1. Overview of
Abstract
High exposure to biomass-burning smoke contributes to the burden of disease in households that lack adequate means to vent smoke outdoors. Less is known about smoke-related health problems in households with more adequate ventilation. In economically developed countries, moderately elevated smoke exposure is likely in households using fireplaces or leaky wood stoves. Even households with efficient wood stoves may have elevated indoor smoke concentrations, especially when stoves are improperly operated and when the smoke outside infiltrates back inside.
This presentation gives overviews of the published time-series studies done in a few of the communities in the United States and New Zealand where residential wood-burning is a major source of airborne particulate matter, and of wood smoke-associated health effects research involving households with wood-burning devices in the United States, Russia, some European Union countries, and Canada. Collectively, these studies suggest exposure to residential wood smoke can result in harmful respiratory and cardiovascular effects: Asthma symptoms are most strongly associated with exposure. Hospitalization for chronic lung disease, acute respiratory infections and other respiratory conditions are also significantly associated with exposure. Hospitalization rates for cardiovascular conditions tend to increase on the day or day after wood smoke concentrations increase. Studies of children and people with asthma from households with wood-burning devices show positive associations of burning with several acute respiratory effects, and current and former smokers from households with wood-burning devices have increased odds of chronic bronchitis and airflow obstruction. There is also evidence that long-term residential wood smoke exposure increases risks of developing asthma, aeroallergen sensitivity, COPD and lung cancer.
Relative risks of hospital admissions or emergency department visits for respiratory problems
Chronic lung disease HA
All age
2-d lag
Winter PM10 (>80% RWS)
avg. 12.5°C
McGowan et al. 2002
Pneumonia / Flu
"
Acute resp. infection
Respiratory
≥65 yr
15-64 yr
<15 yr
EDV
1-d lag
Heating season PM2.5 *
1.9°C †
Schreuder et al. 2006
0-d lag
Year-round PM2.5 *
avg. 8.6°C
* Vegetative burning tracer
† Median seasonal temperature
Relative risks of hospitalizations for coronary problems
Cardiac
>65 yr
0-d lag
Winter PM10 (>80% RWS)
avg. 12.5°C
McGowan et al. 2002
"
15-64 yr
<15 yr
All age
1-d lag
Year-round PM2.5 *
avg. 8.6°C
Schreuder et al. 2006
Heating season PM2.5 *
1.9°C †
Dysrhythmia
Coronary Ischemia
Heart Failure
* Vegetative burning tracer
† Median seasonal temperature
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(Heart failure: Pathological ventricular hypertrophy)
Relative risks of hospital admissions or emergency department visits for asthma HA
2-d lag
Winter PM10 (>80% RWS)
avg. 12.5°C
McGowan et al. 2002
EDV
1-d lag
Winter PM10 (~85% RWS)
avg. min. 7.9°C
Schwartz et al. 1993
"
Winter PM10 (~45% RWS)
avg. -7°C
Lipsett et al. 1997
avg. -1°C
avg. 4°C
Literature search and selection
National Library of Medicine, Google Scholar, Bibliographies
Peer-reviewed epidemiology studies Communities with > 45% residential wood smoke in ambient wintertime PM.
Wood-burning households in developed countries (if wood-burning was distinguished from coal-burning)
Containing a Relative Risk, Odds Ratio or Incidence Rate Ratio or enough information to calculate one of these measures of association.
Lung cancer
Males age 35-75
who lived in households cooking with wood or gas
at age 20 or older
Ramanakumar et al. 2007
"
at some time
before age 20
Females age 35-75
People age 20-79
who lived in households cooking with wood
Lissowska et al. 2005
who lived in households heating with wood
Residential wood smoke particles
Matt Kadlec, PhD, DABT
Air Quality Program
PO Box 47600
Olympia, WA
The opinions expressed are those of the author and not necessarily the Department of Ecology
Chronic cough
People age 18-69
Rare use of WS in wintertime
"
Use of WS 1-d/wk in wintertime
Use of WS 2-6 -d/wk in wintertime
Use of WS 7-d/wk in wintertime
Never-smokers age 18-69
Never or very seldom use of WS in wintertime
Current smokers age 18-69
1-µm
(Tesfaigzi et al. 2002)
ALRI Acute lower respiratory infection
EDV Emergency Dept. Visit
FP Fireplace
HA Hospital Admission
IRR Incidence Rate Ratio
OR Odds Ratio
RR Relative Risk
RWS Residential Wood Smoke
WS Woodstove
(Data: Hersoug et al. 2010)

2. research on residential wood smoke-associated health effects In economically
Wt. of Evidence
(0 – 5)
Effect
Number of Studies 5
Respiratory HA/EDV 2
Cardiac HA/EDV
Lung cancer, women 4
Worsening of asthma and asthma-like symptoms
Induction of COPD and COPD-like symptoms 3
Induction of seasonal allergies and IgE reactivity
Physician-diagnosed asthma
Acute lower respiratory tract infection
Otitis media
Acute cough
Lung cancer, men 1
Wheeze 7
Acute upper respiratory tract infection
Main limitations of most of these studies
Uncertainty in the timing of exposures relative to symptoms (when exposures occurred and when symptoms developed).
Uncertainty in exposure classification:
Community studies relied on a central PM monitor, but there are large differences in peoples’ exposures to wood smoke.
Indoor and outdoor and personal wood smoke PM concentrations not assessed.
Most studies didn’t distinguish wood-burning PM from other PM sources.
Immunoglobulin E reactivity and allergies
Atopic dermatitis
People age 18 to 25
Wood-heated household when age 0-6
Kilpeläinen et al. 2001
Allergic rhinitis and or conjunctivitis
"
1+ Positive pollen IgE test
People age 15 to 16
Wood-burning household heating system
Van Miert et al. 2012
Grass pollen IgE test positive
Tree pollen IgE test positive
Weed pollen IgE test positive
Non-seasonal allergic rhinitis
Seasonal allergic rhinitis
Onset of asthma
OR Atopic asthma
People age 15 to 16
"
Van Miert et al. 2012
OR Physician-diagnosed asthma
People age 5 to 9
Household with any wood-burning in the past year
Maier et al. 1997
People age 18 to 25
Wood-heated household wood when age 0-6
Kilpeläinen et al. 2001
People age 20 to 50
Household with a WS
Thorn et al. 2001
Males age 20 to 50
Females age 20 to 50
Household with a FP, tiled stove, or iron stove
Chronic bronchitis, airflow obstruction and COPD
OR Chronic bronchitis
Former smokers with >10 pack-yr age 40-75
Wood smoke exposure
Sood et al. 2010
"
Current or former smokers with >10 pack-yr age 40-75
Current smokers with >10 pack-yr age 40-75
Female current or former smokers with >10 pack-yr age 40-75
Male current or former smokers with >10 pack-yr age 40-75
Hispanic current or former smokers with >10 pack-yr age 40-75
Non-Hispanic white current or former smokers with >10 pack-yr age 40-75
OR Airflow obstruction
OR COPD
Females age >50
Living 16-yr on avg. in wood cook stove household*
Orozco-Levi et al. 2006
* Before age 19 in most cases

3. developed regions 72 Asthma symptoms Wheeze
OR Asthma emergency dept. visits
People with asthma age 26 to 62
Household-heating with WS or FP 1-4 /winter wk
Eisner et al. 2002
"
Household-heating with WS or FP > 5 /winter wk
Decreased household-heating with WS or FP over past 18 mo
Continued household-heating with WS or FP over past 18 mo
Increased household-heating with WS or FP over past 18 mo
OR Asthma hospitalizations
Continued household-heating with WS or FP over 18 mo
OR Nocturnal asthma
People with moderate to severe asthma age 18 to 70
Use of a FP or WS that day
Ostro et al. 1994
OR Moderate or severe shortness of breath
OR Moderate or severe cough
OR Restricted activity
Wheeze
OR Wheeze and dyspnea attacks People 20 to 50
Household with a WS
Thorn et al. 2001
OR Wheeze
1st through 8th grade children
Household heated with wood
Noonan and Ward 2007
"
People age 5 to 9
Household with any wood-burning in past year
Maier et al. 1997
People age 18 to 25
Household heated with wood before age 7
Kilpeläinen et al. 2001
People age 18 to 69
Rare use of WS in wintertime
Hersoug et al. 2010
Use of WS 1-d/wk in wintertime
Use of WS 2-6 -d/wk in wintertime
Use of WS 7-d/wk in wintertime
Never-smokers age 18 to 69
Never or very seldom use of WS in wintertime
Current smokers age 18 to 69
OR Wheeze without cold
IRR Wheeze
Postpartum females
1-hr of use of a WS
Triche et al. 2005
1-hr use of a FP
IRR Wheeze days
Infants
8-hr/d use of a WS
Triche et al. 2002
8-hr/d use of a FP
IRR Wheeze episodes
Cough, earache, laryngitis, pneumonia, chest tightness, phlegm, rhinitis and sore throat
IRR Cough
Postpartum Females
1-hr use of a WS
Triche et al. 2005
"
1-hr use of a FP
IRR Cough days
Infants
8-hr/d use of a WS
Triche et al. 2002
8-hr/d use of a FP
IRR Cough episodes
OR Pneumonia
People age yrs
Households with wood fuel use
Van Miert et al. 2012
OR Otitis media physician visit
Children avg. age 4 yrs
Households with a WS
Daigler et al. 1991
OR Otitis media episodes
Households with any daily WS use
Pettigrew et al. 2004
Households with any daily FP use
Households with average daily WS use
Households with average daily FP use
OR Recurrent otitis media
Households with any use of WS
Household with any use of FP
IRR Laryngitis
IRR Chest tightness
IRR Phlegm
IRR Rhinitis
IRR Sore throat
OR ALRI hospitalization
Infants age 1-24 mo
Households heating with wood alone
Robin et al. 1996
Households cooking with wood alone