Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
Lancet Respir Med. 2014 Oct;2(10):823-60. doi: 10.1016/S2213-2600(14)70168-7. Epub 2014 Sep 2.
A third of the world's population uses solid fuel derived from plant material (biomass) or coal for cooking, heating, or lighting. These fuels are smoky, often used in an open fire or simple stove with incomplete combustion, and result in a large amount of household air pollution when smoke is poorly vented. Air pollution is the biggest environmental cause of death worldwide, with household air pollution accounting for about 3·5-4 million deaths every year. Women and children living in severe poverty have the greatest exposures to household air pollution. In this Commission, we review evidence for the association between household air pollution and respiratory infections, respiratory tract cancers, and chronic lung diseases. Respiratory infections (comprising both upper and lower respiratory tract infections with viruses, bacteria, and mycobacteria) have all been associated with exposure to household air pollution. Respiratory tract cancers, including both nasopharyngeal cancer and lung cancer, are strongly associated with pollution from coal burning and further data are needed about other solid fuels. Chronic lung diseases, including chronic obstructive pulmonary disease and bronchiectasis in women, are associated with solid fuel use for cooking, and the damaging effects of exposure to household air pollution in early life on lung development are yet to be fully described. We also review appropriate ways to measure exposure to household air pollution, as well as study design issues and potential effective interventions to prevent these disease burdens. Measurement of household air pollution needs individual, rather than fixed in place, monitoring because exposure varies by age, gender, location, and household role. Women and children are particularly susceptible to the toxic effects of pollution and are exposed to the highest concentrations. Interventions should target these high-risk groups and be of sufficient quality to make the air clean. To make clean energy available to all people is the long-term goal, with an intermediate solution being to make available energy that is clean enough to have a health impact.
世界上有三分之一的人口使用源自植物材料（生物质）或煤炭的固体燃料来烹饪、取暖或照明。这些燃料会产生烟雾，通常在开放式炉灶或简单的不完全燃烧炉灶中使用，当烟雾排放不畅时，会导致大量室内空气污染。空气污染是全球最大的环境致死原因，每年约有 350 万至 400 万人死于室内空气污染。生活在极端贫困中的妇女和儿童受到的室内空气污染暴露最大。在本委员会中，我们回顾了室内空气污染与呼吸道感染、呼吸道癌症和慢性肺部疾病之间关联的证据。呼吸道感染（包括病毒、细菌和分枝杆菌引起的上呼吸道和下呼吸道感染）都与暴露于室内空气污染有关。呼吸道癌症，包括鼻咽癌和肺癌，与煤炭燃烧引起的污染密切相关，还需要进一步了解其他固体燃料的相关数据。慢性肺部疾病，包括女性的慢性阻塞性肺疾病和支气管扩张症，与烹饪用固体燃料有关，暴露于早期生活中的室内空气污染对肺部发育的有害影响尚未得到充分描述。我们还审查了衡量室内空气污染暴露的适当方法，以及研究设计问题和潜在的有效干预措施，以预防这些疾病负担。衡量室内空气污染需要进行个体监测，而不是固定位置监测，因为暴露量会因年龄、性别、地点和家庭角色而异。妇女和儿童特别容易受到污染的毒性影响，并且暴露于最高浓度。干预措施应针对这些高风险群体，并具有足够的质量，使空气清洁。使所有人都能获得清洁能源是长期目标，而中期解决方案是提供足够清洁的能源，以产生健康影响。
