RATIONALE The impact of a household air pollution (HAP) stove intervention on child lung function is poorly described. OBJECTIVES To assess the effect of a prenatal to age one HAP stove intervention on, and exposure-response associations with, age four lung function. METHODS The Ghana Randomized Air Pollution and Health Study (GRAPHS) randomized pregnant women to a liquefied petroleum gas (LPG), improved biomass, or open fire (control) stove through child age one. We quantified HAP exposure by repeated maternal and child personal carbon monoxide (CO) exposure measurements. Children performed oscillometry, an effort-independent lung function measurement, at age four. We examined associations between GRAPHS stove assignment and prenatal and infant CO measurements and oscillometry via generalized linear regression models. We used reverse distributed lag models (rDLMs) to examine time-varying associations between prenatal CO and oscillometry. MEASUREMENTS AND MAIN RESULTS The primary oscillometry measure was reactance at 5 Hertz, X5, a measure of elastic and inertial lung properties. Secondary measures included total, large and small airway resistance (R5, R20, R5-20), area of reactance (AX) and resonant frequency (Fres). Of the 683 children who attended the lung function visit, 567 (83%) performed acceptable oscillometry. Two hundred and twenty-one, 106, and 240 children were from the LPG, improved biomass and control arms, respectively. Compared to control, the improved biomass stove was associated with lower reactance at 5 Hertz (X5 z-score, beta=-0.25, 95% CI -0.39, -0.11), higher large airway resistance (R20 z-score, beta=0.34, 95% CI 0.23, 0.44) and higher area of reactance (AX z-score, beta=0.16, 95% CI 0.06, 0.26) suggestive of overall worse lung function. The LPG stove was associated with higher X5 (beta=0.16, 95% CI 0.01, 0.31) and lower small airway resistance (R5-20 z-score, beta=-0.15, 95% CI -0.30, 0.0) suggestive of better small airway function. Higher average prenatal CO exposure was associated with higher R5 and R20 and DLMs identified sensitive windows of exposure between CO and X5, R5, R20 and R5-20. CONCLUSIONS These data support the importance of prenatal HAP exposure on child lung function. Clinical trial registration available at www. CLINICALTRIALS gov, ID: NCT01335490.

中文翻译：

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家庭空气污染和儿童肺功能：加纳随机空气污染和健康研究。

基本原理 家庭空气污染 (HAP) 炉灶干预对儿童肺功能的影响鲜有描述。目的 评估产前至一岁 HAP 炉干预对四岁肺功能的影响以及暴露反应与四岁肺功能的关系。方法 加纳随机空气污染与健康研究 (GRAPHS) 将孕妇从一岁起随机分配到液化石油气 (LPG)、改良生物质或明火（控制）炉灶。我们通过重复测量孕产妇和儿童个人一氧化碳 (CO) 暴露量来量化 HAP 暴露。儿童在四岁时进行了示波测量，这是一种与努力无关的肺功能测量。我们通过广义线性回归模型研究了 GRAPHS 炉灶分配与产前和婴儿 CO 测量以及示波法之间的关联。我们使用反向分布滞后模型 (rDLM) 来检查产前 CO 和示波法之间随时间变化的关联。测量和主要结果 主要示波测量是 5 赫兹 X5 下的电抗，这是肺弹性和惯性特性的测量。次要测量包括总气道阻力、大气道阻力和小气道阻力（R5、R20、R5-20）、电抗面积（AX）和共振频率（Fres）。在参加肺功能检查的 683 名儿童中，567 名 (83%) 的示波测量结果合格。液化石油气、改进生物质和控制臂分别有 221、106 和 240 名儿童。与对照相比，改进的生物质炉具具有较低的 5 赫兹电抗（X5 z 得分，β=-0.25，95% CI -0.39，-0.11）、较高的大气道阻力（R20 z 得分，β=0.34） ，95% CI 0.23，0.44）和较高的电抗面积（AX z 得分，β=0.16，95% CI 0.06，0.26）表明肺功能总体较差。LPG 炉具与较高的 X5（β=0.16，95% CI 0.01，0.31）和较低的小气道阻力（R5-20 z 分数，β=-0.15，95% CI -0.30，0.0）相关，表明小气道阻力更好气道功能。较高的平均产前 CO 暴露与较高的 R5 和 R20 相关，DLM 确定了 CO 与 X5、R5、R20 和 R5-20 之间的敏感暴露窗口。结论 这些数据支持产前 HAP 暴露对儿童肺功能的重要性。临床试验注册可在 www. 临床试验政府，ID：NCT01335490。