{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T15:05:28Z","timestamp":1772809528248,"version":"3.50.1"},"reference-count":34,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T00:00:00Z","timestamp":1701302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: COPD due to exposure to combustible biomass is an increasingly recognized phenotype, particularly among women who use traditional ovens, known as \u2018Tabouna\u2019, for baking bread. This paper aims to investigate the clinical and functional characteristics of COPD in Tunisian female patients attributed to the use of \u2018Tabouna\u2019. Methods: A retrospective single-center cohort study was conducted on patients recruited from the Department of Respiratory Disease at A. Mami Hospital, who were diagnosed with COPD between January 2014 and December 2022. The diagnosis of COPD adhered to the standards defined in GOLD 2022. Results: Out of the 95 women included in the study, 48 (50.5%) were exposed to tobacco smoke, while 47 (49.5%) were exposed to the \u2018Tabouna\u2019. The median age was 70.4 \u00b1 11.5 years, ranging from 40 to 95 years. Patients exposed to biomass were notably older, with a median age of 75.4 compared to 64.6 (p = 0.04). A significant association was observed between COPD and biomass smoke exposure, both in women residing in rural and urban areas (p = 0.006). The frequency of patients exposed to biomass with comorbidities was higher than in the group exposed to tobacco, but only hypertension showed statistically significant results (p = 0.01). Tobacco smoke induced more impairment in lung function than biomass in the group with FEV1 \u2264 30% (p = 0.04). Long-acting muscarinic antagonists were more commonly prescribed to smokers (p = 0.04). Serious complications such as chronic respiratory failure and intensive care admissions were similar in both groups (p = 0.8 and 0.4). Conclusions: COPD in women after exposure to the \u2018Tabouna\u2019 was observed in older patients and characterized by delayed diagnosis. Despite these clinical differences, poor COPD outcomes were similar in both groups.<\/jats:p>","DOI":"10.3390\/jcm12237424","type":"journal-article","created":{"date-parts":[[2023,11,30]],"date-time":"2023-11-30T09:37:54Z","timestamp":1701337074000},"page":"7424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["COPD after \u201cTabouna\u201d Exposure: A Distinct Phenotype in Tunisian Women?"],"prefix":"10.3390","volume":"12","author":[{"given":"Besma","family":"Hamdi","sequence":"first","affiliation":[{"name":"Laboratory Research 19SP02 \u2018Chronic Pathologies: From Genome to Management\u2019, Department of Respiratory Diseases, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis 1068, Tunisia"},{"name":"Department of Respiratory Diseases, B. Abderrahman Mami Hospital, Tunis 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabrine","family":"Louhaichi","sequence":"additional","affiliation":[{"name":"Laboratory Research 19SP02 \u2018Chronic Pathologies: From Genome to Management\u2019, Department of Respiratory Diseases, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis 1068, Tunisia"},{"name":"Department of Respiratory Diseases, B. Abderrahman Mami Hospital, Tunis 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Aymen","family":"Jebali","sequence":"additional","affiliation":[{"name":"Laboratory Research 19SP02 \u2018Chronic Pathologies: From Genome to Management\u2019, Department of Respiratory Diseases, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis 1068, Tunisia"},{"name":"Department of Respiratory Diseases, B. Abderrahman Mami Hospital, Tunis 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Schlemmer","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases, Cr\u00e9teil Intercommunal Hospital Center, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8061-1252","authenticated-orcid":false,"given":"Bernard","family":"Maitre","sequence":"additional","affiliation":[{"name":"Department of Respiratory Diseases, Cr\u00e9teil Intercommunal Hospital Center, 94000 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnes","family":"Hamzaoui","sequence":"additional","affiliation":[{"name":"Laboratory Research 19SP02 \u2018Chronic Pathologies: From Genome to Management\u2019, Department of Respiratory Diseases, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis 1068, Tunisia"},{"name":"Department of Respiratory Diseases, B. Abderrahman Mami Hospital, Tunis 2080, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1164\/rccm.202302-0289OC","article-title":"Unmet Diagnostic and Therapeutic Opportunities for Chronic Obstructive Pulmonary Disease in Low- and Middle-Income Countries","volume":"15","author":"Florman","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1164\/rccm.201709-1861OC","article-title":"Association between household air pollution exposure and chronic obstructive pulmonary disease outcomes in 13 low-and middle-income countrysettings","volume":"1975","author":"Siddharthan","year":"2018","journal-title":"Am. J. Respir. Crit. 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