Rationale: The impact of a household air pollution (HAP) stove intervention on child lung function has been poorly described. Objectives: To assess the effect of a HAP stove intervention for infants prenatally to age 1 on, and exposure-response associations with, lung function at child age 4. Methods: The Ghana Randomized Air Pollution and Health Study randomized pregnant women to liquefied petroleum gas (LPG), improved biomass, or open-fire (control) stove conditions through child age 1. 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 4. We examined associations between Ghana Randomized Air Pollution and Health Study stove assignment and prenatal and infant CO measurements and oscillometry using generalized linear regression models. We used reverse distributed lag models to examine time-varying associations between prenatal CO and oscillometry. Measurements and Main Results: The primary oscillometry measure was reactance at 5 Hz, X5, a measure of elastic and inertial lung properties. Secondary measures included total, large airway, and small airway resistance at 5 Hz, 20 Hz, and the difference in resistance at 5 Hz and 20 Hz (R5, R20, and R5-20, respectively); area of reactance (AX); and resonant frequency. Of the 683 children who attended the lung function visit, 567 (83%) performed acceptable oscillometry. A total of 221, 106, and 240 children were from the LPG, improved biomass, and control arms, respectively. Compared with control, the improved biomass stove condition was associated with lower reactance at 5 Hz (X5 z-score: β = -0.25; 95% confidence interval [CI] = -0.39, -0.11), higher large airway resistance (R20 z-score: β = 0.34; 95% CI = 0.23, 0.44), and higher AX (AX z-score: β = 0.16; 95% CI = 0.06, 0.26), which is suggestive of overall worse lung function. The LPG stove condition was associated with higher X5 (X5 score: β = 0.16; 95% CI = 0.01, 0.31) and lower small airway resistance (R5-20 z-score: β = -0.15; 95% CI = -0.30, 0.0), which is suggestive of better small airway function. Higher average prenatal CO exposure was associated with higher R5 and R20, and distributed lag models 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 registered with www.clinicaltrials.gov (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。


理由：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 1 岁婴儿的 HAP 炉灶干预对 4 岁时肺功能的影响，以及与肺功能的暴露反应相关性。方法：加纳随机空气污染与健康研究将孕妇随机分配给液化石油气（液化石油气）、改善生物质或直至儿童 1 岁的明火（控制）炉灶条件。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 4 岁时进行示波测量，这是一种与努力无关的肺功能测量。我们使用广义线性回归模型检查了加纳随机空气污染和健康研究炉灶分配与产前和婴儿 CO 测量和示波测量之间的关联。我们使用反向分布滞后模型来检查产前 CO 和示波法之间随时间变化的关联。测量和主要结果：主要的示波测量是 5 Hz、X5 下的电抗，这是肺弹性和惯性特性的测量。次要测量包括 5 Hz、20 Hz 时的总阻力、大气道阻力和小气道阻力，以及 5 Hz 和 20 Hz 时的阻力差（分别为 R5、R20 和 R5-20）；电抗面积 (AX)；和谐振频率。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。共有 221 名、106 名和 240 名儿童分别来自 LPG、改进生物质和控制组。与对照相比，改进的生物质炉条件与 5 Hz 下的较低电抗相关（X5 z 得分：β = -0.25；95% 置信区间 [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 AX（AX z 得分：β = 0.16；95% CI = 0.06, 0.26），即提示肺功能总体较差。 LPG 炉况与较高的 X5（X5 评分：β = 0.16；95% CI = 0.01, 0.31）和较低的小气道阻力（R5-20 z 评分：β = -0.15；95% CI = -0.30， 0.0），这表明小气道功能更好。较高的平均产前 CO 暴露与较高的 R5 和 R20 相关，分布式滞后模型确定了 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。在 www.clinicaltrials.gov 注册的临床试验 (NCT01335490)。