title: Cooking fuels and prevalence of asthma: a global analysis of phase three of the International Study of Asthma and Allergies in Childhood (ISAAC).
abstract: BACKGROUND
  Indoor air pollution from a range of household cooking fuels has been implicated in the development and exacerbation of respiratory diseases. In both rich and poor countries, the effects of cooking fuels on asthma and allergies in childhood are unclear. We investigated the association between asthma and the use of a range of cooking fuels around the world.
  
  
  METHODS
  For phase three of the International Study of Asthma and Allergies in Childhood (ISAAC), written questionnaires were self-completed at school by secondary school students aged 13-14 years, 244,734 (78%) of whom were then shown a video questionnaire on wheezing symptoms. Parents of children aged 6-7 years completed the written questionnaire at home. We investigated the association between types of cooking fuels and symptoms of asthma using logistic regression. Adjustments were made for sex, region of the world, language, gross national income, maternal education, parental smoking, and six other subject-specific covariates. The ISAAC study is now closed, but researchers can continue to use the instruments for further research.
  
  
  RESULTS
  Data were collected between 1999 and 2004. 512,707 primary and secondary school children from 108 centres in 47 countries were included in the analysis. The use of an open fire for cooking was associated with an increased risk of symptoms of asthma and reported asthma in both children aged 6-7 years (odds ratio [OR] for wheeze in the past year, 1·78, 95% CI 1·51-2·10) and those aged 13-14 years (OR 1·20, 95% CI 1·06-1·37). In the final multivariate analyses, ORs for wheeze in the past year and the use of solely an open fire for cooking were 2·17 (95% CI 1·64-2·87) for children aged 6-7 years and 1·35 (1·11-1·64) for children aged 13-14 years. Odds ratios for wheeze in the past year and the use of open fire in combination with other fuels for cooking were 1·51 (1·25-1·81 for children aged 6-7 years and 1·35 (1·15-1·58) for those aged 13-14 years. In both age groups, we detected no evidence of an association between the use of gas as a cooking fuel and either asthma symptoms or asthma diagnosis.
  
  
  CONCLUSIONS
  The use of open fires for cooking is associated with an increased risk of symptoms of asthma and of asthma diagnosis in children. Because a large percentage of the world population uses open fires for cooking, this method of cooking might be an important modifiable risk factor if the association is proven to be causal.
  
  
  BACKGROUND
  BUPA Foundation, the Auckland Medical Research Foundation, the Health Research Council of New Zealand, the Asthma and Respiratory Foundation of New Zealand, the Child Health Research Foundation, the Hawke's Bay Medical Research Foundation, the Waikato Medical Research Foundation, Glaxo Wellcome New Zealand, the NZ Lottery Board, Astra Zeneca New Zealand, Hong Kong Research Grant Council, Glaxo Wellcome International Medical Affairs.
authors.affiliation: Department of Paediatrics and School of Public Health, Prince of Wales Hospital, Hong Kong SAR, China. Electronic address: wingkinwong@cuhk.edu.hk.
authors.forename: Gary W K
authors.initials: GW
authors.lastname: Wong
authors.affiliation: Chinese University of Hong Kong; Institute for Risk Assessment Sciences and Julius Centre for Health Sciences and Primary Care, University Medical Centre Universiteit Utrecht, Utrecht, Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Brunekreef
authors.affiliation: Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
authors.forename: Philippa
authors.initials: P
authors.lastname: Ellwood
authors.affiliation: MRC-HPA Centre for Environment and Health, Division of Public Health Sciences and Education, St George's, University of London, London, UK.
authors.forename: H Ross
authors.initials: HR
authors.lastname: Anderson
authors.affiliation: Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
authors.forename: M Innes
authors.initials: MI
authors.lastname: Asher
authors.affiliation: Wellington Asthma Research Group, Department of Medicine, University of Otago, Wellington, New Zealand.
authors.forename: Julian
authors.initials: J
authors.lastname: Crane
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China.
authors.forename: Christopher K W
authors.initials: CK
authors.lastname: Lai
mesh_terms: D000293:Adolescent; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000706:statistics & numerical data*; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D003296:Cooking / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires