Airflow Obstruction and Use of Solid Fuels for Cooking or Heating. BOLD (Burden of Obstructive Lung Disease) Results

Amaral, André F.S.; Patel, Jaymini; Kato, Bernet; Obaseki, Daniel O.; Lawin, Hervé; Tan, Wan C.; Juvekar, Sanjay; Harrabi, Imed; Studnicka, Michael; Wouters, Emiel F.M.; Loh, Li‐Cher; Bateman, Eric D.; Mortimer, Kevin; Buist, A. Sonia; Burney, Peter

doi:10.1164/rccm.201701-0205oc

Cited by 73 publications

(46 citation statements)

References 32 publications

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“…In India, McKay et al (2012); Moschovis et al (2015); Dave et al (2017) have found sex, smoking status, and indoor air pollution to be significant predictors of lung obstruction. However, some studies (Amaral et al, 2017;Sana et al, 2018) have failed to find significantly higher odds of COPD among those who used solid fuels. These studies have not considered solid fuel externalities.…”

Section: Causes Prevalence and Diagnosis Of Lung Obstructionmentioning

confidence: 99%

Where there is smoke: solid fuel externalities, gender, and adult respiratory health in India

Gupta

2019

Popul Environ

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Chronic respiratory conditions are a leading cause of death in the world. Using data on lung obstruction from the WHO Survey of Global AGEing and Adult Health (WHO-SAGE 2007-08), this paper studies the determinants of respiratory health in India, home to a third of all deaths from Chronic Obstructive Pulmonary Disease. First, we find that smokers and members of households that use solid fuels (wood, biomass, coal or dung) for cooking have higher lung obstruction. Second, even if a respondent's household uses clean fuels, their lung obstruction is higher if their neighbors use solid fuels. In neighborhoods with high solid fuel use, the lungs of members of households that use clean fuels can be as obstructed as lungs of members of households that use solid fuels. These negative externalities of solid fuel use are robust to additional controls for neighborhood socioeconomic status, falsification tests, tests with placebo measures, and tests using alternative measures of respiratory health as outcomes. Third, the influence of the determinants is patterned by gender. Smoking tobacco is an important influence on lung obstruction among men. Confirming non-linear dose-response relationships, we find that women from households that use solid fuels are the only group not further harmed by neighborhood solid fuel smoke, possibly because of high exposure to pollutants while cooking. The study improves our understanding of behavioral, social, and environmental determinants of respiratory health in India. Importantly, it makes a case for greater public investments to promote the adoption and use of cleaner fuels.

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Section: Causes Prevalence and Diagnosis Of Lung Obstructionmentioning

confidence: 99%

Where there is smoke: solid fuel externalities, gender, and adult respiratory health in India

Gupta

2019

Popul Environ

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“…A second explanation relating to the lack of intervention impacts on respiratory health is that of the credibility of the proposed causal relationship between household air pollution and respiratory diagnoses, which has recently been questioned. 49,50 Furthermore, any such relationship between exposure and pathology is likely to be complex, with adverse effects of exposure possibly starting in the antenatal period. 51 This could help explain the comparative lack of impact of the relatively short-term interventions as those considered in this review.…”

Section: Discussionmentioning

confidence: 99%

Air pollution interventions and respiratory health: a systematic review

Saleh

Shepherd

Jewell

et al. 2020

int j tuberc lung dis

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BACKGROUND: Indoor and ambient air pollution exposure is a major risk to respiratory health worldwide, particularly in low- and middle-income countries (LMICs). Interventional trials have mainly focused on alternatives to cooking stoves, with mixed results. Beyond cooking, additional sources of particulate matter also contribute to the burden of air pollution exposure. This review explores evidence from current randomised controlled trials (RCTs) on the clinical effectiveness of interventions to reduce particulate matter in LMICs.METHODS: Twelve databases and the grey literature (e.g., Government reports and policy papers) were searched. Eligible studies were RCTs conducted in LMICs aiming to reduce particulate exposure from any source and reporting on at least one clinical respiratory outcome (respiratory symptoms, lung function or clinical diagnoses). Data from relevant studies were systematically extracted, the risk of bias assessed and narrative synthesis provided.RESULTS: Of the 14 included studies, 12 tested ‘improved' cookstoves, most using biomass, but solar and bioethanol cookers were also included. One trial used solar lamps and another was an integrated intervention incorporating behavioural and environmental components for the treatment and prevention of chronic obstructive pulmonary disease. Of the six studies reporting child pneumonia outcomes, none demonstrated significant benefit in intention-to-treat analysis. Ten studies reported respiratory symptom outcomes with some improvements seen, but self-reporting made these outcomes highly vulnerable to bias. Substantial inter-study clinical and methodological heterogeneity precluded calculation of pooled effect estimates.CONCLUSION: Evidence from the RCTs performed to date suggests that individual household-level interventions for air pollution exposure reduction have limited benefits for respiratory health. More comprehensive approaches to air pollution exposure reduction must be developed so their potential health benefits can be assessed.

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“…This is another issue that is particularly relevant to Africa, where access to quality-assured spirometry is limited, 7,8 and where results from recent BOLD studies have suggested that the most prominent problem is a high prevalence of low lung volume (low forced vital capacity), and not airflow obstruction. 9 One of these studies was a non-communicable lung disease study (incorporating a BOLD study) that we did in urban Blantyre, Malawi, in which 24% of study participants had HIV. We found that more than 40% of the participants had abnormal lung function-mostly low forced vital capacity-but with no association between spirometric abnormalities and HIV.…”

mentioning

confidence: 99%

Collision of communicable and non-communicable disease epidemics—the case of HIV and COPD

Stolbrink

Mortimer

2018

The Lancet Global Health

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Airflow Obstruction and Use of Solid Fuels for Cooking or Heating. BOLD (Burden of Obstructive Lung Disease) Results

Cited by 73 publications

References 32 publications

Where there is smoke: solid fuel externalities, gender, and adult respiratory health in India

Where there is smoke: solid fuel externalities, gender, and adult respiratory health in India

Air pollution interventions and respiratory health: a systematic review

Collision of communicable and non-communicable disease epidemics—the case of HIV and COPD

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