Impaired lung function in individuals chronically exposed to biomass combustion

doi:10.1016/j.envres.2011.10.012

Environmental Research

Volume 112, January 2012, Pages 111-117

https://doi.org/10.1016/j.envres.2011.10.012 Get rights and content

Abstract

Background

The use of biomass for cooking and heating is considered an important factor associated with respiratory diseases. However, few studies evaluate the amount of particulate matter less than 2.5 μm in diameter (PM2.5), symptoms and lung function in the same population.

Objectives

To evaluate the respiratory effects of biomass combustion and compare the results with those of individuals from the same community in Brazil using liquefied petroleum gas (Gas).

Methods

1402 individuals in 260 residences were divided into three groups according to exposure (Gas, Indoor-Biomass, Outside-Biomass). Respiratory symptoms were assessed using questionnaires. Reflectance of paper filters was used to assess particulate matter exposure. In 48 residences the amount of PM2.5 was also quantified. Pulmonary function tests were performed in 120 individuals.

Results

Reflectance index correlated directly with PM2.5 (r=0.92) and was used to estimate exposure (ePM2.5). There was a significant increase in ePM2.5 in Indoor-Biomass and Outside-Biomass, compared to Gas. There was a significantly increased odds ratio (OR) for cough, wheezing and dyspnea in adults exposed to Indoor-Biomass (OR=2.93, 2.33, 2.59, respectively) and Outside-Biomass (OR=1.78, 1.78, 1.80, respectively) compared to Gas. Pulmonary function tests revealed both Non-Smoker-Biomass and Smoker-Gas individuals to have decreased %predicted-forced expiratory volume in the first second (FEV1) and FEV1/forced vital capacity (FVC) as compared to Non-Smoker-Gas . Pulmonary function tests data was inversely correlated with duration and ePM2.5. The prevalence of airway obstruction was 20% in both Non-Smoker-Biomass and Smoker-Gas subjects.

Conclusion

Chronic exposure to biomass combustion is associated with increased prevalence of respiratory symptoms, reduced lung function and development of chronic obstructive pulmonary disease. These effects are associated with the duration and magnitude of exposure and are exacerbated by tobacco smoke.

Highlights

► Exposure to biomass combustion is associated with increased respiratory symptoms. ► This exposure is also associated with reduced lung function and presence of COPD. ► These alterations due to biomass combustion are not dependent on smoking. ► The reduced pulmonary function is associated with the duration and magnitude of exposure. ► Particulate matter can be quantified using the paper filter’s reflectance index.

Introduction

More than 3 billion people around the world use biomass as their primary source of domestic energy for cooking and heating (WHO, 2006). Exposure to indoor air pollution is a significant cause of morbidity and mortality in developing countries (World Health Organization, 2002), responsible for approximately 2.6% of global morbidity and 1.5 million deaths annually (WHO, 2006).

The indoor use of biomass fuels can release 50 times more pollutants during cooking compared to gas stoves (Smith, 2000) and leads to high concentrations of air pollutants including carbon monoxide, nitrogen oxide, sulfur oxide, aldehydes, polycyclic aromatic hydrocarbons and inhalable particulate matter of different sizes (Pierson et al., 1989). Small particles less than 2.5 μm in diameter (PM2.5) have been increasingly related to respiratory and cardiovascular morbidity and mortality (Dennekamp et al., 2010, Park et al., 2010).

Several studies show that exposed individuals have a higher prevalence of cough, phlegm, coryza, wheezing, shortness of breath and itching eyes (Ellegard, 1996, Ellegard, 1997). Furthermore, exposure to biomass combustion has been implicated as a causal/contributory agent for several diseases in developing countries including acute respiratory infections (Bruce et al., 2000, Ezzati and Kammen, 2001, Mishra and Retherford, 1997, Smith et al., 2000), pulmonary arterial hypertension (Sandoval et al., 1993), COPD exacerbations, lung cancer (for coal smoke), asthma, nasopharyngeal and laryngeal cancers (Sapkota et al., 2008) and diseases of the eye (Smith and Mehta, 2003). In children, exposure to biomass pollution is associated with a higher prevalence, duration and poorer outcome of acute respiratory infections (Ezzati and Kammen, 2001, Mishra, 2003, Smith et al., 2000).

Few studies have investigated the impact of biomass combustion exposure on pulmonary function, showing conflicting results. Rinne et al. (2006) did not observe any differences in pulmonary function among Ecuadorian women using biomass or liquefied petroleum gas for cooking. Conversely, studies from Turkey and India show that women exposed to biomass present a higher odds ratio of chronic bronchitis and decreased forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) compared to women using liquefied petroleum gas (Dutt et al., 1996, Ekici et al., 2005, Kiraz et al., 2003). In children, the use of biomass fuel has also been associated with decreased FEV1 and FVC (Qian et al., 2007, Rinne et al., 2007). Although the aforementioned studies report a decreased FEV1 associated with biomass combustion exposure, airflow limitation (Pauwels et al., 2001) was observed in none of them.

Most epidemiologic studies that have evaluated the health effects of biomass combustion (prevalence of symptoms and respiratory diseases or changes in pulmonary function) use qualitative assessments of exposure, such as fuel or housing type. Few of these studies also evaluated the exposure levels of particles less than 10 μm in diameter (PM10) (Regalado et al., 2006). No study has yet evaluated all these effects in the same population and taken into account the intensity of exposure to PM2.5. In the present study we report the respiratory effects of chronic exposure to biomass combustion in a Brazilian population that uses wood and cashew nut bark as the main cooking fuel and compared the results with those of individuals living in the same community that use liquefied petroleum gas instead. The study was designed in order to simultaneously quantify the magnitude of exposure, the prevalence of respiratory symptoms and the effects of exposure on pulmonary function in this population.

Section snippets

Study population

A schematic representation of the study design is presented in Fig. 1. The study was conducted in Joao Camara, a city in the northeast countryside of Brazil.

Joao Camara is a city with an area of 715 km² that is 120 m above sea level and is situated in the Brazilian state of Rio Grande do Norte. The proportion of the population living in extreme poverty in this Brazilian state is around 35%, almost triple that of Brazil as a whole. Demographic and social data show that black people, houses headed

Results

We collected data from a total of 1402 individuals. The demographic data in each group are shown in Table 1. There were no significant differences in sex, age, smoking history, income and literacy between groups.

The PM2.5 concentration during the cooking period in each group was 3.0±3.6 μg/m³ (LPG, n=16), 151.1±114.8 μg/m³ (Outside-Biomass, n=16) and 230.3±157.0 μg/m³ (Indoor-Biomass, n=16). The reflectance index of the exposed filters showed a significant positive correlation with PM2.5

Discussion

In the present study we performed for the first time a simultaneous evaluation of respiratory symptom prevalence, pulmonary function changes and magnitude of exposure in a population chronically exposed to biomass combustion. Our main findings were an increased prevalence of respiratory symptoms, impaired pulmonary function and increased prevalence of chronic obstructive pulmonary disease in individuals exposed to biomass. We also observed a synergistic effect between biomass exposure and

Conclusions

We conclude that chronic exposure to biomass combustion is associated with increased prevalence of respiratory symptoms, reduced lung function and the development of chronic obstructive pulmonary disease. Although there is a synergistic effect, the loss in pulmonary function due to biomass combustion is not dependent on smoking and is associated with the duration and magnitude of biomass exposure.

Acknowledgments

The authors would like to thank Carlos Sampaio for clinical support in pulmonary function tests, Regiani Oliveira for filter reflectance measurements, Klaus F. Rabe and Prof. Thais Mauad for their relevant suggestions, and the members of the “Bandeira Científica” Project organizing committee: Andreza Cadima Silva, Carla Romagnolli, Débora Terribili, Fabíola Oléa Albieri, Gabriella Paiva Bento, Lilian Zancheta Castelli, Livia Caroline Barbosa Mariano, Maíra Grizzo, Marilena Nakaguma, Natália

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^☆: Funding: This work were founded by FAPESP, LIM-HC-FMUSP, CNPq.

^☆☆: This study was approved by the institutional review board for human studies – CAPPesq. Written consent was obtained from all subjects.

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Impaired lung function in individuals chronically exposed to biomass combustion☆,☆☆

Abstract

Background

Objectives

Methods

Results

Conclusion

Highlights

Introduction

Section snippets

Study population

Results

Discussion

Conclusions

Acknowledgments

Lancet

Lancet

Environ. Res.

Environ. Res.

Soc. Sci. Med.

Int. J. Tuberc. Lung. Dis.

Lancet

Respir. Med.

Lancet

Chest

Int. J. Hyg. Environ. Health

Obstructive lung disease in children with mild to severe BPD

Respir. Med.

Indoor air pollution in developing countries: a major environmental and public health challenge

Bull. World Health Organ.

Outdoor air pollution as a trigger for out-of-hospital cardiac arrests

Epidemiology

Effect of indoor air pollution on the respiratory system of women using different fuels for cooking in an urban slum of Pondicherry

Natl. Med. J. India

Cooking fuel smoke and respiratory symptoms among women in low-income areas in Maputo

Environ. Health Perspect.

Quantifying the effects of exposure to indoor air pollution from biomass combustion on acute respiratory infections in developing countries

Environ. Health Perspect.

A pilot study using scripted ventilation conditions to identify key factors affecting indoor pollutant concentration and air exchange rate in a residence

J. Expo. Anal. Environ. Epidemiol.

Chronic pulmonary disease in rural women exposed to biomass fumes

Clin. Invest. Med.

Indoor air pollution from biomass combustion and acute respiratory illness in preschool age children in Zimbabwe

Int. J. Epidemiol.

Cooking smoke increases the risk of acute respiratory infection in children

Natl. Fam. Health Surv. Bull.