Effects of woodsmoke exposure on airway inflammation in rural Guatemalan women

PLoS One. 2014 Mar 13;9(3):e88455. doi: 10.1371/journal.pone.0088455. eCollection 2014.


Background: More than two-fifths of the world's population uses solid fuels, mostly biomass, for cooking. The resulting biomass smoke exposure is a major cause of chronic obstructive pulmonary disease (COPD) among women in developing countries.

Objective: To assess whether lower woodsmoke exposure from use of a stove with a chimney, compared to open fires, is associated with lower markers of airway inflammation in young women.

Design: We carried out a cross-sectional analysis on a sub-cohort of participants enrolled in a randomized controlled trial in rural Guatemala, RESPIRE.

Participants: We recruited 45 indigenous women at the end of the 18-month trial; 19 women who had been using the chimney stove for 18-24 months and 26 women still using open fires.

Measurements: We obtained spirometry and induced sputum for cell counts, gene expression of IL-8, TNF-α, MMP-9 and 12, and protein concentrations of IL-8, myeloperoxidase and fibronectin. Exhaled carbon monoxide (CO) and 48-hr personal CO tubes were measured to assess smoke exposure.

Results: MMP-9 gene expression was significantly lower in women using chimney stoves. Higher exhaled CO concentrations were significantly associated with higher gene expression of IL-8, TNF-α, and MMP-9. Higher 48-hr personal CO concentrations were associated with higher gene expression of IL-8, TNF- α, MMP-9 and MMP-12; reaching statistical significance for MMP-9 and MMP-12.

Conclusions: Compared to using an open wood fire for cooking, use of a chimney stove was associated with lower gene expression of MMP-9, a potential mediator of airway remodeling. Among all participants, indoor biomass smoke exposure was associated with higher gene expression of multiple mediators of airway inflammation and remodeling; these mechanisms may explain some of the observed association between prolonged biomass smoke exposure and COPD.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air Pollutants / adverse effects*
  • Carbon Monoxide / chemistry
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Fibronectins / metabolism
  • Guatemala
  • Humans
  • Inflammation / pathology*
  • Interleukin-8 / metabolism
  • Matrix Metalloproteinase 12 / metabolism
  • Matrix Metalloproteinase 9 / metabolism
  • Peroxidase / metabolism
  • Pulmonary Disease, Chronic Obstructive / etiology*
  • Rural Population*
  • Smoke / adverse effects*
  • Spirometry
  • Tumor Necrosis Factor-alpha / metabolism
  • Young Adult


  • Air Pollutants
  • CXCL8 protein, human
  • Fibronectins
  • Interleukin-8
  • Smoke
  • Tumor Necrosis Factor-alpha
  • Carbon Monoxide
  • Peroxidase
  • MMP9 protein, human
  • Matrix Metalloproteinase 9
  • MMP12 protein, human
  • Matrix Metalloproteinase 12