Baran BALCAN, Berrin CEYHAN, Aylin ÖZSANCAK UĞURLU, Selçuk AKAN

Kırsal alanda yaşayan kadınlarda biyomas dumanına bağlı solunum fonksiyon kapasitesinde bozulma

Giriş: Odun ve organik maddeler, özellikle gelişmekte olan ülkelerde ısınma ve yemek pişirme amaçlı enerji kaynağı olarak kullanılmaktadır. Bu çalışmada biyomas dumanına maruz kalınan süre ile bozulan solunum fonksiyon testi parametreleri arasındaki ilişki değerlendirilmiştir. Materyal ve Metod: Bu çalışma doğuanadolu bölgesinde bir kasabada yaşayan biyomas dumanına maruz kalmış kadınlarla yapılmıştır. Hastalar göğüs hastalıkları polikliniğine nefes darlığı ile başvuran kişiler arasında seçilmiştir. Bulgular: Bağımlı değişken, solunum fonksiyon testi sonuçları ve bağımsız değişkenler, yaş, vücut kitle indeksi, tandır yapmaya başlama yaşı, ayın kaç haftası tandır yaptığı, tandır başında geçen süre (saat), toplam tandır süresi (yıl). Hastaların 92 (%21.6)'sinde obstrüktif patern gözlenmiş, ve bu hastaların 67 (%73)'si GOLD 2.25 (%27)'i GOLD 3 olarak sınıflandırılmıştır. Hastaların 75'inde restriktif paterne rastlanmış ve bu hastaların 54 (%72)'ü hafif, 21 (%28)'i orta restritif tiptedir. Erken yaşta tandır yapmaya başlamak ve tandır başında geçen süre (yıl) restriktif ve obstrüktif akciğer hastalığı gelişmesinde risk faktörüdür. Tandır yılı ile FEV1 (r= -0.917; p= < 0.001), FEV1/FVC (r= -0.739; p< 0.001) ve FVC (r= -0906; p< 0.001) arasında negatif korelasyon vardır. Hastalarda obstrüksiyon gelişmesi için toplam 23 yıl ve restriksiyon gelişmesi için de 25 yıl tandır yapılması gerekmektedir. Sonuç: Tandır yapımında geçen süre arttıkça hastalarda hem restriktif hem de obstrüktif tipte solunum yetmezliği gözlenmektedir. Biyomasa maruz kalmaya bağlı ortaya çıkan bu halk sağlığı problemine karşı gerekli önlemler alınmalıdır.

Altered pulmonary functions due to biomass smoke in a rural population of Turkish women: a descriptive study

Introduction: Wood or other organic sources of fuel are used as source of energy for heating or cooking particularly in developingcountries. The aim of the current study was to evaluate the association between biomass exposure time and parameters of pulmonaryfunction tests.Materials and Methods: Four hundred twenty-four consecutive women who lived and exposed to biomass smoke in a small provincein Eastern Turkey were involved. This study was performed with women who had come to pulmonology out-patient clinic withsymptom of dyspnea.Results: The independent variables assessed in the study patients were age, BMI, starting age of cooking, hours per day and weeksper month spent cooking, and cooking years; the dependent variables were PFT parameters. Ninety-two (21.6%) patients had anobstructive PFT pattern. Sixty-seven (73%) of these patients were classified as GOLD 2 and 25 (27%) patients were classified asGOLD 3. Seventy-five (17.6 %) of the patients had restrictive lung disease; 54 (72%) of these patients were found to have a mildand 21 (27%) had a moderate restrictive pattern. Increased number of years in cooking and to start cooking at younger ages werea risk factors for the development of obstructive and restrictivedisease. There was a statistically significant and negativecorrelation between increased number of years and the value ofFEV1 (r= -0.917; p=< 0.001), FEV1/FVC (r= -0.739; p< 0.001),and FVC (r= -0.906; p< 0.001). The median time of cookingrequired was 23 years for the development of obstruction, and 25years for restriction, respectively.Conclusion: Cumulative biomass exposure time is associated withimpairment in PFT parameters; results in both obstructive and restrictive lung disease. Biomass exposure is a public health problem and pre-cautions should be taken in order to prevent impairedpulmonary functions.

PDF

___

Bruce N, Perez-Padilla R, Albalak R. Indoor air pollution in developing countries: A major environmental and public health challenge. Bull World Health Organ 2000;78:1078- 92.
de Koning HW, Smith KR, Last JM. Biomass fuel combustion and health. Bulletin of the World Health Organization 1985;63:11-26.
Rehfuess E, Mehta S, Pruss-Ustun A. Assessing household solid fuel use: Multiple implications for the millennium development goals. Environmental health perspectives 2006;114:373-8.
Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997;349:1498-504.
Chen BH, Hong CJ, Pandey MR, Smith KR. Indoor air pollution in developing countries. World health statistics quarterly. Rapport Trimestriel de Statistiques Sanitaires mondiales 1990;43:127-38.
Kara M, Bulut S, Tas F, Akkurt I, Seyfikli Z. Evaluation of pulmonary changes due to biomass fuels using highresolution computed tomography. European Radiology 2003;13:2372-7.
Arslan M, Akkurt I, Egilmez H, Atalar M, Salk I. Biomass exposure and the high-resolution computed tomographic and spirometric findings. European journal of Radiology 2004;52:192-9.
Rinne ST, Rodas EJ, Bender BS, Rinne ML, Simpson JM, Galer-Unti R, et al. Relationship of pulmonary function among women and children to indoor air pollution from biomass use in rural ecuador. Respiratory Medicine 2006;100:1208-15.
Kargin R, Kargin F, Mutlu H, Emiroglu Y, Pala S, Akcakoyun M, et al. Long-term exposure to biomass fuel and its relation to systolic and diastolic biventricular performance in addition to obstructive and restrictive lung diseases. Echocardiography (Mount Kisco, N.Y.) 2011;28:52-61.
Dossing M, Khan J, al-Rabiah F. Risk factors for chronic obstructive lung disease in saudi arabia. Respiratory Medicine 1994;88:519-22.
Ekici A, Ekici M, Kurtipek E, Akin A, Arslan M, Kara T, et al. Obstructive airway diseases in women exposed to biomass smoke. Environmental Research 2005;99:93-8.
Orozco-Levi M, Garcia-Aymerich J, Villar J, RamirezSarmiento A, Anto JM, Gea J. Wood smoke exposure and risk of chronic obstructive pulmonary disease. The European Respiratory Journal 2006;27:542-6.
Sezer H, Akkurt I, Guler N, Marakoglu K, Berk S. A casecontrol study on the effect of exposure to different substances on the development of copd. Annals of Epidemiology 2006;16:59-62.
Caballero A, Torres-Duque CA, Jaramillo C, Bolivar F, Sanabria F, Osorio P, et al. Prevalence of copd in five colombian cities situated at low, medium, and high altitude (prepocol study). Chest 2008;133:343-349.
Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with copd: A summary of the ats/ers position paper. The European Respiratory Journal 2004;23:932-46.
Han MK, Muellerova H, Curran-Everett D, Dransfield MT, Washko GR, Regan EA, et al. Gold 2011 disease severity classification in copdgene: A prospective cohort study. The Lancet. Respiratory Medicine 2013;1:43-50.
Celli BR, Halbert RJ, Nordyke RJ, Schau B. Airway obstruction in never smokers: Results from the third national health and nutrition examination survey. The American Journal of Medicine 2005;118:1364-72.
Mena MA, Woll F, Cok J, Ferrufino JC, Accinelli RA. Histopathological lung changes in children due to biomass fuel. American Journal of Respiratory and Critical Care Medicine 2012;185:687-8.
Ramirez-Venegas A, Sansores RH, Quintana-Carrillo RH, Velazquez-Uncal M, Hernandez-Zenteno RJ, SanchezRomero C, et al. Fev1 decline in patients with chronic obstructive pulmonary disease associated with biomass exposure. American journal of Respiratory and Critical Care Medicine 2014;190:996-1002.
Regalado J, Perez-Padilla R, Sansores R, Paramo Ramirez JI, Brauer M, Pare P, et al. The effect of biomass burning on respiratory symptoms and lung function in rural mexican women. American Journal of Respiratory and Critical Care Medicine 2006;174:901-5.
Raj TJ. Altered lung function test in asymptomatic women using biomass fuel for cooking. Journal of clinical and diagnostic research: JCDR 2014;8:Bc01-03.
Gunen H, Hacievliyagil SS, Yetkin O, Gulbas G, Mutlu LC, Pehlivan E. Prevalence of copd: First epidemiological study of a large region in turkey. European Journal of Internal Medicine 2008;19:499-504.