Abstract
Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.
Highlights
Biomass fuel is burned in the home under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP)
The objective of our study was to assess the burden of respiratory symptoms and airway inflammation, measured by fractional exhaled nitric oxide (FeNO) levels, among pregnant women in rural India who utilize biomass fuel within their home, irrespective of individual cookstove design
Istered questionnaire anddyspnea interviewer‐administered dyspnea. This approach, in a biomass has aexposure clear advantage inNepal, possibly avoiding was utilizedexposure by Kurmistudy et al.in inNepal, a biomass study in has a clear challenges advantage faced when using a translated questionnaire in a different cultural setting only in possibly avoiding challenges faced when using a translated questionnaire in a Not different did we utilize both the and Modified Medical Research Council (mMRC), but our study found a correlation between cultural setting [58,59]
Summary
An estimated half of the world’s population, predominantly in low–middle income countries, utilizes biomass fuels as their main source of energy for cooking, heating, and lighting [1,2]. Biomass fuels such as woody fuels and animal wastes are organic materials. Biomass fuel is burned in the home under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP).
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