A Case-Control Study on the Effect of Exposure to Different Substances on the Development of COPD
Introduction
Chronic obstructive pulmonary disease (COPD) is a common disease in our society. The risk factors that are known for the development of COPD are cigarettes, occupational or environmental exposure to various irritant gases, infections, and genetic composition 1, 2.
One of the interesting subjects in recent years in particular has been the development of COPD secondary to air pollution inside homes that is frequently seen in developing countries. Two of the most important factors effecting the development of COPD from domestic air pollution are the inhaling of pollutants that result from passive cigarette smoking and the burning of biomass fuel. “Biomass” refers to all organic flammable materials such as petrol products, coal, firewood, plant waste, and dried animal dung used as fuel (1). When complex organic structure fuels that are known as biomass are burned they release into the atmosphere elemental carbon, nitrogen, oxygen, and hydrogen along with many other elements that are harmful polycyclic hydrocarbons. The burning of these types of fuel, which is done for a variety of reasons (heating, cooking, etc.) in poorly ventilated environments can cause many health problems (1). Different studies have shown that many respiratory disease processes can develop as a result of different internal air pollution, primarily from these types of fuel 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. In our region—Sivas, Turkey—in particular, women use and are affected by these kinds of fuel for heating and for cooking food in ovens called tandır.
Traditional biomass (e.g., dried animal dung) is more frequently used in undeveloped and developing countries for socioeconomic reasons. Biomass is used for cooking in 30% of homes in urban areas of developing countries and in 90% of homes in rural areas (17). A correlation between the use of biomass and COPD has been found in a variety of studies done in rural regions of minimally developed countries. The principal factor for COPD in the Central Anatolian and Southeastern Anatolian regions in our country is smoke from burning dried animal dung. Those who are exposed to this smoke the most are the women who light the fires and cook food and bread over these fires.
Because COPD is seen frequently in the female patients who apply to the hospital in our region, this study was planned for the purpose of studying the effect of exposure to wood ash, biomass, and cigarette smoke on women who were never smokers, yet have been diagnosed with COPD (but no other disease) at the Cumhuriyet University Medical Faculty Hospital's Pulmonary Medicine Clinic in Sivas, a province in the east part of Turkey with a population of 225,000.
Through the selection of housewives who never smoked in this case-control study, we were able to control for active smoking, occupational exposures, and gender simultaneously in examining the effect of exposure to biomass, passive cigarette smoking, and wood ash on the development of COPD. This study adds new knowledge with regard to the understanding the nature of the associations between COPD and exposure to these three substances.
Section snippets
Methods
Seventy-four female patients were selected from the records at the Cumhuriyet University Medical Faculty Hospital Pulmonary Medicine Clinic in Sivas for the case group in this study. These women were housewives (the word “housewife” is used in Sivas for a woman who has been never employed), had never smoked, and had had the diagnosis of COPD made between January 1, 2001 and March 31, 2002. The addresses and telephone numbers for these women were obtained from their records. These addresses were
Results
The case group and control group age distribution is seen in Table 1. The mean age and standard deviation for the case group was 57.08 ± 11.10 years and for the control group was 56.35 ± 10.78 years. No statistically significant difference was found between the two groups when comparing the mean ages (t = 0.405, p > 0.05).
The distribution of wood-ash exposure for the case and control groups is seen in Table 2. No statistically significant difference was found between the two groups for wood ash
Discussion
In our study, the role of factors other than active cigarette smoking were researched for the development of COPD. In particular, the effects of exposure to passive cigarette smoke, biomass, and wood ash were examined for the development of COPD. The effect of passive cigarette smoke exposure on COPD has been known for years (18). Our study, as well, showed this effect: Those who had passive cigarette smoke exposure at home for 30 or more years had a five-times higher risk of developing COPD
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