Household air pollution and COPD: cause and effect or confounding by other aspects of poverty?
OBJECTIVE and DESIGN: The extent to which HAP causes COPD is controversial; we therefore undertook this review to offer a viewpoint on this from the Global Initiative for COPD (GOLD).
RESULTS: We find that while COPD is well-defined in many studies on COPD and HAP, there are major limitations to the definition and measurement of HAP. It is thus difficult to disentangle HAP from other features of poverty that are themselves associated with COPD. We identify other limitations to primary research studies, including the use of cross-sectional designs that limit causal inference.
CONCLUSION: There is substantial preventable morbidity and mortality associated with HAP, COPD and poverty, separately and together. Although it may not be possible to define clear causal links between HAP and COPD, there is a clear urgency to reduce the avoidable burden of disease these inflict on the world´s poor.
Document Type: Research Article
Affiliations: 1: University of Cambridge, Cambridge, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK 2: Hospital Universitario de Caracas Universidad Central de Venezuela and Centro Médico de Caracas, Caracas, Venezuela 3: Pulmocare Research and Education (PURE) Foundation, Pune, India 4: Sri Ramachandra University, Chennai, India 5: Australian Institute for Health Innovation, Macquarie University, Sydney, NSW, Australia 6: Departamento de Investigación en Tabaquismo y EPOC, Instituto Nacional de Enfermedades Respiratorias, Mexico 7: College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK 8: Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria 9: University of Michigan, Ann Arbor, MI, USA 10: Makerere University Lung Institute, Kampala, Uganda 11: Department of Medicine, University of California, San Francisco and Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
Publication date: March 1, 2022
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