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Original Research: COPD |

Lung Function in Rural Guatemalan Women Before and After a Chimney Stove Intervention to Reduce Wood Smoke ExposureAdult Lung Function After a Randomized Stove Trial: 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

Michael Guarnieri, MD, MPH; Esperanza Diaz, MD, PhD; Daniel Pope, PhD; Ellen A. Eisen, ScD; Jennifer Mann, PhD, MPH; Kirk R. Smith, PhD, MPH; Tone Smith-Sivertsen, MD, PhD; Nigel G. Bruce, MBcHB, PhD; John R. Balmes, MD
Author and Funding Information

From the Department of Pulmonary and Critical Care (Dr Guarnieri) and Department of Medicine (Dr Balmes), University of California, San Francisco, San Francisco, CA; Department of Global Public Health and Primary Care (Dr Diaz), University of Bergen, Bergen, Norway; Department of Public Health and Policy (Drs Pope and Bruce), University of Liverpool, Liverpool, England; School of Public Health (Drs Eisen, Mann, Smith, and Balmes), Environmental Sciences, University of California, Berkeley, Berkeley, CA; and Research Unit for General Practice (Dr Smith-Sivertsen), Uni Research Health, Bergen, Norway.

CORRESPONDENCE TO: John R. Balmes, MD, University of California, San Francisco, Box 0843, San Francisco, CA 94143-0843; e-mail: John.balmes@ucsf.edu


FUNDING/SUPPORT: Supported by the Norwegian Research Council [Grant 153987/310] and National Institute of Environmental Health Sciences [Grant NIEHS R01ES010178].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1184-1192. doi:10.1378/chest.15-0261
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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.

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