COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis

Abstract

Background Over half the world is exposed daily to the smoke from combustion of solid fuels. Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease and can be caused by biomass smoke exposure. However, studies of biomass exposure and COPD show a wide range of effect sizes. The aim of this systematic review was to quantify the impact of biomass smoke on the development of COPD and define reasons for differences in the reported effect sizes. Methods A systematic review was conducted of studies with sufficient statistical power to calculate the health risk of COPD from the use of solid fuel, which followed standardised criteria for the diagnosis of COPD and which dealt with confounding factors. The results were pooled by fuel type and country to produce summary estimates using a random effects model. Publication bias was also estimated. Results There were positive associations between the use of solid fuels and COPD (OR¼2.80, 95% CI 1.85 to 4.0) and chronic bronchitis (OR¼2.32, 95% CI 1.92 to 2.80). Pooled estimates for different types of fuel show that exposure to wood smoke while performing domestic work presents a greater risk of development of COPD and chronic bronchitis than other fuels. Conclusion Despite heterogeneity across the selected studies, exposure to solid fuel smoke is consistently associated with COPD and chronic bronchitis. Efforts should be made to reduce exposure to solid fuel by using either cleaner fuel or relatively cleaner technology while performing domestic work.More than 3 billion people, around half the world's population, use solid fuel to meet their basic household energy demands, and a large proportion of this exposed population lives in less economically developed countries (LEDCs).1 In many areas of Africa, Central America, South-east Asia and South Asia >90% of rural homes use solid fuel as the primary cooking and/or heating fuel. Women in the rural areas of LEDCs undertake routine cooking and heating over long periods, often many hours per day, and tend to be exposed to much higher levels of indoor air pollutants than men living in the same household. 2Chronic obstructive pulmonary disease (COPD), regarded as a disease of developed countries, is now recognised as a common disease in LEDCs. COPD is the fourth leading cause of all deaths, leading to the deaths of w3 million people in 2004, of which 90% of all COPD deaths were from low and middle income countries. 3 The main contributory factors are cigarette smoke, occupational exposures and exposure to solid fuel smoke. Lower socioeconomic status increases the risk of developing COPD, although which component factors (eg, poor housing, poor nutrition, low income, no/poor education) are the most important in influencing COPD and to what extent is unclear. The use of solid fuel has been suggested as a key causal factor.4e6 Although the variation in findings across studies is wide, this could be a real effect due to differing causal influences or could be due to methodolog...

Epidemiological and Clinicopathological Characteristics of Lung Cancer in a Teaching Hospital in Iran

“…In a study reported in China in 2008, an association between the indoor air pollution (IAP) due to solid fuel and chronic respiratory disease and lung cancer was confirmed (Galeone et al, 2008). Also, the association between more efficient ventilation of residential building and reduced risk of respiratory diseases has been investigated in a study (Kurmi et al, 2010). In a study carried out in the province of Ardebil (northern Iran), it was shown that 11.3% of patients with lung cancer had a history of bread baking (Ghobadi et al, 2013) however there was no further details on the percentage of lung cancer among rural women.…”

The impact of asthma and COPD in sub-Saharan Africa

“…poor housing, poor nutrition, low income, poor education) are the most important in influencing the development of COPD -and to what extent -is unclear. 47 International health authorities have only recognised the rising morbidity and mortality of COPD in the last decade. 10,43,54 The mortality due to COPD is projected to increase by more than 30% in the next 10 years, particularly in these developing countries.…”

“…10,39,44,45 Biomass smoke has been shown to be an independent risk factor for obstructive airways disease, and earlier and longer time of exposure has been shown to increase the risk for the development of COPD. 43,[46][47][48][49][50] The risk of developing COPD attributable to biomass smoke exposure is similar to the risk due to tobacco smoking. 51 Figure 2 shows the worldwide use of biomass fuel for cooking produced by the World Health Organization.…”

Sensing the Airs: The Cultural Context for Breathing and Breathlessness in Uruguay

“…COPD is defined as largely irreversible airflow obstruction caused by a combination of emphysema and chronic bronchitis and is quickly becoming the third leading cause of death worldwide (WHO 2013) although "it is still relatively unknown or ignored by the public as well as public health and government officials" (GOLD 2011:iii). In addition to smoking, there is increasing evidence that other environmental factors, such as indoor and outdoor air pollution, might not only aggravate COPD but also cause it too (Kurmi et al 2010). Inhalation of any source of carbon monoxide, including that produced from wood-fire smoke for heating or cooking, can lead to the deterioration of lung tissue causing airflow limitation and symptoms of COPD including breathlessness or feeling short of breath, cough, fatigue, and sputum production.…”