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Lancet Respir Med. 2014 Oct;2(10):823-60. doi: 10.1016/S2213-2600(14)70168-7. Epub 2014 Sep 2.

Respiratory risks from household air pollution in low and middle income countries.

Author information

1
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Electronic address: stephen.gordon@lstmed.ac.uk.
2
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
3
Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK.
4
Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
5
Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
6
Institute of Occupational and Environmental Medicine, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
7
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
8
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
9
Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India.
10
Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
11
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
12
Divisions of Epidemiology and Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
13
Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
14
Oregon Health and Science University, Portland, OR, USA.
15
Jindal Clinics, Chandigarh, India.
16
School of Public Health, Fudan University, Shanghai, China.
17
Health Effects Institute, Boston, MA, USA.
18
The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA.
19
Lata Medical Research Foundation, Nagpur, India.
20
Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
21
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
22
University of Aberdeen, Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Aberdeen, UK.
23
Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA. Electronic address: wjmartin@cph.osu.edu.

Abstract

A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.

PMID:
25193349
PMCID:
PMC5068561
DOI:
10.1016/S2213-2600(14)70168-7
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Declaration of interests JG reports personal fees from GlaxoSmithKline and personal fees from Novartis. He is a member of the UK Government’s Committee on the medical effects of air pollution and is co-chair of the Royal College of Physicians working party on the long-term effects of air pollution. SBG and KM received grants from Joint Global Health Trials to carry out an interventional trial in Malawi. The other authors report no competing interests.

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