RESUMO
Background: The fuel used for cooking is a major source of indoor air pollution because of inefficient combustion and inadequate ventilation. This study was conducted to see if there is any association between the type of cooking fuel and common health problems in light of inadequate ventilation. Methods: This was a cross-sectional study; 688 subjects were selected randomly from various sectors and the outlying areas of Surajkund. The impact of indoor air pollution on health was assessed by questionnaires, general physical examination, and pulmonary function testing. Results: One of the key findings of the study has been the implication of LPG, touted as a safe, non-polluting fuel with a definite negative impact on health. There was significantly more breathlessness experienced by LPG users as opposed to the users of wood and cow dung. Though the prevalence of fever in both groups was similar, chest pain, burning of eyes, and fatigue were reported by wood and cow dung users much more frequently. The pulmonary function test showed restrictive pathology in cow dung and wood users, whereas obstructive pathology in LPG users. Conclusions: LPG is considered “clean” fuel because it does not produce visible emissions. However, improper burner design, blocking and clogging of the flue vent, and insufficient combustion air result in improper combustion and the emission of aldehydes, CO, hydrocarbons, and other organics. It would be folly to believe that LPG is harmless. Even a harmless material may become harmful if used inappropriately.
RESUMO
Objectives: Chronic obstructive pulmonary disease (COPD) being a disease with systemic consequences necessitate the use of multidimensional indices for a comprehensive assessment of the disease's impact including the future risk of exacerbations and mortality. To study the role of dyspnea, obstruction, smoking, and exacerbation (DOSE) index as a predictor of future disease severity and its correlation with chronic obstructive pulmonary disease test (CAT) score. Measurements and results: A total of 60 inpatients with COPD exacerbations were followed up for 6 months to record the number of exacerbations of COPD. The DOSE index and CAT score were calculated after stabilization within 48 hours of admission, at 1 week, and again at 6 months. The mean difference between DOSE index score at admission and at 1 week was 1.382 � 0.561 and at admission and at 6 months was 2.15 � 0.988, both being statistically significant (p < 0.001). A high DOSE index score (?4) was associated with a greater risk of 2 or more exacerbations [odds ratio (OR), 12 (3.09�.60) and risk estimate, 3.75 (1.53�17)]. For the prediction of exacerbations, the area under the curve (AUC) was larger for the DOSE index (0.854) than the global initiative for chronic obstructive lung disease (GOLD) stage (0.789), p < 0.001 for both. Furthermore, DOSE index correlated significantly with the CAT score, an established health status measure, at all stages of disease severity; at the onset of exacerbation (r = 0.719, p < 0.001), after stabilization at 1 week (r = 0.736, p < 0.001) and at 6 months (r = 0.884, p < 0.001). Conclusion: The DOSE index is a simple, practical multidimensional grading tool for assessing current symptoms, health status, and future risk in COPD and acts as a guide to disease management as its component items can be modified by interventions. Its correlation with CAT, a well-known score is a novel observation, which further corroborates the validity of the DOSE index.