Cluster Randomized Controlled Trial of an Advanced Stove to Reduce Risk of COPD

慢性阻塞性肺疾病(COPD)是发病率和 全球范围内的死亡率。固体低效燃烧引起的室内生物质烟雾暴露 燃料可能是欠发达地区妇女中主要的可预防原因 国家。尽管有大量证据表明生物质烟雾与 暴露和慢性阻塞性肺病已经在观察性研究中得到证实，主要 限制是暴露评估通常是通过自我报告进行的，没有 允许量化生物质烟雾对比率的影响的纵向研究 已经进行了肺功能下降的研究。此外，目前还没有关于 先进生物质燃烧炉延缓肺功能衰退的效果 生物质烟雾暴露妇女戒烟的功能。致信地址 这些数据差距，我们建议利用这一独特的机会，在 马拉维两项英国资助的研究的基础设施，一项先进的炉子干预试验 预防儿童肺炎(烹饪和肺炎研究或CAPS)和 肺疾病负担方案成人肺健康研究(ALHS)正在进行 在一些与CAPS相同的村庄进行。我们计划跟踪2000名成年人 肺活量测定、呼吸问卷管理和个人生物量烟雾 在6年内每年监测一次暴露情况。我们的假设是 更多的生物质烟雾暴露与肺功能更快的下降有关 以及更频繁的呼吸道症状。为了验证这一假设，我们将申请 R01资助进行前瞻性队列研究，具体目标如下：1) 检验炉灶干预对减少肺功能每年下降的效果 和呼吸道症状的发生率之间的关系；以及2)建立 接触生物质烟雾成分(一氧化碳、细颗粒物和 使用个人监测数据和肺功能下降率。为 这份为期一年的R56提案，我们计划对所有2000个科目进行个人监测 参加ALHS。要获得的知识对预防工作至关重要。 降低发展中国家患慢性阻塞性肺病的风险。

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Indoor biomass smoke exposure from inefficient burning of solid fuels may be the leading preventable cause among women in lesser developed countries. Although considerable evidence of an association between biomass smoke exposures and COPD has been demonstrated in observational studies, major limitations are that exposure assessment has been typically by self-report and no longitudinal studies that allow quantification of the effect of biomass smoke on the rate of decline in lung function have been conducted. Moreover, there are no studies of the efficacy of advanced biomass combustion stoves to slow the rate of decline in lung function in biomass smoke-exposed women as exist for smoking cessation. To address these data gaps, we propose to take advantage of the unique opportunity to build on the infrastructure of two UK-funded studies in Malawi, an advanced stove intervention trial to prevent childhood pneumonia (the Cooking and Pneumonia Study or CAPS) and a Burden of Lung Disease protocol Adult Lung Health Study (ALHS) which is being conducted in some of the same villages as CAPS. We plan to follow 2000 adults with spirometry, respiratory questionnaire administration, and personal biomass smoke exposure monitoring on an annual basis over a 6-year period. Our hypothesis is that greater biomass smoke exposure is associated with more rapid decline in lung function and more frequent respiratory symptoms. To test this hypothesis, we will be applying for R01 funding to conduct a prospective cohort study with the following specific aims: 1) to test the efficacy of the stove intervention to reduce the annual decline in lung function and incidence of respiratory symptoms; and 2) to establish the relationship between exposure to biomass smoke constituents (carbon monoxide, fine particulate matter, and black carbon) using personal monitoring data and rate of decline in lung function. For this 1-year R56 proposal, we plan to conduct personal monitoring on all 2000 subjects to be enrolled in the ALHS. The knowledge to be gained is critical to prevention efforts to reduce risk of COPD in the developing world.