HEPA filtration intervention in classrooms may improve some students’ asthma
Open accessAbstract
Objective The School Inner-City Asthma Intervention Study 2 (SICAS 2) tested interventions to reduce exposures in classrooms of students with asthma. The objective of this post-hoc analysis was limited to evaluating the effect of high-efficiency particulate (HEPA) filtration interventions on mold levels as quantified using the Environmental Relative Moldiness Index (ERMI) and the possible improvement in the students’ asthma, as quantified by spirometry testing.Methods Pre-intervention dust samples were collected at the beginning of the school year from classrooms and corresponding homes of students with asthma (n = 150). Follow-up dust samples were collected in the classrooms at the end of the HEPA or Sham intervention. For each dust sample, ERMI values and the Group 1 and Group 2 mold levels (components of the ERMI metric) were quantified. In addition, each student’s lung function was evaluated by spirometry testing, specifically the percentage predicted forced expiratory volume at 1 sec (FEV1%), before and at the end of the intervention.Results For those students with a higher Group 1 mold level in their pre-intervention classroom than home (n = 94), the FEV1% results for those students was significantly (p < 0.05) inversely correlated with the Group 1 level in their classrooms. After the HEPA intervention, the average Group 1 and ERMI values were significantly lowered, and the average FEV1% test results significantly increased by an average of 4.22% for students in HEPA compared to Sham classrooms.Conclusions HEPA intervention in classrooms reduced Group 1 and ERMI values, which corresponded to improvements in the students’ FEV1% test results.
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The 2009 IPM study demonstrates that integrated pest management achieved a greater and meaningful reduction in cockroach allergen levels, providing a model for school-based allergen control.
“While clinical outcomes were not assessed, the study demonstrates that IPM achieved a greater and meaningful reduction in cockroach allergen levels providing a model for school-based allergen control with demonstrated efficacy at reducing exposure, a necessary first step toward impacting asthma outcomes (59).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [59]
The Introduction (page unavailable) reports a 63% reduction in asthma symptoms in IPM schools, contrary to the citing sentence’s statement that clinical outcomes were not assessed. The Methods describe SICAS 2 rather than a 2009 study; no passage found in our copy reports a reduction in cockroach allergen levels. (LLM, conf=0.82)
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Experimental — accuracy not yet measuredIn the 2009 IPM study, allergen reductions were especially pronounced in food service areas.
“Allergen reductions were especially pronounced in food service areas (59).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [59]
The Introduction reports reduced airborne mouse and dog allergens in HEPA-treated classrooms. It does not report allergen reductions in food service areas, compare reductions across school areas, or identify a 2009 IPM study as the basis for this finding; the Methods describe a later five-year classroom intervention. No page numbers are available in our copy. (LLM, conf=0.80)
Experimental — accuracy not yet measuredIn a 2009 study of North Carolina public schools, schools using integrated pest management had significantly lower cockroach counts and allergen concentrations (Bla g 1) compared with schools using conventional pest control.
“This study found that schools using integrated pest management (IPM) had significantly lower cockroach counts and allergen concentrations (Bla g 1) compared with schools using conventional pest control (59).”
From Indoor Allergen Interventions in Homes and Schools for Managing Asthma (2025) · cites this paper as [59]
The Methods describe a classroom intervention that included integrated pest management, and the Introduction reports a reduction in asthma symptoms at IPM schools. Our copy does not report cockroach counts, Bla g 1 concentrations, or a comparison with conventional pest control; searches for those terms and the claimed 2009 North Carolina study found no matching passage. The supplied sections have no page numbers. (LLM, conf=0.76)
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- Authors
- Vesper, S. J., Wymer, L., Coull, B. A., Koutrakis, P., Cunningham, A., Petty, C. R., Metwali, N., Sheehan, W. J., Gaffin, J. M., Permaul, P., Lai, P. S., Bartnikas, L. M., Hauptman, M., Gold, D. R., Baxi, S. M., & Phipatanakul, W.
- Affiliations
- Environmental Protection Agency (US)
- Harvard University (US)
- Boston Children's Hospital (US)
- University of Iowa (US)
- NewYork–Presbyterian Hospital (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Vesper, Stephen J.
- ORCID
- Venue
- Journal of Asthma
- Publisher
- Informa UK Limited
- Published
- 2022-04-10
- Volume
- 60
- Issue
- 3
- Pages
- 479-486
- ISSN
- 0277-0903 (ISSN-L)
- 1532-4303
- PMC
- PMC9548522
- OpenAlex
- W4220827177
- Cited by
- 19
- References
- 25
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 2
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Asthma (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- HEPA filtration, classroom air quality, childhood asthma, indoor mold exposure, lung function, FEV1, school-based intervention, dust sampling, sham intervention
- MeSH terms
- Asthma, Dust, Fungi, Housing, Humans, Spirometry, Air Pollution, Indoor
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