Chest
Volume 142, Issue 5, November 2012, Pages 1308-1315
Journal home page for Chest

Ahead of the Curve
Household Air Pollution Is a Major Avoidable Risk Factor for Cardiorespiratory Disease

https://doi.org/10.1378/chest.12-1596Get rights and content

Household air pollution (HAP) from biomass fuels, coal, and kerosene burned in open fires, primitive stoves, and lamps causes at least 2 million deaths per year. Many of these deaths occur in children <5 years of age with pneumonia and in women with COPD, lung cancer, and cardiovascular disease. HAP is inextricably linked to poverty, with activities to obtain fuel consuming a large proportion of the time and financial resources of poor households. Thus, fewer resources used in this way means less is available for basic needs like food, education, and health care. The burden of work and the exposure to smoke, particularly during cooking, are predominantly borne by women and children. Although historically HAP has not received sufficient attention from the scientific, medical, public health, development, and policy-making communities, the tide has clearly changed with the broad-based support and launch of the Global Alliance for Clean Cookstoves in 2010. There is now considerable reason for optimism that this substantial cause of cardiorespiratory morbidity and mortality will be addressed comprehensively and definitively. Drawing on our experience from four continents, we provide background information on the problem of HAP, health impacts of HAP, opportunities for research, and the current best solutions.

Section snippets

The Indian Subcontinent

More than 75% of households in India use dried cattle dung (Fig 2), crop residue, and firewood for domestic fuels that are most commonly burned in open three-stone fires.4 In exposure studies, the use of dung was associated with high concentrations of indoor pollutants, followed by other fuel types.5 Similarly, pollutant concentrations in kerosene-using houses were twice those seen in gas-using homes. Mixed-fuel use in India is common in most kitchens. There is poor efficiency of energy

Health Impacts of HAP

There is an increasing body of epidemiologic evidence to show that the spectrum of adverse health effects from HAP is the same as that for tobacco smoking. The magnitude of the exposure effect is somewhere between passive and active tobacco smoke exposure.17,18 Here we highlight some of the evidence to associate household smoke exposure with pneumonia, COPD, asthma, cancer, TB, and cardiovascular disease.

Opportunities for Research

There are important gaps in our understanding of HAP disease associations that need to be addressed to identify clearly the health risks and the specific strategies that can be implemented to offset premature death and disabilities for millions. In particular, a better understanding of the risk of pneumonia in adults, TB, lung cancer, and cardiovascular diseases in people exposed to HAP is needed. At the same time, faced with an avoidable risk factor that is responsible for potentially as many

Toward Solutions

Alongside the need for research, there is a clear need for decisive action. The challenge this represents is not unlike the major challenges of the past that have required science, clinical medicine, and public health measures to decrease the global burden of disease. TB in the first one-half of the 20th century and tobacco-related illnesses in the second one-half serve to remind us of the challenges and the decades of commitment required to improve human health. The scale of the HAP problem is

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions: The authors thank Christa Roth, food and fuel consultant, for providing the photograph from Ethiopia used in Figure 1; Duncan Fullerton, PhD, Liverpool School of Tropical Medicine, for the photograph from Malawi in Figure 1; and Jamie Rylance, BMBS, Wellcome Trust

References (59)

  • Quantifying Environmental Health Impacts WHO

    Global Estimates of Burden of Disease Caused by Environmental Risks

    (2009)
  • World Health Organization

    Global Health Risks. Mortality and Burden of Disease Attributable to Selected Major Risks

    (2009)
  • WJ Martin et al.

    Public health. A major environmental cause of death

    Science

    (2011)
  • K Balakrishnan et al.

    Air pollution from household solid fuel combustion in India: an overview of exposure and health related information to inform health research priorities

    Glob Health Action

    (2011)
  • C Venkataraman et al.

    Emission factors of carbon monoxide and size-resolved aerosols from biofuel combustion

    Environ Sci Technol

    (2001)
  • World Health Organization
    (2007)
  • KR Smith

    National burden of disease in India from indoor air pollution

    Proc Natl Acad Sci U S A

    (2000)
  • EA Rehfuess et al.

    Solid fuel use and cooking practices as a major risk factor for ALRI mortality among African children

    J Epidemiol Community Health

    (2009)
  • DG Fullerton et al.

    Biomass fuel use and indoor air pollution in homes in Malawi

    Occup Environ Med

    (2009)
  • DG Fullerton et al.

    Domestic smoke exposure is associated with alveolar macrophage particulate load

    Trop Med Int Health

    (2009)
  • RIC Accinelli et al.

    Efecto de los combustibles de biomasa en el aparato respiratorio: impacto del cambio de cocinas con diseño mejorado

    Revista de la Sociedad Peruana de Neumologia

    (2004)
  • TJ Ward et al.

    Community woodstove changeout and impact on ambient concentrations of polycyclic aromatic hydrocarbons and phenolics

    Environ Sci Technol

    (2009)
  • AC Barry et al.

    Exposure to indoor biomass fuel pollutants and asthma prevalence in Southeastern Kentucky: results from the Burden of Lung Disease (BOLD) study

    J Asthma

    (2010)
  • RW Allen et al.

    An air filter intervention study of endothelial function among healthy adults in a woodsmoke-impacted community

    Am J Respir Crit Care Med

    (2011)
  • M Orozco-Levi et al.

    Wood smoke exposure and risk of chronic obstructive pulmonary disease

    Eur Respir J

    (2006)
  • CA Pope et al.

    Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship

    Circulation

    (2009)
  • KR Smith et al.

    Mind the gap

    Environ Health Perspect

    (2010)
  • I Rudan et al.

    Epidemiology and etiology of childhood pneumonia

    Bull World Health Organ

    (2008)
  • M Dherani et al.

    Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis

    Bull World Health Organ

    (2008)
  • Cited by (78)

    • Clinical Features and Diagnosis of COPD

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    View all citing articles on Scopus

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

    View full text