Impact of the wood-burning Justa stove on Fractional Exhaled Nitric Oxide: A stepped-wedge randomized trial in Honduras
Year: 2022
Type: conference-abstract
Abstract: Background: In 2019, household air pollution from combustion related to household energy needs (e.g., cooking) was estimated to be responsible for 2.3 million premature deaths globally, including nearly 400,000 from chronic respiratory diseases. In rural Honduras, we demonstrated substantially reduced personal fine particulate matter [PM2.5] concentrations following a 3-year wood-burning Justa stove (engineered combustion chamber and chimney) intervention (e.g., 24-hour PM2.5 median [25th, 75th percentiles]: Justa, 43 [27, 73]; traditional stove, 81 [50, 141] µg/m3). We evaluated the impact of the intervention and PM2.5 and black carbon (BC) concentrations on fractional exhaled nitric oxide (FeNO), a noninvasively collected biomarker of eosinophilic airway inflammation previously associated with exposure to ambient air pollution. Methods: With 6 visits per household over 3 years, the individual-level, stepped-wedge randomized controlled trial was conducted among 230 primary female cooks aged 24-59 years and using traditional stoves at baseline. In addition to 24-hour gravimetric personal and kitchen PM2.5 and BC concentrations, we longitudinally assessed FeNO levels with the NIOX Vero device at each visit in a random sample of 90 participants. Among participants reporting no use of anti-inflammatory medications, we explored FeNO impacts of the intervention in intent-to-treat (adjusted for time trends) and exposure-response (adjusted for potential confounders) linear mixed effect models (n=414 observations). Results: We did not observe an effect of the intervention on FeNO levels (3% higher geometric mean among those assigned to the Justa compared to the traditional stove, 95% confidence interval [CI]: -12%, 21%). Associations between pollution concentrations and FeNO were consistent with the null association (e.g., we observed a difference of 4% lower FeNO per 1-unit higher log-transformed personal PM2.5, 95% CI: -9%, 1%). Conclusion: Evidence from ambient and HAP studies regarding associations with FeNO is inconsistent, and may be attributable to differing study populations, exposures, and FeNO measurement procedures.
Source: ISEE Conference Abstracts
Language: English
Subfield: Pollution
Field: Environmental Science
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W4316924878