Bronchial anthracofibrosis: an emerging pulmonary disease due to biomass fuel exposure

OBJECTIVES: 1) To document current knowledge of bronchial anthracofibrosis (BAF), an emerging pulmonary disease recognised just over a decade ago; 2) to highlight the demographic profile, and clinical, radiological and bronchoscopic features peculiar to BAF; and 3) to discuss the postulated causes and clinical conditions associated with BAF, emphasising the need to characterise and recognise it as a distinct clinical disorder. DATA SOURCES: An extensive search of the literature was performed in Medline/PubMed and other databases with key terms 'anthracosis', 'biomass fuels', 'bronchial anthracofibrosis' and 'pulmonary tuberculosis'. The bibliographies of papers identified were searched for further relevant articles. RESULTS: A total of 17 studies and six case series/reports describing 1320 patients with bronchoscopically confirmed BAF were documented. BAF was predominantly observed in elderly housewives in rural areas with prolonged exposure to biomass fuel, and was associated with respiratory diseases such as tuberculosis (TB), chronic obstructive pulmonary disease, pneumonia and malignancy. Exposure to biomass fuel smoke emerged as the main causative factor, but the possibility of an occupational lung disorder was also raised. Characteristic clinical, thorax computed tomography and bronchoscopic features of BAF were identified and its differentiation from endobronchial TB and bronchogenic carcinoma was described. CONCLUSION: As a pulmonary disease, BAF is yet to be highlighted in both developing and industrialised countries. BAF is currently diagnosed only on bronchoscopy, whereas a suitable non-invasive diagnostic modality would enable rapid diagnosis and increased recognition. Approaches for patients with BAF need to be developed and the serious hazards of biomass fuel use should be emphasised.