title: Respiratory risks from household air pollution in low and middle income countries.
abstract: A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK. Electronic address: stephen.gordon@lstmed.ac.uk.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Gordon
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: Nigel G
authors.initials: NG
authors.lastname: Bruce
authors.affiliation: Centre for Paediatrics, Blizard Institute, Queen Mary, University of London, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Grigg
authors.affiliation: Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.affiliation: Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Om P
authors.initials: OP
authors.lastname: Kurmi
authors.affiliation: Institute of Occupational and Environmental Medicine, School of Health and Population Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Kin-bong Hubert
authors.initials: KB
authors.lastname: Lam
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Mortimer
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Kwaku Poku
authors.initials: KP
authors.lastname: Asante
authors.affiliation: Department of Environmental Health Engineering, Sri Ramachandra University, Chennai, India.
authors.forename: Kalpana
authors.initials: K
authors.lastname: Balakrishnan
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Balmes
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Naor
authors.initials: N
authors.lastname: Bar-Zeev
authors.affiliation: Divisions of Epidemiology and Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Bates
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Breysse
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Buist
authors.affiliation: Clinical Trials Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Zhengming
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Havens
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Darby
authors.initials: D
authors.lastname: Jack
authors.affiliation: Jindal Clinics, Chandigarh, India.
authors.forename: Surinder
authors.initials: S
authors.lastname: Jindal
authors.affiliation: School of Public Health, Fudan University, Shanghai, China.
authors.forename: Haidong
authors.initials: H
authors.lastname: Kan
authors.affiliation: Health Effects Institute, Boston, MA, USA.
authors.forename: Sumi
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Moschovis
authors.affiliation: The University of Georgia, College of Public Health, Department of Environmental Health Science, Athens, GA, USA.
authors.forename: Luke
authors.initials: L
authors.lastname: Naeher
authors.affiliation: Lata Medical Research Foundation, Nagpur, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Perez-Padilla
authors.affiliation: Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pope
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: Jamie
authors.initials: J
authors.lastname: Rylance
authors.affiliation: University of Aberdeen, Scottish Centre for Indoor Air, Division of Applied Health Sciences, Royal Aberdeen Children's Hospital, Aberdeen, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Semple
authors.affiliation: Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA. Electronic address: wjmartin@cph.osu.edu.
authors.forename: William J
authors.initials: WJ
authors.lastname: Martin
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects* / Q000032:analysis; D002648:Child; D003296:Cooking; D003906:Developing Countries; D004781:Environmental Exposure; D052918:Environmental Restoration and Remediation; D005260:Female; D006798:Housing; D006801:Humans; D007182:Income; D008297:Male; D012140:Respiratory Tract Diseases / Q000209:etiology*; D012142:Respiratory Tract Neoplasms / Q000209:etiology; D012307:Risk Factors; D012924:Social Conditions; D012959:Socioeconomic Factors