title: OBSTRUCTIVE LUNG DISEASE AND EXPOSURE TO BURNING BIOMASS FUEL IN THE INDOOR ENVIRONMENT.
abstract: It is estimated that up to half of the world's population burns biomass fuel (wood, crop residues, animal dung and coal) for indoor uses such as cooking, lighting and heating. As a result, a large proportion of women and children are exposed to high levels of household air pollution (HAP). The short and long term effects of these exposures on the respiratory health of this population are not clearly understood. On May 9-11, 2011 NIH held an international workshop on the "Health Burden of Indoor Air Pollution on Women and Children," in Arlington, VA. To gather information on the knowledge base on this topic and identify research gaps, ahead of the meeting we conducted a literature search using PubMed to identify publications that related to HAP, asthma, and chronic obstructive pulmonary disease (COPD). Abstracts were all analyzed and we report on those considered by the respiratory sub study group at the meeting to be most relevant to the field. Many of the studies published are symptom-based studies (as opposed to objective measures of lung function or clinical examination etc.) and measurement of HAP was not done. Many found some association between indoor exposures to biomass smoke as assessed by stove type (e.g., open fire vs. liquid propane gas) and respiratory symptoms such as wheeze and cough. Among the studies that examined objective measures (e.g. spirometry) as a health outcome, the data supporting an association between biomass smoke exposure and COPD in adult women are fairly robust, but the findings for asthma are mixed. If an association was observed between the exposures and lung function, most data seemed to demonstrate mild to moderate reductions in lung function, the pathophysiological mechanisms of which need to be investigated. In the end, the group identified a series of scientific gaps and opportunities for research that need to be addressed to better understand the respiratory effects of exposure to indoor burning of the different forms of biomass fuels.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 East Monument St., Room 521, Baltimore, MD 21205, USA, ,  gdiette@jhmi.edu.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Roberto A
authors.initials: RA
authors.lastname: Accinelli
authors.forename: John R
authors.initials: JR
authors.lastname: Balmes
authors.forename: A Sonia
authors.initials: AS
authors.lastname: Buist
authors.forename: William
authors.initials: W
authors.lastname: Checkley
authors.forename: Paul
authors.initials: P
authors.lastname: Garbe
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Hansel
authors.forename: Vikas
authors.initials: V
authors.lastname: Kapil
authors.forename: Stephen
authors.initials: S
authors.lastname: Gordon
authors.forename: David K
authors.initials: DK
authors.lastname: Lagat
authors.forename: Fuyuen
authors.initials: F
authors.lastname: Yip
authors.forename: Kevin
authors.initials: K
authors.lastname: Mortimer
authors.forename: Rogelio
authors.initials: R
authors.lastname: Perez-Padilla
authors.forename: Christa
authors.initials: C
authors.lastname: Roth
authors.forename: Julie M
authors.initials: JM
authors.lastname: Schwaninger
authors.forename: Antonello
authors.initials: A
authors.lastname: Punturieri
authors.forename: James
authors.initials: J
authors.lastname: Kiley