Biomass exposure and the high resolution computed tomographic and spirometric findings

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Abstract

Background: The adverse health effects of biomass fuel exposure (BFE) is complex and widespread. According to our knowledge, the interstitial lung disease due to BFE is not clear in literature. Objective: In this descriptive crossectional study, the main objective was to assess the effects of BFE on the respiratory system. Methods: Patient group was included non-smoker 21 woman and the control group was included non-smoker 22 woman. High resolution computed tomographic (HRCT) examinations were made with supin and prone positions in two groups. The spirometric measurements, including the diffusion capacity at rest for carbon monoxide, single breath (DLCO), were also made. Results: It was found that BFE caused obstructive and restrictive spirometric impairments. The prevalence of the fibrotic bands, peribronchovascular thickenings, nodular radio opacities, and curvilinear densities in the high resolution computed tomographic examinations were 7, 5, 7, and 16 times higher in the exposure group than the control group, respectively. There was a significant positive correlation between the forced vital capacity (FVC), forced expiratory volume first second (FEV1), FEV1/FVC, forced expiratory flow during middle half of forced vital capacity (FEF25-75), DLCO and the volumetric densities of the HRCT slices with deep expiration in prone position. Conclusions: We think that, the findings due to BFE, pose a special situation and it can be named “biomass lung”.

Introduction

Air pollution is associated only with urban combustion of fossil fuels in industrialized countries, where the high level of economic development has led to a high consumption of energy per capita. Biomass fuels (wood, agricultural waste, and dung) are used by about half of the world population, as the major, often the only source of domestic energy for cooking and heating. The smoke emissions from these fuels are the important sources of the indoor air pollution, especially in rural communities of the developing countries. These emissions contain important pollutants that adversely affect health, such as suspended particles and polycyclic organic matter, which are known as carcinogenic, such as benzopyrene, as well as gaseous polutants-like carbon monoxide and formaldehyde. Frequently, the most affected persons are the women; who cooks for the households in rural villages. They suffer from impaired health due to prolonged and repeated contact with these harmful pollutants. In the developing countries, exposure to biomass fuel emissions is probably one of the most important occupational health hazards for women. On the world, conservatively estimated 300–400 million people, mostly in the rural areas of the developing countries, are affected by these harmful pollutants [1].

Also the exposure of the biomass fuel emission produces a significant respiratory morbidity; there are only a few systematic studies that have been directly addressed to the health effects of biomass combustion products. Most of these epidemiological studies are related to respiratory effects of the biomass fuel exposure (BFE). So it is clear that, exposure to biomass combustion products, may play an important role in the aetiology of both acute and chronic respiratory diseases [2], [3], [4], [5], [6], [7].

Recently, it was shown that, there were relationships between traditional biomass combustion and the development of the chronic obstructive pulmonary diseases (COPD) in women, who live in our rural areas [8]. Also, a study from our clinic showed that, there was a significant increase in lipid peroxidation activity and a significant decrease in antioxidant enzyme activity in females, who exposed to biomass fuels [9]. Furthermore, we also observed the constant and harmful effects of the biomass fuels on the sister-chromatid exchange frequency levels [10].

In the literature, although, there are no clear results about the interstitial lung diseases due to BFE, we observed that, female patients with chronic pulmonary diseases often have the interstitial lung diseases. Also there was not another clear aetiology; most of them had prolonged antecedent exposure to biomass smoke and thus, a possible aetiological relationship should be considered.

The main objective of our study was to assess the effects of the BFE on the respiratory system by the radiological findings of the high resolution computed tomographic (HRCT) and spirometric parameters including the diffusion capacity at rest for carbon monoxide, single breath (DLCO).

Section snippets

Study region

The study region is Sivas, in the northern-east of the central Anatolia. Biomass fuels (wood, agricultural waste, and dung) are used as the major and frequently the only, source of the domestic energy for cooking and heating by the rural population in this region.

Study population and design

This is a cross-sectional, case-control study. The local ethic committee approved our study and the informed consents were obtained from the cases. Patient group consists of included consecutively non-smoker 21 women, using biomass for

Results

Spirometric results of the control and BFE groups were shown on Table 1. Statistically, there were significant differences between the two groups’ FVC, forced expiratory volume first second (FEV1), FEV1/FVC and forced expiratory flow during middle half of FVC (FEF25-75) parameters. Also, there were statistically borderline significant differences between the DLCO of the two groups. These findings showed that, BFE was caused to combined type (obstructive and restrictive) spirometric impairments.

Discussion

Biomass fuels are composed of complex organic matters, vegetable proteins and carbohydrates incorporating carbon, nitrogen, oxygen, hydrogen, and certain other elements in trace amounts. Their combustion often produces substances harmful to human health, such as a range of polycyclic hydrocarbons that are not found in the fuels themselves. Biomass fuel emissions present a health hazard whose effects vary in type and severity depending on the local situation, the type of the fuel, and the

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