{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T06:20:06Z","timestamp":1774074006118,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Evidence supporting the association of chronic obstructive pulmonary disease or airflow obstruction with use of solid fuels is conflicting and inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the association of airflow obstruction with self-reported use of solid fuels for cooking or heating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 18,554 adults from the BOLD (Burden of Obstructive Lung Disease) study, who had provided acceptable post-bronchodilator spirometry measurements, and information on use of solid fuels. The association of airflow obstruction with use of solid fuels for cooking or heating was assessed by sex, within each site, using regression analysis. Estimates were stratified by national income and meta-analyzed. We performed similar analyses for spirometric restriction, chronic cough, and chronic phlegm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>We found no association between airflow obstruction and use of solid fuels for cooking or heating (odds ratio [OR] for men, 1.20 [95% confidence interval (CI), 0.94\u20131.53]; OR for women, 0.88 [95% CI, 0.67\u20131.15]). This was true for low-\/middle- and high-income sites. Among never-smokers, there was also no evidence of an association of airflow obstruction with use of solid fuels (OR for men, 1.00 [95% CI, 0.57\u20131.76]; OR for women, 1.00 [95% CI, 0.76\u20131.32]). Overall, we found no association of spirometric restriction, chronic cough, or chronic phlegm with the use of solid fuels. However, we found that chronic phlegm was more likely to be reported among female never-smokers and those who had been exposed for 20 years or longer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Airflow obstruction assessed from post-bronchodilator spirometry was not associated with use of solid fuels for cooking or heating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.201701-0205oc","type":"journal-article","created":{"date-parts":[[2017,9,12]],"date-time":"2017-09-12T11:20:17Z","timestamp":1505215217000},"page":"595-610","source":"Crossref","is-referenced-by-count":68,"title":["Airflow Obstruction and Use of Solid Fuels for Cooking or Heating. BOLD (Burden of Obstructive Lung Disease) Results"],"prefix":"10.1093","volume":"197","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-9449","authenticated-orcid":false,"given":"Andr\u00e9 F. S.","family":"Amaral","sequence":"first","affiliation":[{"name":"Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom"}]},{"given":"Jaymini","family":"Patel","sequence":"additional","affiliation":[{"name":"Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom"}]},{"given":"Bernet S.","family":"Kato","sequence":"additional","affiliation":[{"name":"Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom"}]},{"given":"Daniel O.","family":"Obaseki","sequence":"additional","affiliation":[{"name":"Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria"}]},{"given":"Herv\u00e9","family":"Lawin","sequence":"additional","affiliation":[{"name":"Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin"}]},{"given":"Wan C.","family":"Tan","sequence":"additional","affiliation":[{"name":"University of British Columbia, Heart Lung Innovation Center, Vancouver, British Columbia, Canada"}]},{"given":"Sanjay K.","family":"Juvekar","sequence":"additional","affiliation":[{"name":"Vadu Health and Demographic Surveillance System and Vadu Rural Health Program, King Edward Memorial Hospital Research Centre, Pune, India"}]},{"given":"Imed","family":"Harrabi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University Hospital Farhat Hached, Sousse, Tunisia"}]},{"given":"Michael","family":"Studnicka","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria"}]},{"given":"Emiel F. M.","family":"Wouters","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands"}]},{"given":"Li-Cher","family":"Loh","sequence":"additional","affiliation":[{"name":"Penang Medical College, Penang, Malaysia"}]},{"given":"Eric D.","family":"Bateman","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cape Town, Cape Town, South Africa"}]},{"given":"Kevin","family":"Mortimer","sequence":"additional","affiliation":[{"name":"Liverpool School of Tropical Medicine, Liverpool, United Kingdom; and"}]},{"given":"A. Sonia","family":"Buist","sequence":"additional","affiliation":[{"name":"Oregon Health and Sciences University, Portland, Oregon"}]},{"given":"Peter G. J.","family":"Burney","sequence":"additional","affiliation":[{"name":"Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, United Kingdom"}]}],"member":"286","published-online":{"date-parts":[[2018,3,1]]},"reference":[{"key":"2026032023162778200_bib1","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1016\/S0140-6736(12)61728-0","article-title":"Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Lozano","year":"2012","journal-title":"Lancet"},{"key":"2026032023162778200_bib2","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1164\/rccm.201204-0596PP","article-title":"Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary","volume":"187","author":"Vestbo","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023162778200_bib3","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1164\/rccm.201007-1125OC","article-title":"Risk factors for chronic obstructive pulmonary disease in a European cohort of young adults","volume":"183","author":"de Marco","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023162778200_bib4","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1378\/chest.10-1253","article-title":"COPD in never smokers: results from the population-based Burden of Obstructive Lung Disease study","volume":"139","author":"Lamprecht","year":"2011","journal-title":"Chest"},{"key":"2026032023162778200_bib5","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/S0140-6736(09)61303-9","article-title":"Chronic obstructive pulmonary disease in non-smokers","volume":"374","author":"Salvi","year":"2009","journal-title":"Lancet"},{"key":"2026032023162778200_bib6","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1164\/rccm.200811-1757ST","article-title":"An official American Thoracic Society public policy statement: novel risk factors and the global burden of chronic obstructive pulmonary disease","volume":"182","author":"Eisner","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023162778200_bib7","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1136\/thx.2009.124644","article-title":"COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis","volume":"65","author":"Kurmi","year":"2010","journal-title":"Thorax"},{"key":"2026032023162778200_bib8","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1378\/chest.08-2114","article-title":"Risk of COPD from exposure to biomass smoke: a metaanalysis","volume":"138","author":"Hu","year":"2010","journal-title":"Chest"},{"key":"2026032023162778200_bib9","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1136\/thx.2010.147884","article-title":"Respiratory disease associated with solid biomass fuel exposure in rural women and children: systematic review and meta-analysis","volume":"66","author":"Po","year":"2011","journal-title":"Thorax"},{"key":"2026032023162778200_bib10","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1146\/annurev-publhealth-032013-182356","article-title":"Millions dead: how do we know and what does it mean? Methods used in the comparative risk assessment of household air pollution","volume":"35","author":"Smith","year":"2014","journal-title":"Annu Rev Public Health"},{"key":"2026032023162778200_bib11","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1183\/09031936.00152413","article-title":"Prevalence and correlates of airflow obstruction in \u223c317,000 never-smokers in China","volume":"44","author":"Smith","year":"2014","journal-title":"Eur Respir J"},{"key":"2026032023162778200_bib12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12931-015-0198-2","article-title":"Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru","volume":"16","author":"Jaganath","year":"2015","journal-title":"Respir Res"},{"key":"2026032023162778200_bib13","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1136\/thoraxjnl-2015-206938","article-title":"Characteristics of COPD in never-smokers and ever-smokers in the general population: results from the CanCOLD study","volume":"70","author":"Tan","year":"2015","journal-title":"Thorax"},{"key":"2026032023162778200_bib14","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1183\/09031936.00002711","article-title":"Risk factors for COPD spirometrically defined from the lower limit of normal in the BOLD project","volume":"39","author":"Hooper","year":"2012","journal-title":"Eur Respir J"},{"key":"2026032023162778200_bib15","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1164\/rccm.200810-1556OC","article-title":"Improved biomass stove intervention in rural Mexico: impact on the respiratory health of women","volume":"180","author":"Romieu","year":"2009","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023162778200_bib16","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1136\/thoraxjnl-2015-207783","article-title":"Lung function in woodsmoke-exposed Guatemalan children following a chimney stove intervention","volume":"71","author":"Heinzerling","year":"2016","journal-title":"Thorax"},{"key":"2026032023162778200_bib17","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1081\/COPD-57610","article-title":"The Burden of Obstructive Lung Disease Initiative (BOLD): rationale and design","volume":"2","author":"Buist","year":"2005","journal-title":"COPD"},{"key":"2026032023162778200_bib18","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1183\/09031936.05.00034505","article-title":"General considerations for lung function testing","volume":"26","author":"Miller","year":"2005","journal-title":"Eur Respir J"},{"key":"2026032023162778200_bib19","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1136\/thx.2008.098483","article-title":"Using the lower limit of normal for the FEV1\/FVC ratio reduces the misclassification of airway obstruction","volume":"63","author":"Swanney","year":"2008","journal-title":"Thorax"},{"key":"2026032023162778200_bib20","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1164\/ajrccm.159.1.9712108","article-title":"Spirometric reference values from a sample of the general U.S. population","volume":"159","author":"Hankinson","year":"1999","journal-title":"Am J Respir Crit Care Med"},{"key":"2026032023162778200_bib21","doi-asserted-by":"crossref","DOI":"10.1002\/9780470374597","volume-title":"Sampling of populations: methods and applications","author":"Levy","year":"2008"},{"key":"2026032023162778200_bib22","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"2026032023162778200_bib23","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1002\/sim.1186","article-title":"Quantifying heterogeneity in a meta-analysis","volume":"21","author":"Higgins","year":"2002","journal-title":"Stat Med"},{"key":"2026032023162778200_bib24","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1183\/09031936.00080312","article-title":"Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations","volume":"40","author":"Quanjer","year":"2012","journal-title":"Eur Respir J"},{"key":"2026032023162778200_bib25","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1183\/09031936.00220511","article-title":"Reduced lung function due to biomass smoke exposure in young adults in rural Nepal","volume":"41","author":"Kurmi","year":"2013","journal-title":"Eur Respir J"},{"key":"2026032023162778200_bib26","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1289\/ehp.1408200","article-title":"Exposure to household air pollution from wood combustion and association with respiratory symptoms and lung function in nonsmoking women: results from the RESPIRE trial, Guatemala","volume":"123","author":"Pope","year":"2015","journal-title":"Environ Health Perspect"},{"key":"2026032023162778200_bib27","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1378\/chest.15-0261","article-title":"Lung function in rural Guatemalan women before and after a chimney stove intervention to reduce wood smoke exposure: results from the randomized exposure study of pollution indoors and respiratory effects and chronic respiratory effects of early childhood exposure to respirable particulate matter study","volume":"148","author":"Guarnieri","year":"2015","journal-title":"Chest"},{"key":"2026032023162778200_bib28","doi-asserted-by":"crossref","first-page":"e1001621","DOI":"10.1371\/journal.pmed.1001621","article-title":"Lung function and incidence of chronic obstructive pulmonary disease after improved cooking fuels and kitchen ventilation: a 9-year prospective cohort study","volume":"11","author":"Zhou","year":"2014","journal-title":"PLoS Med"},{"key":"2026032023162778200_bib29","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1164\/arrd.1983.128.3.491","article-title":"The relevance in adults of air-flow obstruction, but not of mucus hypersecretion, to mortality from chronic lung disease: results from 20 years of prospective observation","volume":"128","author":"Peto","year":"1983","journal-title":"Am Rev Respir Dis"},{"key":"2026032023162778200_bib30","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1378\/chest.14-2240","article-title":"Chronic bronchitis is associated with worse symptoms and quality of life than chronic airflow obstruction","volume":"148","author":"Meek","year":"2015","journal-title":"Chest"},{"key":"2026032023162778200_bib31","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/S2213-2600(14)70168-7","article-title":"Respiratory risks from household air pollution in low and middle income countries","volume":"2","author":"Gordon","year":"2014","journal-title":"Lancet Respir Med"},{"key":"2026032023162778200_bib32","doi-asserted-by":"crossref","first-page":"400","DOI":"10.5588\/ijtld.12.0591","article-title":"Cross-sectional relation of ethnicity to ventilatory function in a west London population","volume":"17","author":"Hooper","year":"2013","journal-title":"Int J Tuberc Lung Dis"}],"container-title":["American Journal of Respiratory and Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/197\/5\/595\/67122408\/ajrccm_197_5_595.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajrccm\/article-pdf\/197\/5\/595\/67122408\/ajrccm_197_5_595.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T03:16:36Z","timestamp":1774062996000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajrccm\/article\/197\/5\/595\/8498609"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,1]]},"references-count":32,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2018,3,1]]},"published-print":{"date-parts":[[2018,3,1]]}},"URL":"https:\/\/doi.org\/10.1164\/rccm.201701-0205oc","relation":{},"ISSN":["1073-449X","1535-4970"],"issn-type":[{"value":"1073-449X","type":"print"},{"value":"1535-4970","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2018,3]]},"published":{"date-parts":[[2018,3,1]]}}}