30 October 2026 Punjab Khabarnama Bureau : People living with Chronic Obstructive Pulmonary Disease (COPD) who are exposed to both cigarette smoke and household biomass fuel smoke may experience more severe respiratory complications than those exposed to either source alone, according to a new study published in October 2026.
The research found that combined exposure was associated with poorer lung function, greater breathlessness, more frequent disease flare-ups and a higher prevalence of pulmonary hypertension. The findings highlight the importance of considering indoor air pollution alongside tobacco smoking when assessing respiratory health.
The study, published in the journal Tobacco Induced Diseases, analysed clinical outcomes among COPD patients exposed to cigarette smoke, biomass smoke or both.
Study Examined 319 COPD Patients
Researchers conducted a retrospective observational study involving 319 patients with stable COPD who received treatment at two tertiary care centres in Türkiye between January 2024 and August 2025.
Participants were divided into three groups: 159 patients exposed to cigarette smoke, 80 exposed to biomass smoke and 80 exposed to both sources.
The researchers compared lung function, breathlessness, annual exacerbations and respiratory complications across the groups.
One notable finding was that patients exposed to both cigarette and biomass smoke had poorer lung function despite being younger on average than those in the cigarette-smoking group.
Their mean forced expiratory volume in one second (FEV1) was 48.27% of the predicted value. This was lower than the 55.28% recorded in the cigarette-only group and 55.62% in the biomass-only group.
FEV1 is an important measurement used in lung function testing. It indicates how much air a person can forcefully breathe out in one second and helps doctors assess the severity of airflow limitation.
Greater Breathlessness and More Severe Exacerbations
The study also found that patients exposed to both smoke sources experienced greater breathlessness.
Their average modified Medical Research Council (mMRC) breathlessness score was 2.18, compared with 1.39 among cigarette smokers and 1.88 among those exposed to biomass smoke alone.
COPD exacerbations, which are episodes when symptoms become worse than usual, were also more frequent in the combined-exposure group.
Patients with dual exposure experienced an average of 2.18 exacerbations annually, compared with 2.08 in the cigarette-only group and 1.88 in the biomass-only group.
The difference was particularly notable for severe exacerbations. The combined-exposure group experienced an average of 1.78 severe episodes annually, compared with 1.39 and 1.20 in the other two groups, respectively.
Severe COPD exacerbations can require hospitalisation, intensive medical treatment and, in some cases, mechanical ventilation.
After adjusting for age, sex and selected medical conditions, researchers found that combined smoke exposure was associated with 89% higher odds of severe exacerbations compared with cigarette smoking alone.
Pulmonary Hypertension Also More Common
Another important finding involved pulmonary hypertension, a condition in which blood pressure in the arteries carrying blood from the heart to the lungs becomes abnormally high.
The condition was identified in 22.5% of patients exposed to both cigarette and biomass smoke. In comparison, its prevalence was 10.1% among cigarette smokers and 8.75% among those exposed to biomass smoke alone.
After adjustment for selected factors, the combined-exposure group had higher odds of pulmonary hypertension than the cigarette-only group.
Chronic respiratory failure was also more frequent among patients with dual exposure, as reflected by greater use of long-term oxygen therapy. The proportion receiving such treatment was 26.2% in the combined group, compared with 17% among cigarette smokers and 11.2% among biomass-exposed patients.
The researchers also reported a higher prevalence of bronchiectasis, a condition involving permanent widening and damage to the airways, among patients exposed to both smoke sources.
Why Biomass Smoke Matters
Biomass fuels include wood, crop residues, dung and other organic materials burned for cooking or heating. In households with inadequate ventilation, burning these fuels can release smoke containing fine particulate matter and other harmful pollutants.
Long-term exposure to household smoke can irritate the respiratory system and contribute to chronic lung damage.
In several parts of the world, including rural communities in developing countries, biomass fuel exposure remains an important public health concern. Women, children and older people may experience substantial exposure when cooking or spending long periods indoors.
The study highlights that COPD risk assessment should not focus exclusively on cigarette smoking. A patient’s history of cooking-fuel exposure, indoor ventilation and occupational pollution may also provide important information.
What the Findings Mean for COPD Prevention
The research suggests that reducing exposure to both tobacco and household air pollution should be an important part of respiratory health strategies.
Quitting smoking is one of the most important steps for people with COPD. Improving kitchen ventilation, using cleaner cooking fuels and reducing exposure to indoor smoke may also help limit respiratory risks.
Doctors may need to ask patients about both smoking habits and household fuel use when evaluating COPD symptoms and disease progression.
However, the researchers cautioned that the study’s retrospective observational design cannot establish that combined exposure directly caused the poorer outcomes. The research was also conducted at two centres in Türkiye, and its findings may not automatically apply to every population.
Further prospective studies involving larger and more diverse groups of patients are needed to understand the long-term effects of combined exposure.
The findings nevertheless underline an important public health message: protecting lung health requires attention to all major sources of harmful smoke, not just cigarettes.