Bronchopulmonary disease in Iranian housewives chronically exposed to indoor smoke

Tobacco smoking is recognized as the main cause of chronic bronchitis followed by occupational exposure to dust, fumes and gases. Indoor inhalation of smoke is being investigated increasingly but mainly the acute morbidity has been described while the late features and complications which may lead to respiratory disability are less well known. Among the 388 female patients who were referred to the main Bronchoscopy Unit of Tehran University of Medical Sciences between 1986 and 1995, 10 nonsmoking elderly housewives were found with chronic bronchopulmonary lesions characterized by widespread mucosal swelling and anthracotic plaques of the airways. Enquiry into their past history revealed massive exposure to smoke over many years whilst baking household rustic bread inside dwellings. No other source of air pollution was detected. The main clinicopathological features were respiratory disability due to chronic bronchitis with intracellular as well as extracellular black particles. As similar cases may present to medical practitioners even in affluent societies as a result of increasing amounts of immigrants from developing countries, recognition of these patients is important to avoid irrelevant diagnoses and unnecessary interventions.