Chronic Airflow Obstruction and Use of Solid Fuels

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is a pressing global public health challenge, ranking as the third leading cause of mortality and seventh cause of disability-adjusted life-years worldwide. Historically more prevalent in males, COPD's impact has become increasingly equal on both sexes. Low- and middle-income countries (LMICs) bear the brunt of COPD-related deaths, with nearly 90% occurring in people under seventy. Although tobacco smoking remains the primary cause of COPD, surprisingly, over 20% of affected individuals are not active smokers, and smoking rates are low in most LMICs. Instead, the widespread use of solid fuels for cooking and heating in LMICs has emerged as a significant contributor to indoor air pollution and potentially to the development of COPD. The aim of this study was to assess the association between chronic airflow obstruction and the use of solid fuels, including biomass, using longitudinal data from a multinational study. An additional aim was to explore potential variation in this association by sex.

Data from the BOLD study, encompassing multiple world regions and involving non-institutionalised individuals aged 40 years and older, were utilised in this study. A total of 1,609 participants across six locations were analysed, with females constituting 58.6% of the sample. The prevalence of solid fuel use varied across sites, with Estonia demonstrating the highest reliance (88%) and Iceland the lowest (11.9%).

Among males, no significant association was found between solid fuel use and chronic airflow obstruction. However, location-specific variations were observed, with Tunisia indicating a significantly decreased likelihood of chronic airflow obstruction with solid fuel usage. Among females, statistically significant correlations were observed, showing a lower likelihood of chronic airflow obstruction with solid fuel use. However, no significant associations were found for chronic cough or phlegm due to small sample sizes.

This study provides evidence of the potential link between solid fuel use and chronic airflow obstruction, particularly among female non-smokers in specific locations. Nonetheless, it is crucial to note that the relationship between solid fuel use, sex, and other risk factors for COPD is complex and warrants further investigation. As such, additional research is necessary to comprehend these intricate interactions fully. Implementing public health interventions targeting solid fuel usage in LMICs may prove beneficial in alleviating the burden of COPD and improving respiratory health.

In conclusion, COPD poses a substantial global health threat, impacting both males and females alike, with LMICs bearing a disproportionate burden of the disease. Although smoking remains a prominent risk factor, the role of solid fuel use cannot be overlooked. The meta-analysis emphasises the necessity of understanding the complex relationships between solid fuel use and lung health. Although no definite link between solid fuel usage and chronic airflow obstruction was discovered, the study emphasises the need for additional research and focus attention on the importance of switching to cleaner energy sources to improve respiratory health and public well-being.