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Respiratory risks from household air pollution in low and middle income countries
Open accessAbstract
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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Metadata
- Authors
- Gordon, S. B., Bruce, N. G., Grigg, J., Hibberd, P. L., Kurmi, O. P., Lam, K.-B. H., Mortimer, K., Asante, K. P., Balakrishnan, K., Balmes, J., Bar-Zeev, N., Bates, M. N., Breysse, P. N., Buist, S., Chen, Z., Havens, D., Jack, D., Jindal, S., Kan, H., Mehta, S., Moschovis, P., Naeher, L., Patel, A., Perez-Padilla, R., Pope, D., Rylance, J., Semple, S., & Martin, W. J.
- Affiliations
- Liverpool School of Tropical Medicine (GB)
- University of Liverpool (GB)
- Queen Mary University of London (GB)
- Harvard University (US)
- University of Oxford (GB)
- University of Birmingham (GB)
- Columbia University (US)
- Sri Ramachandra Institute of Higher Education and Research (IN)
- University of California, San Francisco (US)
- University of California, Berkeley (US)
- Johns Hopkins University (US)
- Oregon Health & Science University (US)
- Fudan University (CN)
- Health Effects Institute (US)
- University of Georgia (US)
- Lata Medical Research Foundation (IN)
- University of Malawi (MW)
- University of Aberdeen (GB)
- The Ohio State University (US)
- ORCID
- Gordon, Stephen B
- Grigg, Jonathan
- Hibberd, Patricia L
- Kurmi, Om P
- Mortimer, Kevin
- Asante, Kwaku Poku
- Balakrishnan, Kalpana
- Balmes, John
- Bates, Michael N
- Buist, Sonia
- Chen, Zhengming
- Jack, Darby
- Kan, Haidong
- Mehta, Sumi
- Moschovis, Peter
- Naeher, Luke
- Patel, Archana
- Pope, Daniel
- Rylance, Jamie
- Semple, Sean
- Martin, William J
- Venue
- The Lancet Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 2
- Issue
- 10
- Pages
- 823-860
- ISSN
- 2213-2600 (ISSN-L)
- PMC
- PMC5068561
- OpenAlex
- W2152501249
- Cited by
- 953
- References
- 311
- Citations by year
- 2026: 60 · 2025: 76 · 2024: 89 · 2023: 105 · 2022: 89 · 2021: 102 · 2020: 99 · 2019: 83 · 2018: 86 · 2017: 54 · 2016: 60 · 2015: 44 · 2014: 5
- FWCI
- 4.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- Funders
- Wellcome Trust (101113, 100890)
- National Institute for Health and Care Research (CL-2006-12-004)
- Medical Research Council (MR/L009242/1, MR/K006533/1, MR/L002515/1)
- National Heart, Lung, and Blood Institute (F32HL124951)
- National Institute of Environmental Health Sciences (P30ES009089)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD078439)
- Topics
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- household air pollution, solid fuel use, biomass cooking, coal combustion, respiratory infections, respiratory cancer, chronic lung disease, chronic obstructive pulmonary disease, bronchiectasis, nasopharyngeal carcinoma, lung development, exposure measurement, women and children, clean cooking, low- and middle-income countries
- MeSH terms
- Adult, Child, Cooking, Developing Countries, Environmental Exposure, Female, Housing, Humans, Income, Male, Respiratory Tract Diseases, Respiratory Tract Neoplasms, Risk Factors, Social Conditions, Socioeconomic Factors, Air Pollution, Indoor, Environmental Restoration and Remediation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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