Reviews and feature article
Respiratory health effects of air pollution: Update on biomass smoke and traffic pollution

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Mounting evidence suggests that air pollution contributes to the large global burden of respiratory and allergic diseases, including asthma, chronic obstructive pulmonary disease, pneumonia, and possibly tuberculosis. Although associations between air pollution and respiratory disease are complex, recent epidemiologic studies have led to an increased recognition of the emerging importance of traffic-related air pollution in both developed and less-developed countries, as well as the continued importance of emissions from domestic fires burning biomass fuels, primarily in the less-developed world. Emissions from these sources lead to personal exposures to complex mixtures of air pollutants that change rapidly in space and time because of varying emission rates, distances from source, ventilation rates, and other factors. Although the high degree of variability in personal exposure to pollutants from these sources remains a challenge, newer methods for measuring and modeling these exposures are beginning to unravel complex associations with asthma and other respiratory tract diseases. These studies indicate that air pollution from these sources is a major preventable cause of increased incidence and exacerbation of respiratory disease. Physicians can help to reduce the risk of adverse respiratory effects of exposure to biomass and traffic air pollutants by promoting awareness and supporting individual and community-level interventions.

Section snippets

Exposures to BMFs and traffic pollutants

Exposures to BMF smoke and TRAP are widespread. Domestic fires burning biomass (wood, charcoal, dung, crop residues, and other raw plant materials) for cooking, heating, or both remain the most pervasive and important source of exposure to air pollution for much of humanity. About 2.4 billion persons live in households in which BMFs are the primary fuel for cooking, heating, or both,9, 10 with more than 90% of subjects in rural areas of LDCs using BMFs.9 Exposures are often exacerbated by use

Mechanistic insight

As discussed above, oxidative stress is a commonly cited mechanism for the relationship between air pollutants, many of them with oxidant constituents, and asthma worsening or onset. Both particles and gases can produce oxidative stress and can act in concert. Polymorphisms of the genes encoding glutathione-S-transferase M1, glutathione-S-transferase P1, and TNF-α are all reported to have associations/interactions with asthma and air pollution, but data are not consistent enough to allow firm

Beijing Olympics intervention studies

Natural (or politically organized) changes in the environment are viewed by researchers as great opportunities to study the effects on human health of greater than usual degrees of independent variable (pollution) change. This has been applied to the effects of sudden or dramatic changes in air pollution.82, 83 When these changes are anticipated, detailed clinical studies can be designed.84 One such example was the Beijing Olympics of 2008 (Fig 2). One study that came out of this event examined

Clinical guidance

Reducing the effects of BMF smoke and TRAP on respiratory health will require both public policy and the actions of individual patients. Consensus standards recognize the importance of air pollutants in the prevention and management of asthma and COPD and have recommended that clinicians counsel patients to become aware of and avoid exposures to air pollution (see the Global Initiative for Chronic Obstructive Lung Disease and National Heart, Lung, and Blood Institute Expert Panel 3 reports).

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    Series editors: Donald Y. M. Leung, MD, PhD, and Dennis K. Ledford, MD

    Supported in part by National Institute of Environmental Health Sciences grant P30 ES005022 and US Environmental Protection Agency STAR Grant RD 83457901.

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