Indoor fuel exposure and the lung in both developing and developed countries: an update

Abstract

Almost 3 billion people worldwide burn solid fuels indoors. Despite the large population at risk worldwide, the effect of exposure to indoor solid fuel smoke has not been adequately studied. Indoor air pollution from solid fuel use is strongly associated with chronic obstructive pulmonary disease, acute respiratory tract infections, and lung cancer, and weakly associated with asthma, tuberculosis, and interstitial lung disease. Tobacco use further potentiates the development of respiratory disease among subjects exposed to solid fuel smoke. There is a need to perform additional interventional studies in this field.

Figure 1

The Energy Ladder. Fuels lower in the energy ladder are less efficient and produce more pollution, but are less expensive. Conversely, fuels higher in the energy ladder are more efficient and produce less pollution, but are more expensive.

Figure 2

Global Use of indoor solid fuels in 2010, as reported in percent, by the World Health Organization (WHO). Reproduced with permission from the WHO .

Figure 3

Key differences in solid fuel exposure between developing and developed countries. The picture in the right in the panel was reprinted with permission from Elsevier (The Lancet, 2009; 374:733–743 ).

Figure 4

Traditional open fire used for cooking (panel A) and the locally developed and constructed chimney woodstove, the plancha (panel B) in Guatemala. The chimney woodstove has a thick metal heating surface for cooking tortillas and holes with removable concentric rings for pots, a firebrick combustion chamber with baffling, a concrete and brick body, tile surfaces around the cooking area, dirt and pumice stone insulation, a metal fuel door, and a metal chimney with damper. Infants and toddlers are highly exposed to combustion smoke as they are carried on their mother’s back while she cooks, a common cultural practice in Guatemala and other regions. Picture reprinted with permission from Elsevier (The Lancet, 2011; 378:1717–1726) .