IntroductionChronic obstructive pulmonary disease (COPD) is a major and growing cause of morbidity and mortality worldwide. The global prevalence of COPD is growing faster in women than in men. Women are often exposed to indoor pollutants produced by biomass fuels burning during household activities.MethodsWe conducted a meta-analysis to establish the association between COPD and exposure to biomass smoke in women.Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE and Scopus databases in 31December 2016, with the terms: “wood”, “charcoal”, “biomass”, “solid fuels”, “organic fuel”, “biofuel”, “female”, “women”, “COPD”, “chronic bronchitis”, “emphysema”, “chronic obstructive pulmonary disease”. Studies were eligible if they were case–control or cross-sectional studies involving exposure to indoor biomass smoke, conducted at any time and in any geographic location. Fixed-effects or random-effects meta-analysis was used to generate pooled OR.Results24 studies were included: 5 case–control studies and 19 cross-sectional studies. Biomass-exposed individuals were 1.38 times more likely to be diagnosed with COPD than non-exposed (OR 1.38, 95% CI 1.28 to 1.57).Spirometry-diagnosed COPD studies failed to show a significant association (OR 1.20, 95% CI 0.99 to 1.40). Nevertheless, the summary estimate of OR for chronic bronchitis (CB) was significant (OR 2.11, 95% CI 1.70 to 2.52). The pooled OR for cross-sectional studies and case–control studies were respectively 1.82 (95% CI 1.54 to 2.10) and 1.05 (95% CI 0.81 to 1.30). Significant association was found between COPD and biomass smoke exposure for women living as well in rural as in urban areas.ConclusionsThis study showed that biomass smoke exposure is associated with COPD in rural and urban women.In many developing countries, modern fuels are more and more used alongside traditional ones, mainly in urban area. Data are needed to further explore the benefit of the use of mixed fuels for cooking on respiratory health, particularly on COPD reduction.

Background: Approximately 3 billion people, worldwide, rely primarily on biomass for cooking. This study aimed to investigate the association between respiratory symptoms among women in charge of household cooking and the type of fuel used for cooking. Methods: A community-based cross-sectional survey was conducted. A total of 1705 women that were randomly selected, completed the survey. We also performed a bivariate and a multivariate analysis to verify the possible associations between respiratory symptoms in women in charge of household cooking and the type of cooking fuel used. Results: Dry cough, breathing difficulties, and throat irritation frequencies were statistically high in biomass fuel users when compared to liquefied petroleum gas (LPG) users. It was also the case for some chronic respiratory symptoms, such as sputum production, shortness of breath, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty. After adjustment for the respondents’ and households’ characteristics; dry cough, breathing difficulties, sneezing, nose tingling, throat irritation, chronic sputum production, wheezing, wheezing with dyspnea, wheezing without a cold, waking up with shortness of breath, waking up with coughing attacks, and waking up with breathing difficulty were symptoms that remained associated to biomass fuel compared to LPG. Women who used charcoal reported the highest proportion of all the chronic respiratory symptoms compared to the firewood users. However, this difference was not statistically significant except for the wheezing, waking up with coughing attacks, and waking up with breath difficulty, after adjustment. Conclusion: Exposure to biomass smoke is responsible for respiratory health problems in women. Charcoal, which is often considered as a clean fuel compared to other biomass fuels and often recommended as an alternative to firewood, also presents health risks, including increased respiratory morbidity in women. Effective and efficient energy policies are needed to accelerate the transition to clean and sustainable energies.