Chronic Obstructive Pulmonary Disease Secondary to Household Air Pollution

Nour A. Assad, MD; John Balmes, MD; Sumi Mehta, MPH, PhD; Umar Cheema; Akshay Sood, MD, MPH

Disclosures

Semin Respir Crit Care Med. 2015;36(3):408-421. 

In This Article

Abstract and Introduction

Abstract

Approximately 3 billion people around the world cook and heat their homes using solid fuels in open fires and rudimentary stoves, resulting in household air pollution. Household air pollution secondary to indoor combustion of solid fuel is associated with multiple chronic obstructive pulmonary disease (COPD) outcomes. The exposure is associated with both chronic bronchitis and emphysema phenotypes of COPD as well as a distinct form of obstructive airway disease called bronchial anthracofibrosis. COPD from household air pollution differs from COPD from tobacco smoke with respect to its disproportionately greater bronchial involvement, lesser emphysematous change, greater impact on quality of life, and possibly greater oxygen desaturation and pulmonary hypertensive changes. Interventions that decrease exposure to biomass smoke may decrease the risk for incident COPD and attenuate the longitudinal decline in lung function, but more data on exposure–response relationships from well-designed longitudinal studies are needed.

Introduction

Approximately 3 billion people around the world cook and heat their homes using unprocessed solid fuels in open fires and rudimentary stoves, resulting in household air pollution (HAP) (Fig. 1).[1] Illnesses caused by HAP were responsible for approximately 4.3 million premature deaths worldwide in children and adults in 2012.[1] HAP is a leading risk factor for noncommunicable diseases in developing countries, and arguably the leading risk factor among women. Over one-third of premature deaths from chronic obstructive pulmonary disease (COPD) in low and middle income countries can be attributed to exposure to HAP from cooking with solid fuels.[1] Clinical evidence of this association has been well documented for over three decades now[2,3,4] and several recent reviews of the epidemiologic evidence have described the association between HAP and COPD.[5,6] This nonsystematic review of the medical literature, with a more clinical focus, describes COPD outcomes secondary to HAP from the combustion of various types of indoor solid fuel (Fig. 2).

Figure 1.

Global use of indoor solid fuels in 2012, as reported in percentage, by the World Health Organization (WHO). (Reproduced with permission from World Health Organization. Global Health observatory map gallery. Map on world populations using solid fuels (%), 2012: total. Available at: http://gamapserver.who.int/mapLibrary/Files/Maps/Global_iap_exposure_2012.png. Accessed January 5, 2015).

Figure 2.

Indoor sources of energy.

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