Lopez Matías, Mongilardi Nicole, Checkley William
Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, EE. UU.
Rev Peru Med Exp Salud Publica. 2014;31(1):94-9.
In this article, the relationship between chronic obstructive pulmonary disease (COPD) and biomass smoke will be discussed. More than half of the world population uses biomass for fuel, especially in rural areas and in developing countries where usage reaches 80%. Biomass smoke inhalation creates an inflammatory chronic state, which is accompanied by metalloproteinases activation and mucociliary mobility reduction. This could explain the existing association between biomass exposure and COPD, revealed by observational and epidemiological studies from developing and developed countries. In this review, the differences between COPD caused by tobacco and biomass were explored. It was found that despite the pathophysiological differences, most of the clinical characteristics, quality of life and mortality were similar. In the last ten years there have been interventions to reduce the biomass smoke exposure by using improved stoves and cleaner fuels. However, these strategies have not yet been successful due to inability to reduce contamination levels to those recommended by the World Health Organization as well as due to the lack of use. Therefore, there is an urgent need for carefully conducted, randomized field trials to determine the actual range of potentially reachable contamination reductions, the probability of use and the long term benefits of reducing the global burden of COPD.
本文将探讨慢性阻塞性肺疾病（COPD）与生物质烟雾之间的关系。世界上超过一半的人口以生物质为燃料，尤其是在农村地区以及使用率高达80%的发展中国家。吸入生物质烟雾会导致慢性炎症状态，同时伴有金属蛋白酶激活和黏液纤毛运动能力降低。这可以解释发展中国家和发达国家的观察性研究及流行病学研究所揭示的生物质暴露与COPD之间的现有关联。在本综述中，探讨了烟草所致COPD与生物质所致COPD之间的差异。研究发现，尽管存在病理生理差异，但大多数临床特征、生活质量和死亡率是相似的。在过去十年中，已经采取了一些干预措施，如使用改良炉灶和更清洁的燃料来减少生物质烟雾暴露。然而，由于无法将污染水平降低到世界卫生组织建议的水平，以及缺乏使用，这些策略尚未取得成功。因此，迫切需要精心开展随机现场试验，以确定潜在可实现的污染减少的实际范围、使用概率以及减轻COPD全球负担的长期益处。
