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. 2003 Jan;111(1):71–78. doi: 10.1289/ehp.5559

Effect of indoor air pollution from biomass combustion on prevalence of asthma in the elderly.

Vinod Mishra 1
PMCID: PMC1241308  PMID: 12515681

Abstract

In this study I examined the effect of cooking smoke on the reported prevalence of asthma among elderly men and women greater than or equal to 60 years old). The analysis is based on 38,595 elderly persons included in India's second National Family Health Survey conducted in 1998-1999. Effects of exposure to cooking smoke, ascertained by type of fuel used for cooking (biomass fuels, cleaner fuels, or a mix of biomass and cleaner fuels), on the reported prevalence of asthma were estimated using logistic regression. Because the effects of cooking smoke are likely to be confounded with effects of age, tobacco smoking, education, living standard, and other such factors, the analysis was carried out after statistically controlling for such factors. Results indicate that elderly men and women living in households using biomass fuels have a significantly higher prevalence of asthma than do those living in households using cleaner fuels [odds ratio (OR) = 1.59; 95% confidence interval (95% CI), 1.30-1.94], even after controlling for the effects of a number of potentially confounding factors. Active tobacco smoking was also associated with higher asthma prevalence in the elderly, but not environmental tobacco smoke. Availability of a separate kitchen in the house and a higher living standard of the household were associated with lower asthma prevalence. The adjusted effect of cooking smoke on asthma was greater among women (OR = 1.83; 95% CI, 1.32-2.53) than among men (OR = 1.46; 95% CI, 1.14-1.88). The findings have important program and policy implications for countries such as India, where large proportions of the population rely on polluting biomass fuels for cooking and space heating. More epidemiologic research with better measures of smoke exposure and clinical measures of asthma is needed to validate the findings.

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Selected References

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  1. Albalak R., Frisancho A. R., Keeler G. J. Domestic biomass fuel combustion and chronic bronchitis in two rural Bolivian villages. Thorax. 1999 Nov;54(11):1004–1008. doi: 10.1136/thx.54.11.1004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Althuis M. D., Sexton M., Prybylski D. Cigarette smoking and asthma symptom severity among adult asthmatics. J Asthma. 1999 May;36(3):257–264. doi: 10.3109/02770909909075409. [DOI] [PubMed] [Google Scholar]
  3. Anderson H. R. Air pollution and trends in asthma. Ciba Found Symp. 1997;206:190–207. [PubMed] [Google Scholar]
  4. Armstrong J. R., Campbell H. Indoor air pollution exposure and lower respiratory infections in young Gambian children. Int J Epidemiol. 1991 Jun;20(2):424–429. doi: 10.1093/ije/20.2.424. [DOI] [PubMed] [Google Scholar]
  5. Azizi B. H., Henry R. L. The effects of indoor environmental factors on respiratory illness in primary school children in Kuala Lumpur. Int J Epidemiol. 1991 Mar;20(1):144–150. doi: 10.1093/ije/20.1.144. [DOI] [PubMed] [Google Scholar]
  6. Azizi B. H., Zulkifli H. I., Kasim S. Indoor air pollution and asthma in hospitalized children in a tropical environment. J Asthma. 1995;32(6):413–418. doi: 10.3109/02770909409077752. [DOI] [PubMed] [Google Scholar]
  7. Baldi I., Tessier J. F., Kauffmann F., Jacqmin-Gadda H., Nejjari C., Salamon R. Prevalence of asthma and mean levels of air pollution: results from the French PAARC survey. Pollution Atomosphérique et Affections Respiratoires Chroniques. Eur Respir J. 1999 Jul;14(1):132–138. doi: 10.1034/j.1399-3003.1999.14a22.x. [DOI] [PubMed] [Google Scholar]
  8. Bates D. V. Observations on asthma. Environ Health Perspect. 1995 Sep;103 (Suppl 6):243–247. doi: 10.1289/ehp.95103s6243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Beeh K. M., Micke P., Ksoll M., Buhl R. Cigarette smoking, but not sensitization to Alternaria, is associated with severe asthma in urban patients. J Asthma. 2001 Feb;38(1):41–49. doi: 10.1081/jas-100000020. [DOI] [PubMed] [Google Scholar]
  10. Behera D., Dash S., Malik S. K. Blood carboxyhaemoglobin levels following acute exposure to smoke of biomass fuel. Indian J Med Res. 1988 Dec;88:522–524. [PubMed] [Google Scholar]
  11. Ben-Noun L. Is there a relationship between smoking and asthma in adults? J Int Med Res. 1999 Jan-Feb;27(1):15–21. doi: 10.1177/030006059902700102. [DOI] [PubMed] [Google Scholar]
  12. Björkstén B. The environmental influence on childhood asthma. Allergy. 1999;54 (Suppl 49):17–23. doi: 10.1111/j.1398-9995.1999.tb04383.x. [DOI] [PubMed] [Google Scholar]
  13. Bruce N., Neufeld L., Boy E., West C. Indoor biofuel air pollution and respiratory health: the role of confounding factors among women in highland Guatemala. Int J Epidemiol. 1998 Jun;27(3):454–458. doi: 10.1093/ije/27.3.454. [DOI] [PubMed] [Google Scholar]
  14. Bruce N., Perez-Padilla R., Albalak R. Indoor air pollution in developing countries: a major environmental and public health challenge. Bull World Health Organ. 2000;78(9):1078–1092. [PMC free article] [PubMed] [Google Scholar]
  15. Castellsague J., Sunyer J., Sáez M., Antó J. M. Short-term association between air pollution and emergency room visits for asthma in Barcelona. Thorax. 1995 Oct;50(10):1051–1056. doi: 10.1136/thx.50.10.1051. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Chang J. C., Distler S. G., Kaplan A. M. Tobacco smoke suppresses T cells but not antigen-presenting cells in the lung-associated lymph nodes. Toxicol Appl Pharmacol. 1990 Mar 1;102(3):514–523. doi: 10.1016/0041-008x(90)90046-w. [DOI] [PubMed] [Google Scholar]
  17. Collings D. A., Sithole S. D., Martin K. S. Indoor woodsmoke pollution causing lower respiratory disease in children. Trop Doct. 1990 Oct;20(4):151–155. doi: 10.1177/004947559002000403. [DOI] [PubMed] [Google Scholar]
  18. Dales R. E., Burnett R., Zwanenburg H. Adverse health effects among adults exposed to home dampness and molds. Am Rev Respir Dis. 1991 Mar;143(3):505–509. doi: 10.1164/ajrccm/143.3.505. [DOI] [PubMed] [Google Scholar]
  19. Eisner M. D., Yelin E. H., Henke J., Shiboski S. C., Blanc P. D. Environmental tobacco smoke and adult asthma. The impact of changing exposure status on health outcomes. Am J Respir Crit Care Med. 1998 Jul;158(1):170–175. doi: 10.1164/ajrccm.158.1.9801028. [DOI] [PubMed] [Google Scholar]
  20. Flodin U., Jönsson P., Ziegler J., Axelson O. An epidemiologic study of bronchial asthma and smoking. Epidemiology. 1995 Sep;6(5):503–505. doi: 10.1097/00001648-199509000-00007. [DOI] [PubMed] [Google Scholar]
  21. Fujii T., Hayashi S., Hogg J. C., Vincent R., Van Eeden S. F. Particulate matter induces cytokine expression in human bronchial epithelial cells. Am J Respir Cell Mol Biol. 2001 Sep;25(3):265–271. doi: 10.1165/ajrcmb.25.3.4445. [DOI] [PubMed] [Google Scholar]
  22. Green G. M., Jakab G. J., Low R. B., Davis G. S. Defense mechanisms of the respiratory membrane. Am Rev Respir Dis. 1977 Mar;115(3):479–514. doi: 10.1164/arrd.1977.115.3.479. [DOI] [PubMed] [Google Scholar]
  23. Greer J. R., Abbey D. E., Burchette R. J. Asthma related to occupational and ambient air pollutants in nonsmokers. J Occup Med. 1993 Sep;35(9):909–915. doi: 10.1097/00043764-199309000-00014. [DOI] [PubMed] [Google Scholar]
  24. Hajat S., Haines A., Goubet S. A., Atkinson R. W., Anderson H. R. Association of air pollution with daily GP consultations for asthma and other lower respiratory conditions in London. Thorax. 1999 Jul;54(7):597–605. doi: 10.1136/thx.54.7.597. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Hardin J. A., Hinoshita F., Sherr D. H. Mechanisms by which benzo[a]pyrene, an environmental carcinogen, suppresses B cell lymphopoiesis. Toxicol Appl Pharmacol. 1992 Dec;117(2):155–164. doi: 10.1016/0041-008x(92)90232-h. [DOI] [PubMed] [Google Scholar]
  26. Kong L. Y., Luster M. I., Dixon D., O'Grady J., Rosenthal G. J. Inhibition of lung immunity after intratracheal instillation of benzo(a)pyrene. Am J Respir Crit Care Med. 1994 Oct;150(4):1123–1129. doi: 10.1164/ajrccm.150.4.7921446. [DOI] [PubMed] [Google Scholar]
  27. Koren H. S. Associations between criteria air pollutants and asthma. Environ Health Perspect. 1995 Sep;103 (Suppl 6):235–242. doi: 10.1289/ehp.95103s6235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Koren H. S., Utell M. J. Asthma and the environment. Environ Health Perspect. 1997 May;105(5):534–537. doi: 10.1289/ehp.97105534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Lewis Sarah A., Weiss Scott T., Platts-Mills Thomas A. E., Burge Harriet, Gold Diane R. The role of indoor allergen sensitization and exposure in causing morbidity in women with asthma. Am J Respir Crit Care Med. 2002 Apr 1;165(7):961–966. doi: 10.1164/ajrccm.165.7.2103044. [DOI] [PubMed] [Google Scholar]
  30. Litonjua A. A., Sparrow D., Weiss S. T., O'Connor G. T., Long A. A., Ohman J. L., Jr Sensitization to cat allergen is associated with asthma in older men and predicts new-onset airway hyperresponsiveness. The Normative Aging Study. Am J Respir Crit Care Med. 1997 Jul;156(1):23–27. doi: 10.1164/ajrccm.156.1.9608072. [DOI] [PubMed] [Google Scholar]
  31. Maier W. C., Arrighi H. M., Morray B., Llewellyn C., Redding G. J. Indoor risk factors for asthma and wheezing among Seattle school children. Environ Health Perspect. 1997 Feb;105(2):208–214. doi: 10.1289/ehp.97105208. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Martinez F. D., Cline M., Burrows B. Increased incidence of asthma in children of smoking mothers. Pediatrics. 1992 Jan;89(1):21–26. [PubMed] [Google Scholar]
  33. Mishra V. K., Retherford R. D., Smith K. R. Biomass cooking fuels and prevalence of tuberculosis in India. Int J Infect Dis. 1999 Spring;3(3):119–129. doi: 10.1016/s1201-9712(99)90032-2. [DOI] [PubMed] [Google Scholar]
  34. Mohamed N., Ng'ang'a L., Odhiambo J., Nyamwaya J., Menzies R. Home environment and asthma in Kenyan schoolchildren: a case-control study. Thorax. 1995 Jan;50(1):74–78. doi: 10.1136/thx.50.1.74. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Mukae H., Vincent R., Quinlan K., English D., Hards J., Hogg J. C., van Eeden S. F. The effect of repeated exposure to particulate air pollution (PM10) on the bone marrow. Am J Respir Crit Care Med. 2001 Jan;163(1):201–209. doi: 10.1164/ajrccm.163.1.2002039. [DOI] [PubMed] [Google Scholar]
  36. Noorhassim I., Rampal K. G., Hashim J. H. The relationship between prevalence of asthma and environmental factors in rural households. Med J Malaysia. 1995 Sep;50(3):263–267. [PubMed] [Google Scholar]
  37. Pandey M. R. Domestic smoke pollution and chronic bronchitis in a rural community of the Hill Region of Nepal. Thorax. 1984 May;39(5):337–339. doi: 10.1136/thx.39.5.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Platts-Mills T. A., Woodfolk J. A. Rise in asthma cases. Science. 1997 Nov 7;278(5340):1001–1001. doi: 10.1126/science.278.5340.997c. [DOI] [PubMed] [Google Scholar]
  39. Qureshi K. A. Domestic smoke pollution and prevalence of chronic bronchitis/asthma in a rural area of Kashmir. Indian J Chest Dis Allied Sci. 1994 Apr-Jun;36(2):61–72. [PubMed] [Google Scholar]
  40. Rieder H. L., Arnadottir T., Trébucq A., Enarson D. A. Tuberculosis treatment: dangerous regimens? Int J Tuberc Lung Dis. 2001 Jan;5(1):1–3. [PubMed] [Google Scholar]
  41. Rosenstreich D. L., Eggleston P., Kattan M., Baker D., Slavin R. G., Gergen P., Mitchell H., McNiff-Mortimer K., Lynn H., Ownby D. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997 May 8;336(19):1356–1363. doi: 10.1056/NEJM199705083361904. [DOI] [PubMed] [Google Scholar]
  42. Schnizlein C. T., Bice D. E., Mitchell C. E., Hahn F. F. Effects on rat lung immunity by acute lung exposure to benzo(a)pyrene. Arch Environ Health. 1982 Jul-Aug;37(4):201–206. doi: 10.1080/00039896.1982.10667565. [DOI] [PubMed] [Google Scholar]
  43. Siroux V., Pin I., Oryszczyn M. P., Le Moual N., Kauffmann F. Relationships of active smoking to asthma and asthma severity in the EGEA study. Epidemiological study on the Genetics and Environment of Asthma. Eur Respir J. 2000 Mar;15(3):470–477. doi: 10.1034/j.1399-3003.2000.15.08.x. [DOI] [PubMed] [Google Scholar]
  44. Smith K. R., Samet J. M., Romieu I., Bruce N. Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax. 2000 Jun;55(6):518–532. doi: 10.1136/thorax.55.6.518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Strachan D. P., Cook D. G. Health effects of passive smoking. 6. Parental smoking and childhood asthma: longitudinal and case-control studies. Thorax. 1998 Mar;53(3):204–212. doi: 10.1136/thx.53.3.204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Tan W. C., Qiu D., Liam B. L., Ng T. P., Lee S. H., van Eeden S. F., D'Yachkova Y., Hogg J. C. The human bone marrow response to acute air pollution caused by forest fires. Am J Respir Crit Care Med. 2000 Apr;161(4 Pt 1):1213–1217. doi: 10.1164/ajrccm.161.4.9904084. [DOI] [PubMed] [Google Scholar]
  47. Taszakowski W., Dwornicki J. Wpływ czynników środowiskowych na system obronny układu oddechowego. Pol Tyg Lek. 1992 Aug 18;47(34-35):763–765. [PubMed] [Google Scholar]
  48. Thorn J., Brisman J., Torén K. Adult-onset asthma is associated with self-reported mold or environmental tobacco smoke exposures in the home. Allergy. 2001 Apr;56(4):287–292. doi: 10.1034/j.1398-9995.2001.00805.x. [DOI] [PubMed] [Google Scholar]
  49. Togias A., Horowitz E., Joyner D., Guydon L., Malveaux F. Evaluating the factors that relate to asthma severity in adolescents. Int Arch Allergy Immunol. 1997 May-Jul;113(1-3):87–95. doi: 10.1159/000237515. [DOI] [PubMed] [Google Scholar]
  50. Vesterinen E., Kaprio J., Koskenvuo M. Prospective study of asthma in relation to smoking habits among 14,729 adults. Thorax. 1988 Jul;43(7):534–539. doi: 10.1136/thx.43.7.534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Volkmer R. E., Ruffin R. E., Wigg N. R., Davies N. The prevalence of respiratory symptoms in South Australian preschool children. II. Factors associated with indoor air quality. J Paediatr Child Health. 1995 Apr;31(2):116–120. doi: 10.1111/j.1440-1754.1995.tb00758.x. [DOI] [PubMed] [Google Scholar]
  52. Wang J., Hu S. M. [The effects of kitchen air pollution on animals immune function]. Zhonghua Yu Fang Yi Xue Za Zhi. 1992 Mar;26(2):86–88. [PubMed] [Google Scholar]
  53. Xu X, Niu T, Christiani DC, Weiss ST, Chen C, Zhou Y, Fang Z, Jiang Z, Liang W, Zhang F. Occupational and Environmental Risk Factors for Asthma in Rural Communities in China. Int J Occup Environ Health. 1996 Jul;2(3):172–176. doi: 10.1179/oeh.1996.2.3.172. [DOI] [PubMed] [Google Scholar]
  54. Zhang J., Qian Z., Kong L., Zhou L., Yan L., Chapman R. S. Effects of air pollution on respiratory health of adults in three Chinese cities. Arch Environ Health. 1999 Nov-Dec;54(6):373–381. doi: 10.1080/00039899909603368. [DOI] [PubMed] [Google Scholar]
  55. de Diego Damiá A., León Fabregas M., Perpiñ Tordera M., Compte Torrero L. Effects of air pollution and weather conditions on asthma exacerbation. Respiration. 1999;66(1):52–58. doi: 10.1159/000029337. [DOI] [PubMed] [Google Scholar]
  56. van Eeden S. F., Tan W. C., Suwa T., Mukae H., Terashima T., Fujii T., Qui D., Vincent R., Hogg J. C. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med. 2001 Sep 1;164(5):826–830. doi: 10.1164/ajrccm.164.5.2010160. [DOI] [PubMed] [Google Scholar]
  57. von Mutius E., Illi S., Nicolai T., Martinez F. D. Relation of indoor heating with asthma, allergic sensitisation, and bronchial responsiveness: survey of children in south Bavaria. BMJ. 1996 Jun 8;312(7044):1448–1450. doi: 10.1136/bmj.312.7044.1448. [DOI] [PMC free article] [PubMed] [Google Scholar]

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