What’s the hottest gift this Chinese new year? Perhaps instead of moon cakes and red envelopes, you could give “the gift that keeps on giving”: an indoor air purifier. They certainly are all the rage in China since last year, with skyrocketing sales and sold-out inventories after the trio of highly publicized airpocalyptic crises. I think this is a good turn of events: plenty of independent testing,including mine, has documented that a good air purifier can dramatically improve your indoor PM2.5 by 80% or more. But is there any good data that proves that this actually makes you healthier? It seems logical, of course, that decreasing exposure to pollution would decrease harmful health effects. But medical history is filled with tales of common sense and tradition that later turn out to be worthless or harmful — like bloodletting, or the more modern tradition of multivitamins. A big percentage of people reading this article take a daily multivitamin, assuming it’s “healthier” to do so, but the best evidence shows they are worthless, and possibly harmful. Could air purifiers be the same?
In theory and in testing, a good purifier should improve a room’s pollution levels more than 80%; this80% reduction is also what the private Association of Home Appliance Manufacturers (AHAM) uses in their clean air delivery rate (CADR) tests, which are widely cited in comparison charts of air purifiers. So let’s say you’ve installed a top-of-the-line purifier in your living room, feeling quite safe and cozy. But how much of your time is actually in that filtered room? Or maybe the purifier is too small for that room size, or the filters are old, or the fan speed is too low, or the windows are open? Even this commonly cited CADR test is just a lab test for only 20 minutes — what about in the real world? I want to take this conversation to the next level, seeking out proof that your health will improve when using these machines. I want to be able to tell my patients and readers that there are published research studies which followed people over many months or even years, compared them to a control group not using air purifiers, and measured their health to see if there was any improvement in heart and lung disease, cancers and death rates. Are there any such studies?
I searched the Pubmed scientific database to find the best studies, and I was disappointed but not surprised to find very little strong data. A properly designed research project like this would be very difficult and expensive. But there are a few attempts, especially studies looking at using HEPA filters to help children with asthma. One was a systematic review published in 2002, which found that air filters helped to improve asthma symptoms — but the effect was small, and there was wide variation between studies which made conclusive assessments difficult. A more recent, very well designed study published in Pediatrics in 2011 followed two hundred children with asthma who also were exposed to secondhand smoke at home, and gave half of the kids a true HEPA purifier and the other half a fake purifier for their bedrooms. After a year, the HEPA group of children had less doctor visits for asthma flares, which possibly — but not conclusively — could be due to the 25% decrease in PM2.5 in their homes.
Other studies have focused on allergies, including an interesting study from 2008 which assessed children with documented pet allergies, following them over a year and recording lung function and blood markers. After a year, those who used HEPA air purifiers showed no clear difference in lung function, use of allergy medicines, or blood markers of allergies. Another study back in 1990 was a bit more impressive, showing not only a 70% reduction in indoor PM0.3 but also improved patient symptoms of allergies.
All of these hint at health benefits, but they still dance around the edges of what I want to know for us in China and the developing world. In the USA, most of the air purifier marketing and testing focuses on allergies and asthma. But here in the developing countries, the air pollution is much more severe and thus the health risks are far more serious. We are worried about pollution’s long-term risks of death, heart and lung disease and cancer. These studies I just mentioned still aren’t answering that deeper question: can long-term use of indoor air purifiers prevent death, heart and lung disease, and cancer?