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Approximately 40% of people worldwide are exposed to household air pollution (HAP) from the burning of biomass fuels. Previous efforts to document health benefits of HAP mitigation have been stymied by an inability to lower emissions to target levels. We sought to determine if a cleaner energy intervention improved cardiopulmonary health outcomes in adult women living in a resource-poor setting in Peru. We conducted a randomized controlled field trial in 180 women aged 25-64 years living in rural Puno, Peru. Intervention women received a liquefied petroleum gas (LPG) stove, continuous fuel delivery for one year, education and behavioral messaging, whereas control women were asked to continue their usual cooking practices. We assessed for stove use adherence using temperature loggers installed in both LPG and biomass stoves of intervention households. At baseline and at 3-4 visits post-randomization, we measured blood pressure, peak expiratory flow (PEF) and respiratory symptoms using the St. George's Respiratory Questionnaire (SGRQ). Intervention women used their LPG stove exclusively for 98% of days. We did not find average differences in post-randomization systolic (intervention-control 0.7 mmHg, 95% CI-2.1 to 3.4) or diastolic blood pressure (0.3 mmHg,-1.5 to 2.0), pre-(0.14 L/sec/m2,-0.02 to 0.29) or post-bronchodilator PEF/height2 (0.11 L/sec/m2,-0.05 to 0.27), or SGRQ total score (-1.4,-3.9 to 1.2) in intention-to-treat analysis. There were no reported harms related to the intervention. We did not find evidence of a difference in blood pressure, lung function or respiratory symptoms during the year-long cleaner energy …