Although particulate matter (PM) exposures have been linked with poor respiratory health outcomes, most of these studies have focused on air sheds with urban and industrial sources of PM2.5. Wood smoke-derived PM also contributes to ambient PM in these urban areas, and is the major source of PM in many US rural or peri-urban areas, as well as in many communities within developing countries. This study will focus on indoor air quality and clinically relevant changes in health effects among asthmatics living in homes whose primary heating sources are non EPA-certified woodstoves. The Primary Aim of this study is to assess the efficacy of residential interventions to reduce indoor PM exposure from woodstoves and the corresponding improvements in quality of life and health outcomes for asthmatic children. The study area for this project will be three rural communities in Idaho and western Montana, including one Indian Reservation. This study will use a three arm (Tx1, Tx2, and Tx3) randomized placebo-controlled intervention trial. The interventions will be at the household level, and exposure and outcomes will be assessed for one asthmatic child in each household. Households in Tx1 will receive inactive high efficiency particulate air (HEPA) devices and will serve as the placebo group. Households in Tx2 will receive a new EPA-certified woodstove, while households in Tx3 will receive active HEPA devices. The Secondary Aims of this study are to assess the impact of these interventions on residential PM2.5 exposures and other health outcomes. Secondary exposure outcomes measured prior to and following the intervention will include PM2.5 mass, chemical wood smoke markers on PM2.5 filters (including levoglucosan and abietic acids), and biomarkers of wood smoke exposure in urine and exhaled breath condensate. Secondary asthma-related health outcomes measured prior to and following the intervention will include peak expiratory flow (PEF) and forced expiratory volume in first second (FEV1), biomarkers in exhaled breath condensate (i.e., pH and nitric oxide), and frequency of asthma symptoms, medication usage, and healthcare utilization. To our knowledge, this will be the first randomized trial in the US to utilize a wood smoke intervention to assess the impact of the consequent reductions in indoor PM on health outcomes in a susceptible population. The results from this project will be translatable to other regions in the US and the world where biomass burning is commonly used for heating and cooking. Relevance: This study will determine if reductions in PM2.5 from residential woodstoves, a common source of indoor air pollution, will result in health improvements among asthmatic children. Clinically significant health outcomes will be measured. Results from this study will provide important information for implementing public health strategies for asthma management in the presence of this common exposure.

National Institute of Health (NIH)
National Institute of Environmental Health Sciences (NIEHS)
Research Project (R01)
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Infectious Diseases, Reproductive Health, Asthma and Pulmonary Conditions Study Section (IRAP)
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Gray, Kimberly A
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University of Montana
Other Health Professions
Schools of Pharmacy
United States
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Ward, Tony J; Semmens, Erin O; Weiler, Emily et al. (2017) Efficacy of interventions targeting household air pollution from residential wood stoves. J Expo Sci Environ Epidemiol 27:64-71
McNamara, Marcy L; Thornburg, Jonathon; Semmens, Erin O et al. (2017) Reducing indoor air pollutants with air filtration units in wood stove homes. Sci Total Environ 592:488-494
Montrose, L; Ward, T J; Semmens, E O et al. (2017) Dietary intake is associated with respiratory health outcomes and DNA methylation in children with asthma. Allergy Asthma Clin Immunol 13:12
Noonan, Curtis W; Semmens, Erin O; Smith, Paul et al. (2017) Randomized Trial of Interventions to Improve Childhood Asthma in Homes with Wood-burning Stoves. Environ Health Perspect 125:097010
Noonan, Curtis W; Ward, Tony J; Semmens, Erin O (2015) Estimating the number of vulnerable people in the United States exposed to residential wood smoke. Environ Health Perspect 123:A30
Weiler, Emily; Semmens, Erin; Noonan, Curtis et al. (2015) Dust Allergens within Rural Northern Rocky Mountain Residences. Jacobs J Allergy Immunol 1:1-6
Semmens, Erin O; Noonan, Curtis W; Allen, Ryan W et al. (2015) Indoor particulate matter in rural, wood stove heated homes. Environ Res 138:93-100
McNamara, M; Thornburg, J; Semmens, E et al. (2013) Coarse particulate matter and airborne endotoxin within wood stove homes. Indoor Air 23:498-505
Noonan, Curtis W; Ward, Tony J (2012) Asthma randomized trial of indoor wood smoke (ARTIS): rationale and methods. Contemp Clin Trials 33:1080-7
McNamara, Marcy L; Noonan, Curtis W; Ward, Tony J (2011) Correction factor for continuous monitoring of wood smoke fine particulate matter. Aerosol Air Qual Res 11:315-322

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