Effects of a Household Air Pollution Intervention with Liquefied Petroleum Gas on Cardiopulmonary Outcomes in Peru. A Randomized Controlled Trial

Abstract

Rationale: Approximately 40% of people worldwide are exposed to household air pollution (HAP) from the burning of biomass fuels. Previous efforts to document health benefits of HAP mitigation have been stymied by an inability to lower emissions to target levels.Objectives: We sought to determine if a household air pollution intervention with liquefied petroleum gas (LPG) improved cardiopulmonary health outcomes in adult women living in a resource-poor setting in Peru.Methods: We conducted a randomized controlled field trial in 180 women aged 25-64 years living in rural Puno, Peru. Intervention women received an LPG stove, continuous fuel delivery for 1 year, education, and behavioral messaging, whereas control women were asked to continue their usual cooking practices. We assessed for stove use adherence using temperature loggers installed in both LPG and biomass stoves of intervention households. Measurements and Main Results:We measured blood pressure, peak expiratory flow (PEF), and respiratory symptoms using the St. George's Respiratory Questionnaire at baseline and at 3-4 visits after randomization. Intervention women used their LPG stove exclusively for 98% of days. We did not find differences in average postrandomization systolic blood pressure (interventioncontrol 0.7 mm Hg; 95% confidence interval, 22.1 to 3.4), diastolic blood pressure (0.3 mm Hg; 21.5 to 2.0), prebronchodilator peak expiratory flow/height 2 (0.14 L/s/m 2 ; 20.02 to 0.29), postbronchodilator peak expiratory flow/height 2 (0.11 L/s/m 2 ; 20.05 to 0.27), or St. George's Respiratory Questionnaire total score (21.4; 23.9 to 1.2) over 1 year in intention-to-treat analysis. There were no reported harms related to the intervention.Conclusions: We did not find evidence of a difference in blood pressure, lung function, or respiratory symptoms during the year-long intervention with LPG.Clinical trial registered with www.clinicaltrials.gov (NCT02994680).

Fidelity and Adherence to a Liquefied Petroleum Gas Stove and Fuel Intervention During Gestation: The Multi-country Household Air Pollution Intervention Network (HAPIN) Randomized Controlled Trial

“…In Malawi, use of the improved biomass intervention stove declined over time, with a quarter of the trial households abandoning the intervention stove after one year (Mortimer et al 2017). By contrast, less stacking with traditional stoves has been reported in previous trials that, like ours, intervened with LPG stoves, and where both stoves and fuel were available at no cost to the participants (Checkley et al 2020.…”

“…HAP is responsible for 2.3 million deaths and 91 million disability-adjusted life years lost each year (GBD 2019 Risk Factors Collaborators 2020). Throughout the last decade, many interventions have attempted to mitigate HAP through cleaner burning biomass stoves or cleaner energy interventions (Mortimer et al 2017;Jack et al 2021;Tielsch et al 2014;Alexander et al 2018); however, most intervention trials have failed to achieve clean air quality targets until recently (Checkley et al 2020). Proposed reasons for failure include continued mixed use of traditional and intervention stoves ("stove stacking," Mortimer et al 2017;Dickinson et al 2019) and infiltration of outdoor air pollution (Chillrud et al 2021).…”

Inequities in air pollution exposure and gaps in air quality monitoring

“…Successful interventions to mitigate household air pollution require a multifaceted approach that involves not only affordable clean fuel but also education and behavioral messaging to bring about change in cultural views and cooking behaviors and promote exclusive use of clean fuel. 10 Despite the extensive body of scientific evidence linking air pollution with increased morbidity and mortality, air pollution has only recently begun receiving public and policy attention, and mitigation strategies remain largely absent from guidelines on disease prevention. In a landmark ruling in 2020 that attracted global media attention, air pollution was recorded as a cause of death for a British girl who died in 2013 following an asthma attack, marking the first instance of air pollution being explicitly linked to a specific person's death (https://www.bbc.com/news/ uk-england-london-55330945#:;:text5A%20nine%2Dyear% 2Dold%20girl,east%20London%2C%20died%20in%202013).…”

The Conundrum of Cleaner Cookstove Interventions: Necessary but Insufficient?

“…In this issue of the Journal , Checkley and colleagues (pp. 1386–1397 ) examine the effect of a year-long, multifaceted liquefied petroleum gas (LPG) cookstove intervention as compared with biomass (commonly animal dung) cookstove on cardiopulmonary health in adults, specifically resting BP, peak expiratory flow (PEF), and respiratory symptoms as measured by the St. George’s Respiratory Questionnaire ( 13 ). The intervention included provision of a three-burner LPG stove, education and behavioral messaging, and biweekly LPG fuel refills and stove inspections and repairs for the duration of the study.…”