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Biomass Fuels for Cooking: Clear that Smoke

We thank Dr. Navneet Singh for his interest in our recent article (1). Dr. Singh's comments related to the role of kerosene exposure on respiratory symptoms of adults and children are certainly plausible. In our survey, we explored the use of multiple cooking fuels, including liquefied petroleum gas (LPG), petroleum, charcoal, biomass, and electricity. In the studied community, and in other areas of Mexico, the use of kerosene as cooking fuel is very uncommon. This may explain why in our study only cooking with biomass stoves was associated with reports of increased phlegm production and the slight decrease of lung function. We did not analyze the presence of bronchial hyperresponsiveness among participants, but it is clear that women with chronic obstructive pulmonary disease (COPD) due to wood smoke exposure have this and, at least in one study conducted at our institute, the degree of hyperresponsiveness was greater in patients with COPD exposed to biomass than in those exposed to tobacco smoke (2).

At the time of the survey, tobacco smoking was uncommon in women (3%), and we decided to analyze the impact of cooking with biomass stoves in nonsmoking women. Therefore, we were unable to study the impact of cooking with biomass stoves in smokers. However, it is now more common to see women with COPD who cooked with biomass stoves and were smokers. We should increase public awareness of the health impact of traditional cooking with solid fuels and other polluting fuels, as it is very unlikely that poor communities will change to cleaner fuels in the near future. The alternative is the dissemination of improved biomass stoves and better house ventilation as Dr. Singh suggests.

Justino Regalado

National Institute of Respiratory Diseases (INER), Mexico City, Mexico

FOOTNOTES

Conflict of Interest Statement: J.R. 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. García Guillén L, Ramírez-Venegas A, Regalado J, Sansores RH. The role of atopy and nonspecific bronchial hyperresponsiveness in chronic bronchitis and chronic air flow limitation in women exposed to wood smoke [abstract]. Am J Respir Crit Care Med 2000;161:A818.

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