Peer-reviewed article
Early-life liquefied petroleum gas cooking intervention and lung function in Guatemalan children: a randomized clinical trial.
Laura M Grajeda, Keyla Castellanos, Anaité Díaz-Artiga, María R López, Alexander Ramirez et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This randomized controlled trial tested whether providing pregnant women and families in Guatemala with gas cookstoves instead of biomass cooking would improve children's lung function by age 3 years. The study enrolled 800 pregnant women and measured lung function using specialized testing in 525 three-year-old children. The intervention did not improve the main measures of lung function tested, though exploratory analysis suggested possible benefits for airway width.
Key points
- 525 of 750 (70%) eligible 3-year-olds completed valid lung function testing
- The gas cookstove intervention did not significantly improve prespecified lung function outcomes compared to biomass cooking
- 57% of missed tests were because children were unwilling to perform the measurements
- Exploratory analysis found lower resistance across the frequency spectrum in the intervention group (adjusted difference: -0.31 cm H2O*S/L), suggesting possible positive impact on airway caliber
- The intervention ran from mid-gestation through the child's first year of life
Limitations
The study could not measure lung function in 30% of eligible children, limiting generalizability. The analysis was restricted to prespecified oscillometry outcomes which showed no benefit, though post-hoc exploratory findings suggest possible effects that require further investigation.
Abstract
RATIONALE: Household air pollution is a risk factor for obstructive lung diseases. OBJECTIVES: We estimated the effect of an early-life liquefied petroleum gas cooking intervention on childhood lung function. METHODS: The multi-country Household Air Pollution Intervention Network trial randomized 800 pregnant women (9 to <20 weeks gestation, 18 to <35 years) in Guatemala to receive a gas cookstove and free fuel intervention or continue cooking with biomass until the child is aged 1 year. The present analysis includes only Guatemalan children. At age 3 years, we measured lung function using oscillometry at 7-41 Hz (Tremoflo C-100, Thorasys). Outcomes were resistance and reactance at 7 Hz, area of reactance, resistance at 19 Hz, resistance difference between 7 and 19 Hz, and, as exploration, resistance across frequencies. Upper airway artifacts were removed using Tremoflo software. The effect of the intervention was estimated using linear regression models, unadjusted and adjusted (height, weight, age, sex). Children with respiratory infections during a 7-day recall period were excluded. RESULTS: Valid oscillometry was obtained from 525/750 (70%) 3-year-olds. Among the 225 missed oscillometry tests, 129/225 (57%) were due to the children not being willing to perform the measurements. We did not find evidence of an effect on prespecified oscillometry outcomes. Exploratory analysis suggested that resistance across the frequency spectrum was lower in intervention than control participants (adjusted difference: -0.31 cm H2O*S/L, 95% CI: -0.59, -0.03). CONCLUSIONS: Gas cooking compared to biomass cooking from mid-gestation through infancy was not associated with improved prespecified oscillometry outcomes in 3-year-old children. However, lowered resistance across all frequencies in the intervention arm suggests the intervention may have positively impacted airway caliber. Further studies are warranted, including exposure-response analysis and lung function trajectories. TRIAL REGISTRATION: Clinical trial registered at ClinicalTrials.gov (NCT02944682).