Attributable Burden of COPD from Indoor PM2.5 Exposure in Spanish Households, 2025

Background

Chronic obstructive pulmonary disease (COPD) is a major global health threat, ranking as the fourth leading cause of death worldwide. COPD aetiology is multifactorial, involving genetics, lifestyle, and environmental exposures. Household air pollution (HAP) is a significant risk factor, with sources releasing harmful pollutants such as fine particulate matter (PM2.5), which penetrates deep into the lungs and bloodstream, damaging multiple organs. This study aimed to estimate the burden of disease of COPD attributable to HAP in Spanish households.

Methods

Within the K-HEALTHinAIR project, the COPD burden attributable to indoor PM2.5 exposure in Spanish households was estimated for 2025 using a comparative risk assessment framework. Measured indoor PM2.5 concentrations, GBD 2023 health data for Spain, and exposure–response functions from robust epidemiological evidence were combined to calculate the population attributable fraction (PAF) and thereafter, the attributable years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) across different households.

Results

The mean estimated attributable COPD burden in Spanish households was 116 thousand DALYs. Homes characteristics accounted for differences in burden estimations and the highest estimations were found for homes with daily and weekly smokers (327 thousand DALYs); gas cooking devices (119 thousand DALYs), air-conditioning for heating (183 thousand DALYs), and absence of climatic control (192 thousand DALYs).

Conclusions

Household air pollution increases COPD risk through both combustion-related pollutants and poor indoor thermal conditions. Reducing PM2.5 exposure with cleaner fuels, better ventilation, and targeted policies is essential to lower future disease burden.

Acknowledgments: This study has been performed in the framework of the K-HEALTHinAIR project funded by the European Union (Grant agreement ID: 101057693).

Key messages

• Household PM2.5 exposure contributes to COPD burden in Spain, particularly in homes with smokers, combustion sources, and poor climate control.

• This work provides evidence to support targeted household and policy interventions to reduce indoor air pollution and prevent COPD-related disability and deaths.