• AmaralAndré F SAFS0000-0002-0369-9449Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ; a.amaral@imperial.ac.uk., Jaymini Patel, Bernet S Kato, Daniel O Obaseki, Hervé Lawin, Wan C Tan, Sanjay K Juvekar, Imed Harrabi, Michael Studnicka, WoutersEmiel F MEFMDepartment of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands ; woutersemiel@gmail.com., Li-Cher Loh, Eric D Bateman, Kevin Mortimer, A Sonia Buist, BurneyPeter G JPGJImperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland ; p.burney@imperial.ac.uk., and BOLD Collaborative Research Group.
• Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland ; a.amaral@imperial.ac.uk.
• Am. J. Respir. Crit. Care Med. 2018 Mar 1; 197 (5): 595610595-610.

RationaleEvidence supporting the association of COPD or airflow obstruction with use of solid fuels is conflicting and inconsistent.ObjectiveTo assess the association of airflow obstruction with self-reported use of solid fuels for cooking or heating.MethodsWe analysed 18,554 adults from the BOLD 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-analysed. We carried out similar analyses for spirometric restriction, chronic cough and chronic phlegm.Measurements And Main ResultsWe found no association between airflow obstruction and use of solid fuels for cooking or heating (ORmen=1.20, 95%CI 0.94-1.53; ORwomen=0.88, 95%CI 0.67-1.15). 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 (ORmen=1.00, 95%CI 0.57-1.76; ORwomen=1.00, 95%CI 0.76-1.32). 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.ConclusionAirflow obstruction assessed from post-bronchodilator spirometry was not associated with use of solid fuels for cooking or heating.

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