Lung health consequences of exposure to smoke from domestic use of solid fuels: A guide for low-income countries on what it is and what to do about it

Indoor air pollution resulting from the use of solid fuels for cooking and heating in homes is increasingly recognised as contributing to lung diseases, especially in the poorest countries. It is estimated that 1.5 to 2 million deaths worldwide were attributable to indoor air pollution. Three types of lung disease have been judged to have strong evidence of association with exposure to solid fuel smoke: acute lower respiratory infections (ALRIs) in young children, chronic obstructive pulmonary disease (COPD) and lung cancer in women exposed. Evidence for associations with COPD and lung cancer (from coal smoke exposure) in men is considered moderate, and association of biomass smoke with lung cancer, asthma in children and adults, and tuberculosis in adults is considered scarce.

To address the problem of indoor air pollution, The Union has joined with partners in low-income countries to find a way forward to address this problem. This monograph was therefore prepared thanks to the support of the World Bank.

Worldwide, tobacco use is a major cause of illness and premature death, and contributes to 50% of deaths due to lung disease. The majority (80%) of all tobacco users in the world reside in low- and middle-income countries, and this emphasises the important role that needs to be played by developing countries to reduce the global burden of tobaccorelated diseases.

Tobacco use in Sudan includes both smoking (mainly cigarettes but also water pipe) and snuff dipping, using a traditional and highly addictive form of moist oral snuff called toombak. Few women admit to tobacco use due to cultural norms in the society, and among males the estimated prevalence is around 20%.

This guide is a description of Sudan's experience (as a developing country) in fighting tobacco use and participating in global tobacco research. Publication of this Guide was made possible thanks to the support of the World Bank.

Exposure to tobacco smoke has been shown to cause or exacerbate a wide variety of cancers, infections, cardiovascular and respiratory diseases. Smoking is the most important risk factor for chronic obstructive pulmonary disease and lung cancer.
This new Union Guide, Tobacco Cessation Interventions for Tuberculosis Patients: A Guide for Low-Income Countries, specifically addresses the association between tobacco smoke and tuberculosis, and how tuberculosis patients can be helped to discontinue tobacco use. It in no way implies that tuberculosis is primarily caused by tobacco smoking, or that only tuberculosis patients would benefit from a tobacco cessation intervention. While tuberculosis patients have been selected as the intervention target, the same principles apply to other patients and to tobacco users wherever they may be encountered.
This technical guide was written to provide assistance to health service providers caring for tuberculosis patients to help their patients to stop using tobacco. It starts with an overview of the relationship between tobacco smoking and tuberculosis and is followed by a general overview about tobacco use. It then looks at the topic of tobacco cessation interventions: how to create the correct environment, possible methods to follow, more intensive cognitive behaviour strategies for patients and suggested monitoring documents and procedures.
Publication of this guide was made possible thanks to the support of the World Bank.

The third edition of the Guide addresses issues raised at the launch of the ADF: treatment guidelines have been updated, given the availability of chlorofluorocarbon-free (CFC-free) metered-dose inhalers; and simpler tools, including an electronic database, have been developed for the monitoring of patients treated with asthma medicines purchased through the ADF. The Guide also incorporates findings gained through the evaluation of the implementation of the Guide.

As in the previous editions, the third edition of the Guide proposes that the model adopted for management of tuberculosis in the health services should be applied to implement The Union’s “package of technical measures” for asthma management. The health structures of the first level of referral are selected as the organisational base for the management of asthma patients, and patient care is provided in the context of the general health services.

Training materials for this Guide are available: Participant Manual (PDF 359 Ko), instructor manual (available on request) and slide presentations (examples: Course introduction and rationale (PDF 453Ko); Methods for assessing the patient for asthma (PDF 74Ko))

If you are interested in receiving the Instructor Manual, additional slide presentations or information about asthma training courses provided by The Union and other services such as the Asthma Drug Facility for purchasing affordable, quality assured essential medicines, please contact adf@theunion.org.

This second edition of the "Red book" entitled “Priorities for tuberculosis bacteriology services in low-income countries” provides guidance to national tuberculosis programmes and the laboratory network, the role of tuberculosis laboratory services, main responsibilities within the network and technical and organisational aspects of microscopic sputum smear examination and surveillance of antituberculosis drug resistance. The purpose of this monograph is to complement other texts on mycobacteriology and is thus limited in its scope and emphasis. It does not attempt to cover the entire field of mycobacteriology; but rather focuses on the specific set of minimum required tasks at each level of the national laboratory network.