Peter Burney National Heart and Lung Institute

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Presentation transcript:

Biomass and chronic lung disease: Is the evidence good enough, and does it matter? Peter Burney National Heart and Lung Institute Imperial College, London

Burden of disease attributable to 20 leading risk factors in 2010, expressed as a percentage of global disability-adjusted life-years From Lim et al. Lancet 2012; 380: 2224–60

Biomass smoke exposure and the risk of chronic obstructive pulmonary disease (COPD). [redrawn] Redrawn from: Eisner et al. Am J Respir Crit Care Med 2010; 182: 693-718

Biomass smoke exposure and the risk of chronic obstructive pulmonary disease (COPD). [redrawn] Strong evidence of publication bias Highly variable results (I2>80%) Redrawn from: Eisner et al. Am J Respir Crit Care Med 2010; 182: 693-718

Millions Dead: How Do We Know and What Does It Mean? Methods Used in the Comparative Risk Assessment of Household Air Pollution “….strong evidence of publication bias (Egger’s test: p = 0.007); the pooled OR was 1.94 (1.62, 2.33) with substantial heterogeneity (I2 =85%)…… …….Causal inference is supported by these findings……” Smith et al. and the HAP CRA Risk Expert Group. Annu. Rev. Public Health 2014. 35:185–206

Burden of Obstructive Lung Disease (BOLD) sites

Ala Muala, et al. Acute exposure to wood smoke from incomplete combustion - indications of cytotoxicity. Particle and Fibre Toxicology (2015) 12:33

The evidence relating to biomass and COPD is not good enough and it does matter: Deflects attention from more important issues Leads to sub-optimal prioritisation Distorts the research agenda Leads to ineffective policies Wastes resources