Should Household Air Quality Monitoring Be Considered in Selected Asthma & COPD Patients?

BackgroundIndoor air quality (IAQ) is a well demonstrated actionable determinant of health status. Low-cost sensors (LCS) could enable patient-centred assessments, but real-world clinical utility is uncertain. ObjectiveEvaluate the feasibility, usability, and clinical indications of home IAQ monitoring with LCS. MethodsWe conducted a cohort study involving household continuous IAQ monitoring with LCS of 205 adults with COPD, bronchiectasis, or asthma. Household IAQ was profiled prospectively over two-month period registering concentrations of CO2, PM2.5and formaldehyde every 10 min. For each pollutant, dwellings were classified as Good, Moderate or Unhealthy according to the Global Open Air Quality Standards thresholds (GO-AQS). Pulmonary exacerbations requiring unplanned hospitalizations, and all-cause emergency department (ED) visits, over the preceding 12 months were registered and potential relationships with household IAQ results were explored. ResultsMore than half of homes (51.7%) had at least one pollutant in an at-risk category. The burden was mostly generated by PM2.5: 40.1% of dwellings were classified as at risk (32.8% Moderate; 7.3% Unhealthy). Formaldehyde exceeded the low-risk threshold in 22 homes (12.4%). Tobacco smoking, either active or passive, was significantly associated with PM2.5levels (p<0.001). No relationships were found between IAQ categories and hospitalizations nor with all-cause ED visits. ConclusionsLCS are useful tools for short-term, targeted household IAQ screening in chronic respiratory patients. Indoor pollution is highly prevalent and largely PM2.5driven. Further research is needed to assess the short-term health impacts of these exposures. RegistrationNCT06421402. What is already known on this topicIndoor air pollution constitutes a major environmental determinant of respiratory morbidity, with evidence indicating that reducing exposure through improved IAQ can attenuate associated health risks. The potential of LCS for identifying modifiable exposures in patients with chronic respiratory disease has been suggested, but their real-world feasibility and clinical value to inform preventive care interventions are still uncertain. What this study addsThis study demonstrates that LCS are feasible and reliable tools for short-term household IAQ screening in chronic respiratory patients. Whereas, indoor pollution was found to be highly prevalent, mainly driven by fine PM and indoor smoking, supporting their use for targeted risk assessment. How this study might affect research, practice, or policyThese findings highlight the need to consider IAQ as a modifiable component of chronic respiratory care and support the inclusion of environmental assessments in preventive management. Further research should explore short-term health impacts and develop actionable guidelines for integrating IAQ monitoring into clinical and public health strategies.