Wood smoke-associated lung disease: a clinical, functional, radiological and pathological description.

BACKGROUND: Approximately half of the world's population, and up to 90% of households in rural areas of developing countries, depend on biomass for cooking and heating. SETTING: The National Institute of Respiratory Diseases, Mexico City. OBJECTIVE: To describe wood smoke-associated lung disease (WSLD). DESIGN: Description of the clinical, functional and radiological manifestations of patients with WSLD, and a comparison of pathological findings of patients who died of WSLD and smokers who died of chronic bronchitis. RESULTS: All patients with WSLD were non-smoking women with chronic bronchitis, in whom asthma, bronchiectasis, tuberculosis, congestive heart failure, extreme obesity and alfa-1 antitrypsin deficiency had been excluded. All patients used wood for cooking and had been exposed to wood smoke for a median of 45 years. Dyspnoea, airway obstruction, air trapping, increased airway resistance, pathological evidence of anthracosis, chronic bronchitis, centrilobular emphysema and pulmonary hypertension were present in most patients with WSLD. Bronchial squamous metaplasia was a common finding. There were no significant differences in the histopathological findings between patients with WSLD and smokers. Diffuse interstitial fibrosis was absent in all patients. CONCLUSIONS: Patients with WSLD have obstructive lung disease, chronic bronchitis, emphysema and pulmonary hypertension comparable to smokers.