State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China.
First Municipal People Hospital of Shaoguan, Shaoguan, Guangdong, China.
PLoS Med. 2014 Mar 25;11(3):e1001621. doi: 10.1371/journal.pmed.1001621. eCollection 2014 Mar.
Biomass smoke is associated with the risk of chronic obstructive pulmonary disease (COPD), but few studies have elaborated approaches to reduce the risk of COPD from biomass burning. The purpose of this study was to determine whether improved cooking fuels and ventilation have effects on pulmonary function and the incidence of COPD.
A 9-y prospective cohort study was conducted among 996 eligible participants aged at least 40 y from November 1, 2002, through November 30, 2011, in 12 villages in southern China. Interventions were implemented starting in 2002 to improve kitchen ventilation (by providing support and instruction for improving biomass stoves or installing exhaust fans) and to promote the use of clean fuels (i.e., biogas) instead of biomass for cooking (by providing support and instruction for installing household biogas digesters); questionnaire interviews and spirometry tests were performed in 2005, 2008, and 2011. That the interventions improved air quality was confirmed via measurements of indoor air pollutants (i.e., SO₂, CO, CO₂, NO₂, and particulate matter with an aerodynamic diameter of 10 µm or less) in a randomly selected subset of the participants' homes. Annual declines in lung function and COPD incidence were compared between those who took up one, both, or neither of the interventions. Use of clean fuels and improved ventilation were associated with a reduced decline in forced expiratory volume in 1 s (FEV₁): decline in FEV₁ was reduced by 12 ml/y (95% CI, 4 to 20 ml/y) and 13 ml/y (95% CI, 4 to 23 ml/y) in those who used clean fuels and improved ventilation, respectively, compared to those who took up neither intervention, after adjustment for confounders. The combined improvements of use of clean fuels and improved ventilation had the greatest favorable effects on the decline in FEV₁, with a slowing of 16 ml/y (95% CI, 9 to 23 ml/y). The longer the duration of improved fuel use and ventilation, the greater the benefits in slowing the decline of FEV₁ (p<0.05). The reduction in the risk of COPD was unequivocal after the fuel and ventilation improvements, with an odds ratio of 0.28 (95% CI, 0.11 to 0.73) for both improvements.
Replacing biomass with biogas for cooking and improving kitchen ventilation are associated with a reduced decline in FEV₁ and risk of COPD.
Chinese Clinical Trial Register ChiCTR-OCH-12002398.
生物量烟雾与慢性阻塞性肺疾病（COPD）的风险有关，但很少有研究详细阐述了降低生物量燃烧导致 COPD 风险的方法。本研究的目的是确定改善烹饪燃料和通风是否对肺功能和 COPD 的发生有影响。
2002 年 11 月 1 日至 2011 年 11 月 30 日，在中国南方的 12 个村庄中，对至少 40 岁的 996 名合格参与者进行了一项为期 9 年的前瞻性队列研究。从 2002 年开始实施干预措施，以改善厨房通风（通过提供支持和指导来改善生物质炉灶或安装排气扇）和推广使用清洁燃料（即沼气）代替生物质用于烹饪（通过提供支持和指导来安装家用沼气池）；2005 年、2008 年和 2011 年进行了问卷调查和肺活量测试。通过测量参与者家中室内空气污染物（即 SO₂、CO、CO₂、NO₂和空气动力学直径为 10 µm 或更小的颗粒物），证实了干预措施改善了空气质量。在那些采用了一种、两种或都没有采用干预措施的人中，比较了每年肺功能下降和 COPD 发病率的情况。使用清洁燃料和改善通风与用力呼气量（FEV₁）的下降速度较慢有关：与未采取任何干预措施的人相比，使用清洁燃料和改善通风的人的 FEV₁ 每年下降分别减少 12 ml/y（95%CI，4 至 20 ml/y）和 13 ml/y（95%CI，4 至 23 ml/y），调整混杂因素后。使用清洁燃料和改善通风的联合改善对 FEV₁ 的下降速度有最大的有利影响，减缓了 16 ml/y（95%CI，9 至 23 ml/y）。改善燃料使用和通风的持续时间越长，减缓 FEV₁ 下降的益处越大（p<0.05）。在改善燃料和通风后，COPD 的风险降低是明确的，两种改善的优势比为 0.28（95%CI，0.11 至 0.73）。
用沼气代替生物质烹饪和改善厨房通风与 FEV₁ 下降和 COPD 风险降低有关。
中国临床试验注册中心 ChiCTR-OCH-12002398。
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