Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Wood Smoke Exposure

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 fi res was measured throughout the Randomized Exposure Study of Pollution Indoors and Respiratory Eff ects (RESPIRE) stove intervention trial and continued during the Chronic Respiratory Eff ects 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 eff ects models. RESULTS: Of 306 women participating in both studies, acceptable spirometry was collected in 129 early stove and 136 delayed stove households (n 5 265), with a mean follow-up of 5.6 years. Despite reduced wood smoke exposures in early stove households, there were no signifi cant diff erences in any of the measured spirometric variables during the study period (FEV 1, FVC, FEV 1/FVC ratio, and annual change) aft er 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 diff erences in lung function.