[Stoves] Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves

[Nikhil Desai]

Crispin:

Sorry to say, such studies produce nothing of value in design and promotion
of household cookstoves for the masses in the developing countries.

Just because something gets published in EHP on "rural areas of Montana,
Idaho, and Alaska, where residential wood combustion is a major source of
ambient and indoor PM2:5 and the primary source of home heating during
cold-temperature periods" and pays homage to Kirk Smith doesn't make it
worth giving a dime for it. Fortunately this was free.

I was impressed by the description of tools for "two, 48-h observation
periods during each of two winter periods, before and after intervention".
Seems like this kind of stuff is acceptable in "epidemiology" studies in
US. I kept scratching my head as I read the conclusion - "This trial was
conducted across several rural communities in three states, but translation
of these findings to other settings with similarly exposed child asthma
populations would require further study and inquiry into the challenges
associated with dissemination of in-home PM reduction strategies."

As an asthma sufferer, I don't see just what difference such studies would
make when to whom. This was said to be the first RCT. In recent years, a
lot of economic policy research is marketed in the name of  "first RCT on
this subject. Why, there is this piece by a trio at Harvard-MIT-Chicago
(now) about an RCT on "improved cookstoves" in Odisha, India published as
an MIT e-con department Working Paper a little over five years ago. I think
we should have Cecil get some money to do an RCT on rich theorists of
stoves and health.

Unfortunately, I have not yet found any associational epidemiology study
that has taught me anything but how poor rich science is.

Nikhil



On Tue, Oct 31, 2017 at 3:18 PM, Crispin Pemberton-Pigott <
crispinpigott at outlook.com> wrote:

> Randomized Trial of Interventions to Improve Childhood Asthma in Homes
> with Wood-burning Stoves
>
>
>
> https://ehp.niehs.nih.gov/ehp849/
>
>
>
> Curtis W. Noonan,1 Erin O. Semmens,1 Paul Smith,1,2 Solomon W. Harrar,3,4
> Luke Montrose,1 Emily Weiler,1 Marcy McNamara,1 and Tony J. Ward
>
>
>
> Background:
>
> Household air pollution due to biomass combustion for residential heating
> adversely affects vulnerable populations. Randomized controlled trials to
> improve indoor air quality in homes of children with asthma are limited,
> and no such studies have been conducted in homes using wood for heating.
>
>
>
> Objectives:
>
> Our aims were to test the hypothesis that household-level interventions,
> specifically improved-technology wood-burning appliances or air-filtration
> devices, would improve health measures, in particular Pediatric Asthma
> Quality of Life Questionnaire (PAQLQ) scores, relative to placebo, among
> children living with asthma in homes with wood-burning stoves.
>
>
>
> Methods:
>
> A three-arm placebo-controlled randomized trial was conducted in homes
> with wood-burning stoves among children with asthma. Multiple
> preintervention and postintervention data included PAQLQ (primary outcome),
> peak expiratory flow (PEF) monitoring, diurnal peak flow variability (dPFV,
> an indicator of airway hyperreactivity) and indoor particulate matter (PM)
> PM2.5.
>
>
>
> Results:
>
> Relative to placebo, neither the air filter nor the woodstove intervention
> showed improvement in quality-of-life measures. Among the secondary
> outcomes, dPFV showed a 4.1 percentage point decrease in variability [95%
> confidence interval (CI)=−7.8 to −0.4] for air-filtration use in comparison
> with placebo. The air-filter intervention showed a 67% (95% CI: 50% to 77%)
> reduction in indoor PM2.5, but no change was observed with the
> improved-technology woodstove intervention.
>
>
>
> Conclusions:
>
> Among children with asthma and chronic exposure to woodsmoke, an
> air-filter intervention that improved indoor air quality did not affect
> quality-of-life measures. Intent-to-treat analysis did show an improvement
> in the secondary measure of dPFV.
>
>
>
> Trial registration:
>
> ClincialTrials.gov NCT00807183. https://doi.org/10.1289/EHP849
>
>
>
>
>
>
>
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