LAUSR

Nearly 3 billion people worldwide cook and heat their homes using biomass fuels, primarily in low and middle-income countries.1 Smoke from biomass fuel combustion contains a combination of gases, particulate matter and volatile organic compounds that is particularly harmful to the developing lungs of children.2 Over time, chronic exposure to household air pollution results in mucus hypersecretion, emphysema and bronchiolar fibrosis,3 and exposure to household air pollution is a well-described risk factor for both acute and chronic respiratory disease.4–6 The settings in which biomass smoke exposure is most common are also settings in which there is a high prevalence of reduced lung function.7 8 A recent study of 2000 primarily non-smokers in urban Malawi found a >40% rate of abnormal lung function (primarily reduced forced vital capacity (FVC)),9 and the largest published spirometry study in Uganda reported that 16% of adults over age 30 years had spirometry-confirmed chronic obstructive pulmonary disease (COPD).10 There is increasing evidence that reduced lung function begins early in life11–15; therefore, efforts to understand and prevent chronic respiratory disease must focus on modifiable risk factors that affect lung development in infancy and early childhood.16 17 Several studies have previously measured lung function among children in sub-Saharan Africa,18–21 but no prior study has reported the effect of a cookstove intervention on lung function in African children. Despite a number of cookstove intervention trials, there remains a lack of conclusive evidence regarding the benefit of cookstove interventions on lung health.22 In this issue of Thorax , Rylance et al report the results of …