The MEDEA childhood asthma study design for mitigation of desert dust health effects: implementation of novel methods for assessment of air pollution exposure and lessons learned

Panayiotis Kouis, Stefania I Papatheodorou, Maria G Kakkoura, Nicos Middleton, Emmanuel Galanakis, Eleni Michaelidi, Souzana Achilleos, Nikolaos Mihalopoulos, Marina Neophytou, Gerasimos Stamatelatos, Christos Kaniklides, Efstathios Revvas, Filippos Tymvios, Chrysanthos Savvides, Petros Koutrakis, Panayiotis K Yiallouros, Panayiotis Kouis, Stefania I Papatheodorou, Maria G Kakkoura, Nicos Middleton, Emmanuel Galanakis, Eleni Michaelidi, Souzana Achilleos, Nikolaos Mihalopoulos, Marina Neophytou, Gerasimos Stamatelatos, Christos Kaniklides, Efstathios Revvas, Filippos Tymvios, Chrysanthos Savvides, Petros Koutrakis, Panayiotis K Yiallouros

Abstract

Background: Desert dust events in Mediterranean countries, originating mostly from the Sahara and Arabian deserts, have been linked to climate change and are associated with significant increase in mortality and hospital admissions from respiratory causes. The MEDEA clinical intervention study in children with asthma is funded by EU LIFE+ program to evaluate the efficacy of recommendations aiming to reduce exposure to desert dust and related health effects.

Methods: This paper describes the design, methods, and challenges of the MEDEA childhood asthma study, which is performed in two highly exposed regions of the Eastern Mediterranean: Cyprus and Greece-Crete. Eligible children are recruited using screening surveys performed at primary schools and are randomized to three parallel intervention groups: a) no intervention for desert dust events, b) interventions for outdoor exposure reduction, and c) interventions for both outdoor and indoor exposure reduction. At baseline visits, participants are enrolled on MEDena® Health-Hub, which communicates, alerts and provides exposure reduction recommendations in anticipation of desert dust events. MEDEA employs novel environmental epidemiology and telemedicine methods including wearable GPS, actigraphy, health parameters sensors as well as indoor and outdoor air pollution samplers to assess study participants' compliance to recommendations, air pollutant exposures in homes and schools, and disease related clinical outcomes.

Discussion: The MEDEA study evaluates, for the first time, interventions aiming to reduce desert dust exposure and implement novel telemedicine methods in assessing clinical outcomes and personal compliance to recommendations. In Cyprus and Crete, during the first study period (February-May 2019), a total of 91 children participated in the trial while for the second study period (February-May 2020), another 120 children completed data collection. Recruitment for the third study period (February-May 2021) is underway. In this paper, we also present the unique challenges faced during the implementation of novel methodologies to reduce air pollution exposure in children. Engagement of families of asthmatic children, schools and local communities, is critical. Successful study completion will provide the knowledge for informed decision-making both at national and international level for mitigating the health effects of desert dust events in South-Eastern Europe.

Trial registration: ClinicalTrials.gov: NCT03503812 , April 20, 2018.

Keywords: Asian dust; Asthma; Children; Desert dust; Public health intervention.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Asthma panel study schematic diagram. The bidirectional MEDena® Health-Hubis updated with meteorological forecasting and air-quality information regarding DDS events and sends alerts and exposure reduction guidelines to parents and teachers of asthmatic children participating in the study. At the same time, the MEDena® Health-Hub is automatically collecting the physical activity and GPS data from the wristbands worn by the children. Researchers also manually upload children clinical data and air quality measurements. DDS: Desert Dust Storm, FeNO: Fractional exhaled Nitric Oxide, GPS: Global Positioning System, SMS: Short Messaging Service text message
Fig. 2
Fig. 2
Childhood Asthma panel study SPIRIT flow diagram: The schedule of enrolment, interventions and assessments in the Childhood Asthma panel study according to SPIRIT template
Fig. 3
Fig. 3
Childhood Asthma panel study assessments timeline. Timeline of baseline and follow-up assessments in Childhood Asthma panel study for the two study years. DDS: Desert Dust Storm, FeNO: Fractional exhaled Nitric Oxide, ACT: Asthma Control Test questionnaire

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Source: PubMed

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