, the indoor environment is of particular concern

as most individuals with COPD spend most of their time indoors and the concentration of indoor air particles in the homes of former smokers with COPD has been linked to worse respiratory symptoms

poorer quality of life and increased respiratory exacerbations.  Nadia N. Hansel, MD, MPH, professor of medicine at Johns Hopkins University School of Medicine and from the department of health and environmental engineering at the Johns Hopkins Bloomberg School of Public Health, and colleagues write.

The randomized controlled CLEAN AIR study included 116 former smokers with moderate to severe COPD (average age, 65.7 years; 51.7% women; 84.5% completed the study). 

Portable air cleaners may improve respiratory outcomes in former smokers with COPD October 28, 2021

All participants were randomly assigned to use an active portable high-efficiency particulate air cleaners (HEPA) (n = 58; Austin Air Cleaners) or fake devices that have internal HEPA and carbon filters removed (n = 58). 

Participants were asked to place air cleanerss in their bedrooms and other rooms that they reported spending most of the time. The follow-up is 6 months. Intent to treat analysis included all participants, and per-protocol analysis included participants with at least 80% compliance.

Portable air cleaners intervention strategies are practical and easy to implement by individuals at the household level

and improve respiratory symptoms in other chronic respiratory diseases, including in children with asthma; However

studies of such interventions have not been conducted in COPD and it is not known whether the use of portable air cleanerss in the homes of individuals with COPD can reduce indoor pollutants and improve COPD outcomes," the researchers wrote.

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The main result was a change in the Saint George's Respiratory Questionnaire (SGRQ) at 6 months.

The researchers reported no significant difference in total SGRQ scores in both groups

but the active air cleaners group had greater reductions in the SGRQ symptom subscale (beta =-7.7; 95% CI, -15 to -0.37) and respiratory symptoms (beta=-0.8; 95% CI, -1.5 to -0.1) compared to the fake air cleaners group.

At 6 months, there was no significant difference in the main results between the two groups (SGRQ, -1.55; 95% CI, -5.75 to 2.65; P = 0.46) in the analysis of intent to treat.

In addition, compared to the fake air cleaners group, the active group had lower moderate COPD exacerbation rates (incidence rate ratio [IRR] = 0.32; 95% CI, 0.12-0.91) and rescue drug use (IRR = 0.54; 95% CI, 0.33-0.86).

In the per-protocol analysis, the researchers reported significant differences in 6-month changes in SGRQ in the active air cleaners group compared to the counterfeit group (beta = -4.76; 95% CI, -9.2 to -0.34). 

There were also significant risk differences for moderate COPD exacerbations (beta = -0.51; 95% CI, -3.03 to -2), Breathlessness, Cough and Sputum Scale (beta = -0.81; 95% CI, -1.53 to -0.09) and walking distances of 6 minutes (beta = 54.5 m; 95% CI, -16.8 to 125.9).

Participants in the active air cleaners group who spent more time indoors were most likely to experience the treatment benefits of HEPA air cleanerss

with greater improvements in SGRQ (-6.8; 95% CI, -12.55 to -1.06; P = .021), risk of COPD exacerbation (-3.92; 95% CI, -7.22 to -0.49; P = .023) and Breathlessness, Cough and Sputum Scale (-1.86; 95% CI, -2.82 to -0.9; P < .001) compared to the fake group.

Although this study did not achieve statistical significance for key results in the analysis of intent to treat

the use of portable HEPA air cleanerss improved some respiratory outcomes, especially among those who had more than 80% compliance with air cleanerss

and those who spent most of their time in their homes," the researchers wrote. "Interventions that improve air quality are a potentially new approach to reducing respiratory morbidity in patients with COPD 

and persistent respiratory symptoms and the risk of exacerbation despite quitting smoking. Furthermore

given that environmental exposure contributes to most of the worldwide COPD burden, this study may have far-reaching implications. 

SOURCE ARTICLE : https://www.healio.com



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