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ORIGINAL RESEARCHCOPDRisk of COPD From Exposure to Biomass Smoke: A Metaanalysis
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Search of the Literature
Papers published in the MEDLINE database, the Latin American and Caribbean Literature in Health Sciences Database, and EMBASE were searched (up to January 2009) with key words including “COPD,” “chronic bronchitis,” “emphysema,” “chronic obstructive pulmonary disease,” “biomass fuel,” “biofuel,” “organic fuel,” “wood,” and “indoor air pollution.” Articles about relevant studies in the references were also obtained. Only studies published in the English language were included in the analysis. We
Characteristics of the Included Studies
A detailed flow chart of the review process is presented in Figure 1. The initial search resulted in 984 hits of potential interest. Nine hundred fifty-seven studies were excluded upon review of the titles and abstracts. Among the remaining 27 articles6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 on biomass smoke and the incidence of COPD, some were further excluded because of duplicated publication,6 lack of adequate data for the
Discussion
Metaanalytic methods are powerful tools for studying cumulative data from individual studies with small sample sizes and low statistical power. Pooling the effects from individual studies by a metaanalysis may increase the statistical power and can help detect modest risk differences among study groups. The large data set of this pooled analysis enabled us to investigate aspects of biomass smoke and subgroup-specific associations that could not be addressed adequately in previous studies.
Conclusions
In conclusion, our metaanalysis suggests that biomass smoke is associated with an increase in the risk of COPD. Given the high prevalence of biomass smoke, especially in rural areas, the public health consequences of biomass smoke with regard to COPD are important and suggest that COPD incidence could be reduced by interventions targeting biomass smoke.
Acknowledgments
Author contributions: Dr Hu: contributed to research conception, the first draft of the study protocol, literature searches and selected studies, additional data extraction, data management, statistical analyses, and the final version of the report.
Dr Zhou: contributed to the first draft of the study protocol, literature searches and selected studies, statistical analyses, and the final version of the report.
Dr Tian: contributed to data management and the final version of the report.
Dr Yao:
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