Trishul Siddharthan, Matthew R. Grigsby, Dina Goodman, Muhammad Chowdhury, Adolfo Rubinstein, Vilma Irazola, Laura Gutierrez, J. Jaime Miranda, Antonio Bernabe-Ortiz, Dewan Alam, Bruce Kirenga, Rupert Jones, Frederick van Gemert, Robert A. Wise, William Checkley

Forty percent of households worldwide burn biomass fuels for energy, which may be most the important contributor to household air pollution. To examine the association between household air pollution exposure and COPD outcomes in 13 resource-poor settings. We analyzed data from 12,396 adult participants living in 13 resource-poor, population-based settings. Household air pollution exposure was defined as using biomass materials as the primary fuel source in the home. We used multivariable regressions to assess the relationship between household air pollution exposure and COPD outcomes, evaluated for interactions, and conducted sensitivity analyses to test the robustness of our findings. Average age was 54.9 years (44.2-59.6 years across settings), 48.5% were women (38.3%-54.5%), prevalence of household air pollution exposure was 38% (0.5%-99.6%), and 8.8% (1.7%-15.5%) had COPD. Participants with household air pollution exposure were 41% more likely to have COPD (adjusted OR=1.41, 95% CI 1.18 to 1.68) than those without the exposure, and 13.5% (6.4% to 20.6%) of COPD prevalence may due to household air pollution exposure, compared with 12.4% due to cigarette smoking. The association between household air pollution exposure and COPD was stronger in women (1.70, 1.24 to 2.32) than in men (1.21, 0.92 to 1.58). Household air pollution exposure was associated with a higher prevalence of COPD, particularly among women, and it is likely a leading population attributable risk factor for COPD in resource-poor settings.