Study on the association between domestic biomass fuel exposure and pulmonary function: a systematic review and meta-analysis

Biomass fuel exposure, a health hazard, increases the risk of chronic pulmonary ailments. The current study aimed to investigate the magnitude of pulmonary dysfunction associated with biomass fuel smoke exposure by systematic review and meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed during executing of the study, which is registered at PROSPERO, International Prospective Registry for Systematic Review (CRD42021277664). Studies comparing the pulmonary function between biomass fuels exposed and non-exposed to biomass fuel/exposed to cleaner energy fuels were systematically searched in PubMed, Scopus, and EMBASE databases since inception to September 22, 2022. The mean difference in forced vital capacity (FVC), forced expiratory volume during first second (FEV1), peak expiratory flow rate (PEFR), the ratio of FEV1, FVC, and mid-expiratory flow of FVC (FEF25%-75%), prevalence of obstructive, restrictive and COPD from the included studies were pooled. Heterogeneity (I2 statistic and Cochran-Q test), risk of bias (Newcastle Ottawa Scale, funnel plot and egger's test) sub-group, sensitivity, and meta-regression analyses were performed when possible. Thirty-seven studies from 13,461 citations were identified suitable for the current review. The mean difference of FVC, FEV1, FEV1/FVC, FEF25%-75% and PEFR were -0.25L (-0.33 to -0.17; n = 27, I2 = 95.47%), -0.27L (-0.37 to -0.18; n = 28, I2 = 96.84%), -3.12% (-4.08 to -2.16; n = 27, I2 = 91.7%), -0.45 L/s (-0.57 to -0.32; n = 13, I2 = 79.98%), and -0.38L/s (-0.47 to -0.3; n = 16, I2 = 94.3%) respectively, between bio-mass exposed and controls. Sensitivity, subgroup, and meta-regression analysis did not affect the global results. Majority of the studies exhibited a high risk of bias in participant selection, assessment and comparability of the groups. Synthesized evidence suggests that exposure to biomass fuel smoke is detrimental to pulmonary function and increases pulmonary morbidity compared to clean energy usage. Interestingly, exposure to biomass smoke increases the risk of restrictive and obstructive lung changes irrespective of smoking. These observations discourage the use of biomass fuel and alert the stakeholders to encourage clean energy alternatives.

Automated summary

This study investigated the impact of biomass fuel smoke exposure on pulmonary dysfunction through systematic review and meta-analysis. The findings suggest that biomass fuel smoke exposure is detrimental to pulmonary function and increases the risk of chronic pulmonary ailments, regardless of smoking.