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Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis
  1. Adama Sana1,2,3,
  2. Serge M A Somda4,5,
  3. Nicolas Meda1,2 and
  4. Catherine Bouland3
  1. 1Département de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
  2. 2Département de Santé Publique, Universite Ouaga 1 Pr Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
  3. 3Environmental and Occupational Health Research Center, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
  4. 4Département de Recherche Clinique, Centre Muraz, Bobo-Dioulasso, Belgium
  5. 5Unité de Formation et de Recherche en Sciences et Technologies, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
  1. Correspondence to Dr Adama Sana; adou_sanette{at}


Introduction Chronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities.

Methods We conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: “wood”, “charcoal”, “biomass”, “solid fuels”, “organic fuel”, “biofuel”, “female”, “women”, “COPD”, “chronic bronchitis”, “emphysema”, “chronic obstructive pulmonary disease”. Studies were eligible if they were case–control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR.

Results 24 studies were included: 5 case–control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57).

Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case–control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas.

Conclusions This study showed that biomass smoke exposure is associated with COPD in rural and urban women.

In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.

  • copd epidemiology
  • occupational lung disease
  • emphysema
  • clinical epidemiology

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  • Contributors AS contributed to the study protocol conception, articles searching and studies selection, data extraction, statistical analyses and the writing of all the versions of the manuscript. SMAS contributed to the studies selection, data extraction, statistical analyses, conception of the first draft of the manuscript and the final version of the manuscript. NM contributed to revising the manuscript (first draft and the final version). CB was involved in revising the study protocol and all the versions of this manuscript.

  • Funding AS was supported by a PhD studentship granted by the International Development Research Centre (IRDC) via the project ’Chairepol' (Project IDRC 107347) of the Community of Practice in EcoHealth—West and Central African (CoPEH-WCA) and the ULB (’Université Libre de Bruxelles') cooperation funds.

  • Competing interests None declared.

  • Provenance and peer review Open peer review.

  • Data sharing statement Not applicable

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