Pollution Intervention to Impact Kids Asthma Study (PIKAS) - Over the last several decades, Americans have been increasingly exposed to poor air quality events, such as those from wildfire smoke. Appropriately, there is a growing push for healthcare providers to discuss the Environmental Protection Agency (EPA) Air Quality Index (AQI) with patients, particularly children with asthma as they are more susceptible to the harms of air pollution. While the AQI is founded on decades of strong scientific evidence demonstrating exposure to outdoor air pollution worsens respiratory health including for children with asthma, surprisingly, there have been no large scale randomized clinical trials evaluating if adding the AQI and behavioral recommendations to asthma action plans (the current standard of care for asthma management) improves asthma outcomes in children. Moreover, the moderate category of the EPA-AQI applies to persons “unusually sensitive” to air pollution, yet which child with asthma this applies to is unclear to patients, parents, and clinicians alike. In addition to the EPA-AQI, the last decade has seen a marked increase in personal low-cost air pollution monitors which report an AQI, however the AQIs reported are not equivalent to EPA-AQI. The most widely available personal monitor measures particulate matter <2.5 𝜇m (PM2.5), reports an ultra-short exposure average and has been suggested as a possible tool in addressing hot-spots given better spatial resolution. Similar to the EPA-AQI, this commercial-AQI has not been evaluated as a tool for improving childhood asthma outcomes, despite the public becoming more familiar with such monitors and increased potential for personal use. Our region, Allegheny County, PA is the ideal region to test both AQI’s as the primary outdoor air pollutant is PM2.5. To avoid unnecessary and low value care and pursue evidenceproven effective interventions, we propose to conduct a single-site, unblinded, phase II randomized controlled parallel trial, to determine if adding the EPA-AQI or a commercial-AQI to an asthma action plan, compared to a control, improves asthma control (primary outcome, Aim 1), improves quality of life and reduces severe asthma exacerbations (secondary outcomes, Aim 2) over 48 weeks in children with asthma aged 8-17 years.Additionally, we will prospectively monitor those who report asthma symptoms within the moderate AQI category and conduct a transcriptome-wide analysis in nasal (airway) epithelial samples to identify differentially expressed genes in children with self-reported susceptibility (Aim 3). Results from this proposal will determine if the EPQ-AQI or commercial-AQI, when added to an asthma action plan, improves disease control and quality of life in children with asthma living in a region with PM2.5 as the predominant pollutant. We expect to identify children most susceptible to outdoor air pollution, allowing for future personalized intervention studies. As childhood asthma is highly prevalent, understanding the benefits of both the EPA-AQI and a commercial- AQI is highly relevant for clinical care, public health, and policy.
