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A reduction in the use of biomass fuel for cooking has been mentioned in the article by Li and colleagues. (1) Two points need to be noted. One is the prolonged time period required for developing Chronic Obstructive Pulmonary Disease (COPD) from the use of biomass fuel, which may be in years or decades. (2) The next is the absolute number of people exposed, which is to the tune of 2.8 billion and roughly constant over the decades. (3)
With more and more research pointing towards the use of biomass fuel as a major contributor for COPD, health policies are also undergoing modifications. Examples are India and China, two countries with wide use of biomass fuel, gradually escalating the replacement of biomass with clean fuel. (4,5)
As the present study indicates a fall in proportion of COPD deaths attributable to smoking (1), now there is need to focus more on getting rid of biomass fuel across the globe.
1. Li X, Cao X, Guo M, et al. Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017. BMJ 2020; 368:m234.
2. Sana A, Somda SMA, Meda N, Bouland C. Chronic obstructive pulmonary disease associated with biomass fuel use in women: a systematic review and meta-analysis. BMJ Open Respir Res. 2018;5(1):e000246.
3. Bonjour S, Adair-Rohani H, Wolf J, et al. Solid fuel use for household cooking: country and regional estimates for 1980-2010. Environ Health Perspect 2013;121:784-90.
4. Zhao B, Zheng H, Wang S, et al. Change in household fuels dominates the decrease in PM2.5 exposure and premature mortality in China in 2005-2015. Proc Natl Acad Sci U S A. 2018;115(49):12401–6.
5. Ministry of Petroleum and Natural Gas. Government of India. Pradhan Mantri Ujjwala Yojana. (available from www.pmuy.gov.in, last accessed on 11th February, 2020)