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BIOMASS SMOKE PREDISPOSES RURAL WOMEN TO PULMONARY HYPERTENSION SOONER AND EARLIER THAN COPD

BIOMASS SMOKE PREDISPOSES RURAL WOMEN TO PULMONARY HYPERTENSION SOONER AND EARLIER THAN COPD. The use of biomass fuel for cooking and heating is commonplace in developing countries (1, 2 ,3 )

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BIOMASS SMOKE PREDISPOSES RURAL WOMEN TO PULMONARY HYPERTENSION SOONER AND EARLIER THAN COPD

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  1. BIOMASS SMOKE PREDISPOSES RURAL WOMEN TO PULMONARY HYPERTENSION SOONER AND EARLIER THAN COPD

  2. The use of biomass fuel for cooking and heating is commonplace in developing countries (1, 2,3) 1- Uzun K, Ozbay B. Prevalence of Chronic Bronchitis – Asthma symptoms in Biomass Fuel Exposed Females. Environmental health and Preventive Medicine 2003; 8: 13 - 17 2- Ozbay B, Uzun K. Functional and radiological impairment in women highly exposed to indoor biomass fuels. Respirology 2001; 6: 255 - 8 3-Regalado J, Perez-Padilla R. The effect of biomass burning on respiratory symptoms and lung function in rural Mexican women Am J Respir Crit Care Med. 2006 Oct 15;174(8):901-5. Epub 2006 Jun 23.

  3. Common respiratory irritants included in biomass combustion CO, CO2, NO2, SO2, Ammonium, Cyanide, Aldehyde, Ketone, Acrolein

  4. Common Biomass Related Diseases ( 1, 2 ) Low birth weight Growth retardation Recurrent upper and lower respiratory tract infections, Chronic Bronchitis, COPD Reactive Bronchitis Bronchiolitis Obliterans 1-Baris YI. Solunum Hastalıkları. Atlas Kitapçılık, 1998. 2-Bariş Yİ. Primitive biomass related health problem. Toraks Dergisi 2006 ( supp )

  5. Biomass fuel has deleterious effects on pulmonary function and structure leading to obstructive and restrictive pathologies (1,2,3,4,5,) 1-Demirtaş N, Seyfikli Z, Topçu S.The relationships between traditional biomass combustion and development of COPD in women of Sivas area. Solunum Hastalıkları 1999; 10: 156 – 8. 2-Ozbay B, Uzun K, Arslan H, Zehir I. Functional and radiological impairment in women highly exposed to indoor biomass fuels. Respirology. 2001 Sep;6(3):255-8. 3-Weis S.T, DeMeo D.L, Postma D. S. COPD: Problems in diagnosis and measurement. Eur Respir J 2003; 21: Supll. 41, 4s – 12s.4-Arslan M, Akkurt I, Egilmez H, Atalar M, Salk I.Biomass exposure and the high resolution computed tomographic and spirometric findings.Eur J Radiol. 2004 Nov;52(2):192-9. 5-Chronic pulmonary disease in rural women exposed to biomass fumes.Kiraz K, Kart L, Demir R, Oymak S, Gulmez I, Unalacak M, Ozesmi M.Clin Invest Med. 2003 Oct;26(5):243-8

  6. Alteratıons ın respıratory tractus of anımal models exposed to bıomass smoke have been demonstrated (1, 2) 1-Bülent Özbay, Şükrü Acar, Zabit Yener, Mehmet Kanter Hıstopathologıcal alteratıons ın respıratory tractus of rats exposed to bıomass smoke. Thorax Society 8th Annual Congress, MS 337, 28 . 04. 2005, ANTALYA 2-Fidan F, Unlu M, Sezer M, Sahin O, Tokyol C, Esme H.Acute effects of environmental tobacco smoke and dried dung smoke on lung histopathology in rabbitsPathology. 2006 Feb;38(1):53-7

  7. The relationships between traditional biomass combustion and development of COPD in women of Sivas area. *Demirtaş N, Seyfikli Z, Topçu S. Solunum Hastalıkları 1999; 10: 156 –8.

  8. Biomass fuel has deleterious effects on pulmonary function and structure leading to obstructive and restrictive pathologies* *Functional and radiological impairment in women highly exposed to indoor biomass fuels.Ozbay B, Uzun K, Arslan H, Zehir I.Respirology. 2001 Sep;6(3):255-8.

  9. Biomass fuel exposure causes obstructive and restrictive spirometric impairments. The prevalence of the fibrotic bands, peribronchiovascular thickenings, nodular radio opacities, and curvilinear densities in the high resolution computed tomographic examinations were 7, 5,7, and 16 times higher in the exposure group than the control group, respectively* *Arslan M, Akkurt I, Egilmez H, Atalar M, Salk I.Biomass exposure and the high resolution computed tomographic and spirometric findings.Eur J Radiol. 2004 Nov;52(2):192-9.

  10. Rural women exposed to biomass fumes are more likely to suffer from CB and COPD than urban women even though the prevalence of smoking is higher among the latter group* *Kiraz K, Kart L, Demir R, Oymak S, Gulmez I, Unalacak M, Ozesmi M. Chronic pulmonary disease in rural women exposed to biomass fumes. Clin Invest Med. 2003 Oct;26(5):243-8.

  11. Asthma related symptoms were reported in 63.3 % of those who used biomass fuel, and in 12.9 % of nonusers* *Uzun K, Özbay B, Ceylan E, Gencer M, Zehir İ. Prevalence of Chronic Bronchitis – Asthma symptoms in Biomass Fuel Exposed Females. Environ Health Prev Med 2003; 8: 13 – 17.

  12. In the living conditions existing in the rural Hill Region of Nepal domestic smoke pollution is an important contributing factor in the development of chronic bronchitis * The findings support a causal role of domestic wood smoke exposure in chronic bronchitis and chronic airflow obstruction ** *Pandey MR. Domestic smoke pollution and chronic bronchitis in a rural community of the hill region of Nepal. Thorax 1984; 39: 337 – 9. **Perez-Padilla R, Regalado J, Vedal S, Pare P, Chapela R, Sansores R, Selman M. Exposure to biomass smoke and chronic airway disease in Mexican women. A case-control study Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):701-6.

  13. Biomass Lung* *Primitive Biomass Combustion and Lung Disease. Barış Yİ, Hoskins JA, Seyfikli Z, Demir A. Indoor and Built Environment 2002; 11: 351- 8.

  14. Different aspects of indoor air pollution such as chronic biomass smoke or wood smoke may be relevant to the development of obstructive lung disease* The evidence that indoor pollution biomass cooking and heating in poorly ventilated dwellings is an important risk factor for COPD (especially among women isdevelopeng countres) continues to grow, with case-control studies and other robustly designed studies now available ** *Weis S.T, DeMeo D.L, Postma D. S. COPD: Problems in diagnosis and measurement. Eur Respir J 2003; 21: Supll. 41, 4s – 12s.** GOLD 2006. Burden of COPD, Risk factors s 3

  15. RATIONAL Pulmonary hypertension are frequently encountered among women patients who exposed to biomass smoke in our region. First one may consider it was related to hypoxemia due to COPD. However in some cases we cannot detect any pathology by PE and PFT. Common characteristic of these cases is heavly exposure to biomass smoke *. *Bülent Özbay, Bünyamin Sertoğullarından. Biomass maruziyeti ve izole pulmoner hipertansiyon. Toraks derneği 10. Yıllık Kongresi, PS 230, 28. 05. 2007, ANTALYA

  16. RATIONAL Medial thickening and perivascular lenfoid cells infiltrations in pulmonary vessel have been previously demonstrated*. *Bülent Özbay, Şükrü Acar, Zabit Yener, Mehmet Kanter Hıstopathologıcal alteratıons ın respıratory tractus of rats exposed to bıomass smoke. Thorax Society 8th Annual Congress, MS 337,28 . 04. 2005, ANTALYA

  17. Figure 1 : Sclerosis; medial thickening and perivascular lenfoid cells infiltrations in pulmonary vessel*

  18. RATIONAL In the light of mentioned findings, we decided to investigate the prevalance of PHT among appearently healthy women who exposed to biomass smoke which widely used by women living in our area.

  19. Purpose Aim was to investigate the frequencies and relations of pulmonary hypertension (PH) and COPD among women exposed to biomass smoke

  20. Method We randomly selected 137 women living in traditional houses near Van and having cooking or heating with biomass fuel, and 71 women living in apartments in the city having central heating and cooking with fuels other than biomass ones

  21. Method Inclusion criteria for biomass exposure group • Exposure to biomass fuel at least 10 year • Having no cardiac or pulmonary disease Inclusion criteria for control group ; • No active exposure to biomass smoke • Having no cardiac or pulmonary disease

  22. Method • Symptom of COPD; Cough, sputum, dyspnea • Findings of PE; Decreased chest sounds, prolonged expirium, ronchus, crackles peripheral edema, cyanosis • Spirometer; COPD= FEV1/FVC%70 • Echocardiography; PHT= (PAB)≥ 30 mmHg

  23. Method The individual exposure index was calculated as the average number of hours spent daily for biomass multiplied by the number of years of biomas.

  24. Statistical analysis • Unpaired Student’s t-test was used to compare differences between means of continuos variables • Chi-square test was used to compare the differences between proportions of the control and research groups’ variables. The chi-square test yielded different risk levels. In this case, the risk level was determined using Fisher exact chi-square test. Odds ratios (OR) are reported as OR (95% confidence ınterval).

  25. Results 208 people were followed up 24 subjects were excluded from the study due to; 10 not examined by Echocardiography 2 patients pregnant 1 patient with asthma 5 patients with COPD 2 patients being current smoker 8 patients with cardiac diseases Finally, study included 184 people

  26. Spirometric results of the control and biomass exposure group

  27. The prevalence of COPD (FEV1/FVC<70) in the control and biomass exposure group

  28. Results of symptoms and findings of control and biomass exposure group

  29. Although less than the effects of cigarette smoke, dried dung smoke had severe histopathological effects on rabbits' lungs. * *Fidan F, Unlu M, Sezer M, Sahin O, Tokyol C, Esme H. Acute effects of environmental tobacco smoke and dried dung smoke on lung histopathology in rabbits. Pathology. 2006 Feb;38(1):53-7

  30. Women cooking with biomass fuels have increased respiratory symptoms and a slight average reduction in lung function compared with those cooking with gas.* *Regalado J, Perez-Padilla R. The effect of biomass burning on respiratory symptoms and lung function in rural Mexican women.Am J Respir Crit Care Med. 2006 Oct 15;174(8):901-5. Epub 2006 Jun 23

  31. Women exposed domestically to biomass develop chronic obstructive pulmonary disease with clinical characteristics, quality of life, and increased mortality similar in degree to that of tobacco smokers.* * Ramirez-Venegas A, Sansores RH. Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco. Am J Respir Crit Care Med. 2006 Feb 15;173(4):393-7. Epub 2005 Dec 1

  32. PAH in wood-smoke inhalation-associated lung disease (WSIALD) appears to be more severe than in other forms of interstitial lung disease and tobacco-related COPD Sandoval J, Sales J. at all. Pulmonary arterial hypertension and cor pulmonale associated with chronic domestic woodsmoke inhalation. CHEST Volume 103, Issue 1, 1993, Pages 12-20

  33. Cor pulmonale is prevalent in Delhi, India. Eighteen necropsied cases of chronic cor pulmonale All patient were women Age of 20 to 50 All patient from rural areas of Delhi and all cases in poor socio-econumic status Six subjects having cow-dung smoke exposure Five subjectshaving wood smok exposure Four subjects commented upon in the other Non of patient gave a history of smoking Necropsy finding showed increased right ventricüler thicknesses 17 of 18. Pulmonary specimen showed some emphysema in all cases and bronchiectasis in 61 per cent *Padmavati S, Joshi B. Incidence and etiology of chronic cor pulmonale in Delhi. A necropsy study. Br J Dis Chest 1976 ;70:251-9

  34. Conclusion Biomass exposure poses a greater risk for PH than COPD in women. A 10 year exposure to biomass smoke is enough to develope PH before the diagnosis of COPD established

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