This is a very interesting question in 2012. I think if you live in the first world, one's belief is certainly that COPD is only caused by cigarette smoking, but the true factor is that a lot of it is not caused by cigarette smoke. And in fact, if one looks at the third world, and the figures that have come out of there recently, one would see that a lot of the COPD is in non-smokers, and that it relates to biomass fuel exposure. So this is all the stuff they use at home in their wood fires or in their stoves, which are fired by, amongst other things, wood, but also animal products. And that, the fumes that are released from this, can certainly cause significant lung disease.
And also the other simple thing is that with the stoves and heat sources that they use, a lot of them don't have chimneys. So the smoke is actually inside the house, and particularly in their living space, where they do the cooking, and clearly they spend most of the time. And this is also in women and young children, because the men are out working. And they have certainly found that in third world countries, there's a significant incidence of COPD related to biomass fuel exposure. And then from both a first and the third world perspective, the other thing we have to consider is occupational dust and fume exposure, that this can also cause lung disease. So, as I said, whereas in the first world the bulk of the disease is certainly caused by cigarette smoking, we still do have to keep an open mind. There are other things that can cause it as well.
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