Chronic obstructive pulmonary disease by biomass smoke exposure

In this article, the relationship between chronic obstructive pulmonary disease (COPD) and biomass smoke will be discussed. More than half of the world population uses biomass for fuel, especially in rural areas and in developing countries where usage reaches 80%. Biomass smoke inhalation creates an inflammatory chronic state, which is accompanied by metalloproteinases activation and mucociliary mobility reduction. This could explain the existing association between biomass exposure and COPD, revealed by observational and epidemiological studies from developing and developed countries. In this review, the differences between COPD caused by tobacco and biomass were explored. It was found that despite the pathophysiological differences, most of the clinical characteristics, quality of life and mortality were similar. In the last ten years there have been interventions to reduce the biomass smoke exposure by using improved stoves and cleaner fuels. However, these strategies have not yet been successful due to inability to reduce contamination levels to those recommended by the World Health Organization as well as due to the lack of use. Therefore, there is an urgent need for carefully conducted, randomized field trials to determine the actual range of potentially reachable contamination reductions, the probability of use and the long term benefits of reducing the global burden of COPD.