James Balmes Gordon SB1, Bruce NG2, Grigg J3, Hibberd PL4, Kurmi OP5, Lam KB6, Mortimer K7, Asante KP8, Balakrishnan K9, Balmes J10, Bar-Zeev N11, Bates MN12, Breysse PN13, Buist S14, Chen Z5, Havens D7, Jack D8, Jindal S15, Kan H16, Mehta S17, Moschovis P4, Naeher L18, Patel A19, Perez-Padilla R20, Pope D2, Rylance J21, Semple S22, Martin WJ 2nd23. 19 2014 Oct http://www.ncbi.nlm.nih.gov/pubmed/25193349 Respiratory risks from household air pollution in low and middle income countries. 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.
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