Household Air Pollution and Respiratory Outcomes Among Women Using Biomass Fuel for Cooking in India: Evidence Generation for Policy Action

IF 2.7 2区环境科学与生态学 Q1 CONSTRUCTION & BUILDING TECHNOLOGY

Indoor air Pub Date : 2026-06-20 DOI:10.1155/ina/9520044

Padukudru Anand Mahesh, A. S. Praveena, Mandya V. Greeshma, Vikram Patil, Jayaraj Biligere Siddaiah, Kjell Larsson, Lena Palmberg, Swapna Upadhyay, Koustav Ganguly

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Abstract

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.

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印度使用生物质燃料做饭的妇女的家庭空气污染和呼吸后果：为政策行动提供证据

2016年，印度启动了世界上最大的干预计划，为生活在贫困家庭的妇女提供负担得起的清洁烹饪燃料（液化石油气[LPG]），旨在减轻家庭空气污染（HAP）。据估计，2017年全球有180万人死于HAP，主要发生在中低收入国家。HAP的最高相对风险是慢性阻塞性肺疾病（COPD）。本研究旨在评估生物质燃料与持续使用液化石油气对印度迈苏尔妇女呼吸健康的影响。方法横断面研究纳入不吸烟的女性（≥40岁），使用纯生物质燃料（BMS组，n = 903）或液化石油气（LPG组，n = 441）烹饪。通过有效的问卷调查、肺功能测试和分数呼出一氧化氮（FeNO，气道炎症的生物标志物）测量收集数据。主要终点是COPD的患病率。咳嗽和慢性支气管炎的患病率是次要结局。对一部分受试者（n = 69）进行胸腔高分辨率计算机断层扫描（HRCT），然后进行肺结构分析。结果BMS组COPD患病率为3.90%，LPG组为1.59% （p = 0.036）。当考虑40-69岁年龄组时，BMS组COPD患病率为3.41%，LPG组为0.7% （p = 0.007）。咳嗽和慢性支气管炎在BMS组更为普遍（p < 0.001）。20.3%的BMS组和8.1%的LPG组发现高FeNO水平（≥25 ppb）（p < 0.001）。单因素和多因素logistic回归分析（调整生活水平指数）显示，生物质烟雾暴露指数(BMEI)≥60与发生慢性支气管炎有显著相关性（两项分析均为p <； 0.0001），而BMEI≥90与发生COPD有显著相关性（p = 0.0143和0.0410）。线性回归分析显示，当调整年龄时，肺功能随着BMEI的增加而下降。HRCT观察和肺结构分析表明，生物质烟雾暴露导致肺气肿、毛玻璃混浊和肺血管体积增加的发生率更高。结论：本研究结果表明生物质烟雾暴露对慢性支气管炎、慢性阻塞性肺病和肺功能下降具有剂量依赖性。这些数据将使决策者能够制定基于证据的战略，通过促进高暴露人群持续使用液化石油气来减少HAP。

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来源期刊

Indoor air 环境科学-工程：环境

CiteScore

10.80

自引率

10.30%

发文量

175

审稿时长

3 months

期刊介绍： The quality of the environment within buildings is a topic of major importance for public health. Indoor Air provides a location for reporting original research results in the broad area defined by the indoor environment of non-industrial buildings. An international journal with multidisciplinary content, Indoor Air publishes papers reflecting the broad categories of interest in this field: health effects; thermal comfort; monitoring and modelling; source characterization; ventilation and other environmental control techniques. The research results present the basic information to allow designers, building owners, and operators to provide a healthy and comfortable environment for building occupants, as well as giving medical practitioners information on how to deal with illnesses related to the indoor environment.