Asthma randomized trial of indoor wood smoke (ARTIS): rationale and methods.
BACKGROUND
Particulate matter (PM) exposures have been linked with poor respiratory health outcomes, especially among susceptible populations such as asthmatic children. Smoke from biomass combustion for residential home heating is an important source of PM in many rural or peri-urban areas in the United States.


OBJECTIVE
To assess the efficacy of residential interventions that reduce indoor PM exposure from wood stoves and to quantify the corresponding improvements in quality of life and health outcomes for asthmatic children.


METHODS
The asthma randomized trial of indoor wood smoke (ARTIS) study is an in-home intervention study of susceptible children exposed to biomass combustion smoke. Children, ages 7 to 17, with persistent asthma and living in homes that heat with wood stoves were recruited for this three arm randomized placebo-controlled trial. Two household-level intervention strategies, wood stove replacement and air filters, were compared to a sham air filter placebo. Improvement in quality of life of asthmatic children was the primary outcome. Secondary asthma-related health outcomes included peak expiratory flow (PEF) and forced expiratory volume in first second (FEV(1)), biomarkers in exhaled breath condensate, and frequency of asthma symptoms, medication usage, and healthcare utilization. Exposure outcomes included indoor and outdoor PM(2.5) mass, particle counts of several size fractions, and carbon monoxide.


CONCLUSIONS
To our knowledge, this was the first randomized trial in the US to utilize interventions targeting residential wood stoves to assess the impact on indoor PM and health outcomes in a susceptible population.
Center for Environmental Health Sciences, Department of Biomedical Sciences, The University of Montana, Missoula, MT 59812, USA. curtis.noonan@umontana.edu
Curtis W
CW
Noonan
Tony J
TJ
Ward
D000293:Adolescent; D061808:Air Filters; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis / Q000517:prevention & control; D001249:Asthma / Q000453:epidemiology / Q000628:therapy*; D015415:Biomarkers; D002648:Child; D004784:Environmental Monitoring / Q000379:methods; D005260:Female; D005374:Filtration; D006801:Humans; D008297:Male; D015337:Multicenter Studies as Topic / Q000379:methods; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012129:Respiratory Function Tests; D012906:Smoke / Q000009:adverse effects* / Q000032:analysis; D014481:United States; D014934:Wood
D015415:Biomarkers; D052638:Particulate Matter; D012906:Smoke