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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We enjoyed the article by L&#243;pez-Campos et al&#46;&#44; describing the geographical distribution in Spain of additional risk factors&#44; other than smoking&#44; for chronic obstructive pulmonary disease &#40;COPD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We would like to comment on the results obtained in the On-Sint study&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The authors found that male sex was associated with the presence of an additional risk factor other than tobacco smoke&#44; and that exposure to biomass smoke was low &#40;2&#46;6&#37; of COPD cases on average&#41;&#44; and lower than occupational exposure to other noxas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although biomass combustion is a risk factor of particular relevance in developing countries&#44; exposure to biomass smoke may also be significant in the industrialized world&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In a study conducted in a predominantly rural population in Spain&#44; biomass combustion exposure was the only risk factor for developing the disease in over 20&#37; of COPD patients referred to a specialist respiratory medicine clinic&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Some aspects of the methodology used by L&#243;pez-Campos et al&#46; suggest that the significance of biomass may be underestimated&#46; The authors state that they did not aim to obtain a sample with a uniform geographical distribution&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Most patients were recruited in health centers in urban settings&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> where biomass smoke exposure would have not been significant&#46; The association between male sex and an additional risk factor appears to stem from the preponderance of men engaged in jobs that involve occupational exposure to toxins&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In contrast&#44; exposure to biomass combustion is higher among women&#44; due to sociocultural determinants&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> We would&#44; then&#44; ask the authors for an additional analysis&#44; evaluating exposure to biomass smoke among subjects recruited in rural health centers&#44; and among women&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study only included smokers&#44; and did not aim to evaluate risk factors in non-smokers&#44; a population in which&#44; globally speaking&#44; biomass combustion exposure is the most significant factor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Exposure to biomass smoke was self-reported&#44; and the interview began by asking subjects if they had been exposed to any other risk factor apart from tobacco smoke&#46; They were asked to identify the exposure only if the response was positive&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In our experience&#44; many patients are unaware of the potential clinical relevance of biomass burning&#44; and for this reason they may have responded in the negative to the initial question&#44; particularly if exposure was remote&#44; having occurred in childhood or youth&#44; stages when subjects would plausibly be more sensitive to the adverse effects of inhaled toxins&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In short&#44; while the study of L&#243;pez-Campos et al&#46; offers the best data currently available on the distribution of COPD risk factors other than tobacco in Spain&#44; we believe that specific studies are needed to analyze the real significance of biomass combustion as a risk factor for disease in this country&#44; to fulfill the objective proposed by the authors<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#58; to improve early diagnosis and prevention of COPD&#46;</p></span>"
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Letter to the Editor
Biomass Burning as a Risk Factor for Chronic Obstructive Pulmonary Disease in Spain
Combustión de biomasa como factor de riesgo para enfermedad pulmonar obstructiva crónica en España
Rafael Golpe
Corresponding author
rafagolpe@gmail.com

Corresponding author.
, Irene Martín-Robles, Pilar Sanjuán-López
Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We enjoyed the article by L&#243;pez-Campos et al&#46;&#44; describing the geographical distribution in Spain of additional risk factors&#44; other than smoking&#44; for chronic obstructive pulmonary disease &#40;COPD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> We would like to comment on the results obtained in the On-Sint study&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The authors found that male sex was associated with the presence of an additional risk factor other than tobacco smoke&#44; and that exposure to biomass smoke was low &#40;2&#46;6&#37; of COPD cases on average&#41;&#44; and lower than occupational exposure to other noxas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although biomass combustion is a risk factor of particular relevance in developing countries&#44; exposure to biomass smoke may also be significant in the industrialized world&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In a study conducted in a predominantly rural population in Spain&#44; biomass combustion exposure was the only risk factor for developing the disease in over 20&#37; of COPD patients referred to a specialist respiratory medicine clinic&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Some aspects of the methodology used by L&#243;pez-Campos et al&#46; suggest that the significance of biomass may be underestimated&#46; The authors state that they did not aim to obtain a sample with a uniform geographical distribution&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Most patients were recruited in health centers in urban settings&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> where biomass smoke exposure would have not been significant&#46; The association between male sex and an additional risk factor appears to stem from the preponderance of men engaged in jobs that involve occupational exposure to toxins&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In contrast&#44; exposure to biomass combustion is higher among women&#44; due to sociocultural determinants&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> We would&#44; then&#44; ask the authors for an additional analysis&#44; evaluating exposure to biomass smoke among subjects recruited in rural health centers&#44; and among women&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The study only included smokers&#44; and did not aim to evaluate risk factors in non-smokers&#44; a population in which&#44; globally speaking&#44; biomass combustion exposure is the most significant factor&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Exposure to biomass smoke was self-reported&#44; and the interview began by asking subjects if they had been exposed to any other risk factor apart from tobacco smoke&#46; They were asked to identify the exposure only if the response was positive&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In our experience&#44; many patients are unaware of the potential clinical relevance of biomass burning&#44; and for this reason they may have responded in the negative to the initial question&#44; particularly if exposure was remote&#44; having occurred in childhood or youth&#44; stages when subjects would plausibly be more sensitive to the adverse effects of inhaled toxins&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In short&#44; while the study of L&#243;pez-Campos et al&#46; offers the best data currently available on the distribution of COPD risk factors other than tobacco in Spain&#44; we believe that specific studies are needed to analyze the real significance of biomass combustion as a risk factor for disease in this country&#44; to fulfill the objective proposed by the authors<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#58; to improve early diagnosis and prevention of COPD&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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