Exposures to High Levels of Carbon Monoxide from Wood-fired Temazcal (Steam Bath) Use in Highland Guatemala

The temazcal is a wood-fired steam bath used in the rural highlands of Guatemala for bathing and healing. We measured carbon monoxide (CO) among 288 participants in 72 temazcales. Participants were drawn from communities who participated in the RESPIRE (Randomized Exposure Study of Pollution Indoors and Respiratory Effects) chimney stove intervention trial. Temazcal CO exposures were extremely high, averaging 431 parts per million (time-weighted average). Compared to kitchen wood-smoke exposures, the temazcal contributes significantly to weekly exposures, despite the fact that the population spends less time in the temazcal than in the kitchen. This report 1) describes temazcal use patterns; 2) reports participants' signs and symptoms during temazcal use; 3) models the distribution of temazcal CO concentrations; 4) assesses reliability of exhaled breath CO as a biomarker of CO exposure; and 5) provides a proportional analysis of CO concentrations from temazcal use, as compared to kitchen concentrations.