Background The world′s largest intervention program to provide affordable cleaner cooking fuel (liquefied petroleum gas LPG) to women living in poor households was launched in 2016 in India with the aim to mitigate household air pollution (HAP). Globally, it was estimated that 1.8 million deaths in 2017, primarily in low‐middle income countries, were caused by HAP. The highest pooled relative risk for HAP was chronic obstructive pulmonary disease (COPD). This study is aimed at evaluating the respiratory health impact of biomass fuel versus sustained LPG use among women in Mysuru, India. Methods The cross‐sectional study involved nonsmoking women (≥ 40 years) using exclusive biomass fuel (BMS group; n = 903) or LPG (LPG group; n = 441) for cooking. Data were collected through validated questionnaires, lung function tests, and fractional exhaled nitric oxide (FeNO, biomarker of airway inflammation) measurements. The primary outcome was the prevalence of COPD. Prevalence of cough and chronic bronchitis was the secondary outcome. High‐resolution computed tomography (HRCT) of the thorax followed by lung texture analysis was performed in a subset of the subjects ( n = 69). Results COPD prevalence was 3.90% in the BMS group and 1.59% in the LPG group ( p = 0.036). When the age band 40–69 years is considered, the prevalence of COPD was 3.41% among BMS and 0.7% among LPG groups ( p = 0.007). Cough and chronic bronchitis were more prevalent in the BMS group ( p < 0.001). High FeNO levels (≥ 25 ppb) were found in 20.3% of the BMS group versus 8.1% of the LPG group ( p < 0.001). Univariate and multivariate logistic regression analysis (adjusted for standard of living index) revealed that a biomass smoke exposure index (BMEI) ≥ 60 has a significant association with developing chronic bronchitis ( p < 0.0001 for both analysis), whereas a BMEI ≥ 90 has a significant association with developing COPD ( p = 0.0143 and 0.0410). Linear regression analysis showed a decrease in lung function with increased BMEI when adjusted for age. The HRCT observations and lung texture analysis indicate that biomass smoke exposure results in a higher incidence of emphysema, ground‐glass opacity, and increased pulmonary vessel volume. Conclusions Findings of this study demonstrate dose‐dependent effects of biomass smoke exposure on developing chronic bronchitis, COPD, and declining lung function. These data would equip policymakers to develop evidence‐based strategies to reduce HAP by promoting sustained LPG usage among high‐exposure populations.
Mahesh et al. (Thu,) studied this question.