title: Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Wood Smoke Exposure: Results From the Randomized Exposure Study of Pollution Indoors and Respiratory Effects and Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter Study.
abstract: BACKGROUND
  COPD is the third most frequent cause of death globally, with much of this burden attributable to household biomass smoke exposure in developing countries. As biomass smoke exposure is also associated with cardiovascular disease, lower respiratory infection, lung cancer, and cataracts, it presents an important target for public health intervention.
  
  
  METHODS
  Lung function in Guatemalan women exposed to wood smoke from open fires was measured throughout the Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) stove intervention trial and continued during the Chronic Respiratory Effects of Early Childhood Exposure to Respirable Particulate Matter (CRECER) cohort study. In RESPIRE, early stove households received a chimney woodstove at the beginning of the 18-month trial, and delayed stove households received a stove at trial completion. Personal exposure to wood smoke was assessed with exhaled breath carbon monoxide (CO) and personal CO tubes. Change in lung function between intervention groups and as a function of wood smoke exposure was assessed using random effects models.
  
  
  RESULTS
  Of 306 women participating in both studies, acceptable spirometry was collected in 129 early stove and 136 delayed stove households (n = 265), with a mean follow-up of 5.6 years. Despite reduced wood smoke exposures in early stove households, there were no significant differences in any of the measured spirometric variables during the study period (FEV1, FVC, FEV1/FVC ratio, and annual change) after adjustment for confounding.
  
  
  CONCLUSIONS
  In these young Guatemalan women, there was no association between lung function and early randomization to a chimney stove or personal wood smoke exposure. Future stove intervention trials should incorporate cleaner stoves, longer follow-up, or potentially susceptible groups to identify meaningful differences in lung function.
authors.affiliation: Department of Pulmonary and Critical Care, University of California, San Francisco, San Francisco, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Guarnieri
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Diaz
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, England.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pope
authors.affiliation: School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Eisen
authors.affiliation: School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mann
authors.affiliation: School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Smith
authors.affiliation: Research Unit for General Practice, Uni Research Health, Bergen, Norway.
authors.forename: Tone
authors.initials: T
authors.lastname: Smith-Sivertsen
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, England.
authors.forename: Nigel G
authors.initials: NG
authors.lastname: Bruce
authors.affiliation: Department of Medicine, University of California, San Francisco, San Francisco, CA; School of Public Health, Environmental Sciences, University of California, Berkeley, Berkeley, CA, Norway. Electronic address: John.balmes@ucsf.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Balmes
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects*; D002248:Carbon Monoxide / Q000032:analysis*; D002648:Child; D003296:Cooking; D018876:Environmental Illness / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D052638:Particulate Matter / Q000009:adverse effects*; D012119:Respiration / Q000187:drug effects*; D012424:Rural Population; D012906:Smoke; D013147:Spirometry; D014934:Wood
chemical_list: D052638:Particulate Matter; D012906:Smoke; D002248:Carbon Monoxide