Abstract
Around 41% of the world’s population continue using solid fuels, including wood and other types of biomass, for cooking or heating their homes. Long-term indoor exposure to wood smoke, and biomass smoke in general, is a risk factor for developing chronic obstructive pulmonary disease (COPD). In some regions of the world, biomass exposure is a more frequent cause of COPD than exposure to cigarette smoke. Recently it has been described notable differences between COPD associated with wood smoke (WS-COPD) and that caused by tobacco smoking (TS-COPD): significantly less emphysema and more airway inflammation in WS-COPD. Recognizing these differences, some authors have suggested that WS-COPD should be considered a new COPD phenotype. This chapter summarizes the differences between WS-COPD and TS-COPD. The information about the characteristics of COPD caused by other types of biomass fuels, different from wood, is very scarce. Accepting that the smoke derived from wood burning and tobacco smoking have some differences (etiology), the inhalation patterns are different (pathogenesis) and the physiopathological mechanisms they induce may also differ, we analyze if the disease caused by indoor chronic exposure to wood smoke should be considered as another COPD phenotype or a distinct nosological entity.
Highlights
Solid and biomass fuels are the most important global environmental risk factor
The risk of chronic obstructive pulmonary disease (COPD) from long-term indoor exposure to biomass fuels is high in women [23, 33–36], a population study (n = 5539) showed that, after adjusting for age, smoking, educational level and occupational exposure, men exposed to wood smoke for more than 10 years had a higher risk of COPD (OR: 1.50) [37]
In rural Puno, Peru, daily use of biomass fuel for cooking among women was associated with COPD and the population attributable risk of COPD due to daily exposure to biomass fuel smoke was 55% [31]
Summary
Around 41% of the world’s population, over 2.8 billion people, in developing countries, still use solid fuels, whether coal or biomass (wood, vegetable remains and dung), for cooking or heating their homes [1, 2]. In Latin America, the PREPOCOL [3], the CRONICAS [31] and the PUMA [32] studies have confirmed that the use of biomass fuels, frequently wood, for cooking is a significant and independent risk factor for COPD, stronger in women from rural areas. The risk of COPD from long-term indoor exposure to biomass fuels is high in women [23, 33–36], a population study (n = 5539) showed that, after adjusting for age, smoking, educational level and occupational exposure, men exposed to wood smoke for more than 10 years had a higher risk of COPD (OR: 1.50) [37]. A recent study, from Kyrgyzstan, evaluated the prevalence of COPD associated with indoor contamination at different altitudes and found a higher prevalence of COPD at high altitude versus at low altitude (36.7% vs. 10.4%; p < 0.001) associated with exposure to a greater indoor contamination at high altitude [43]
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