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Biomass Fuels for Cooking: Clear that Smoke

I read with interest the recent article by Regalado and colleagues, wherein the authors have assessed the impact of cooking with biomass fuels (BMFs) on respiratory symptoms and lung function among rural women in a developing country (1). They found the presence of increased respiratory symptoms (predominantly an increase in phlegm) as well as a decline in spirometric indices, both of which correlated with the duration of exposure. These findings reinforce the observations of previous studies done at my institute that BMFs have deleterious effects on respiratory functions of nonsmoking individuals. However, two important aspects related to cooking with domestic fuels merit attention.

First, it is worthwhile to note that exposure to kerosene (another commonly used fuel for domestic cooking in rural areas that do not have access to liquefied petroleum gas [LPG]) also leads to an increase in respiratory symptoms. In fact, increase in respiratory symptoms was maximal with the use of mixed fuels (both BMFs as well as kerosene) compared with either of the two alone (2, 3). These effects occur not only in adults but also in children (4). Moreover, patients with preexisting obstructive airway disease tend to have an increase in respiratory symptoms as well as worsening lung functions after exposure to domestic cooking fuels (5). Second, in addition to obstructive airway disease, exposure to BMFs and mixed fuels can lead to bronchial hyperresponsiveness as well as restrictive defects on spirometry (6, 7). Combined exposure to tobacco smoke and domestic cooking fuels (like BMFs and mixed fuels) leads to much more morbidity than either of them alone (2, 7).

In developing countries, and especially in rural areas, using LPG for cooking is often not possible either due to economic constraints or lack of access to the same. The need to use BMFs and other alternate fuels for domestic cooking is compounded by the absence of proper ventilation in houses, and this enhances the adverse effects of such fuels. The key to avoiding the deleterious effects of these fuels (on respiratory symptoms and function) is to advocate the use of smokeless devices for cooking as well as to improve the ventilation in houses, especially in the area where domestic cooking is done. After all, prevention is better than cure.

Navneet Singh

Postgraduate Institute of Medical Education and Research, Chandigarh, India

FOOTNOTES

Conflict of Interest Statement: N.S. does not have a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Regalado J, Pérez-Padilla R, Sansores R, Ramirez JIP, Brauer M, Paré P, Vedal S. The effect of biomass burning on respiratory symptoms and lung function in rural Mexican women. Am J Respir Crit Care Med 2006;174:901–905.[Abstract/Free Full Text]
2. Behera D, Jindal SK. Respiratory symptoms in Indian women using domestic cooking fuels. Chest 1991;100:385–388.
3. Behera D. An analysis of effect of common domestic fuels on respiratory function. Indian J Chest Dis Allied Sci 1997;39:235–243.[Medline]
4. Behera D, Sood P, Singh S. Passive smoking, domestic fuels and lung function in north Indian children. Indian J Chest Dis Allied Sci 1998;40:89–98.[Medline]
5. Behera D, Chakrabarti T, Khanduja KL. Effect of exposure to domestic cooking fuels on bronchial asthma. Indian J Chest Dis Allied Sci 2001;43:27–31.[Medline]
6. Behera D, Jindal SK, Malhotra HS. Ventilatory function in nonsmoking rural Indian women using different cooking fuels. Respiration (Herrlisheim) 1994;61:89–92.
7. Jindal SK, Gupta D, D'Souza GA, Kalra S. Bronchial responsiveness of non-smoking women exposed to environmental tobacco smoke or biomass fuel combustion. Indian J Med Res 1996;104:359–364.[Medline]

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