‘Biomass/Black Smoke’ Lung disease: an increasingly prevalent but under-recognized global condition

Authors:  Matthew Di Capite MB BChir, Viktor Sekowski MD, Pen Li MD, Vivek Dhawan MD, PhD, Richard Long MD and Lakshmi Puttagunta MD
Presenter:  Dr. Matthew Di Capite
1:45 pm - 2:00 pm

We report the findings of three patients affected by ‘Black Smoke’-lung disease, a consequence of prolonged exposure to solid biomass fuel smoke from domestic and occupational cooking. Over three billion people are exposed globally to this type of fuel. "Black Smoke" lung disease is an under-recognized cause of chronic lung injury in developed countries. At-risk population groups include Immigrants and refugees from low- and middle-income countries where biomass  fuel is commonly used. Women, including during pregnancy, and children are at  even greater risk due to increased time spent indoors. Poor ventilation in small  domestic spaces increases the intensity of exposure and risk of lung injury from  elevated levels of smoke particles and volatile substances produced by incomplete combustion of biomass fuels.  

We briefly summarize the history of anthracosis and the global socioeconomic factors influencing solid biomass fuel use in the context of domestic heating and cooking, to increase awareness of the harmful effects of this exposure. We  recommend assessing biomass fuel exposure history in chronic lung disease, especially among at-risk immigrant populations and non-smoking individuals.  Given global smoke exposure from factors like forest fires and rising air pollution  levels, accurately documenting smoke/air pollution exposure history is crucial for  diagnosis and research into this emerging international health risk.
Dr. Matthew Di Capite is a Consultant Histopathologist, working at the Norfolk and Norwich University Hospital, United Kingdom. He did his fellowship in Gastrointestinal Pathology at the University of Alberta, Edmonton in 2022/23, with a block in Respiratory Pathology. He undertook his histopathology training in the East of England deanery, and foundation programme at University Hospitals Southampton.  He completed his medical degree (MB BChir) at University of Cambridge (Wolfson College) in 2013.
Dr. Lakshmi Puttagunta is an Anatomical Pathologist who completed her medical and residency training at the University of Alberta, with Royal College of Physicians and Surgeons of Canada and American Board of Pathology certification. She completed her fellowship training in lymphoma/molecular pathology at the MD Anderson Cancer Centre, University of Texas, in Houston. She then completed fellowship training in cytopathology and pulmonary pathology at Massachusetts General Hospital, Harvard University, in Boston. Dr. Puttagunta was Program Director of both the Anatomical and General Pathology Residency Training Programs for about 10 years and has participated in developing residency training programs overseas. She was an International External Examiner in Anatomical Pathology for the Aga Khan University Hospital in Kenya for several years.  With over 20 years of experience, she remains as passionate about Anatomical (Molecular and Diagnostic) Pathology today as she was when she first entered her residency training. Her areas of interest are pulmonary pathology including interstitial and occupational lung disease, cytopathology, head and neck pathology, international/global pathology, and, most of all teaching, and participating in collaborative research.