Open Waste Burning in Indonesia: Pulmonary Toxicity, Injury Mechanisms, and Clinical Challenges

Abstract

Open waste burning is a widespread but underrecognized source of air pollution, particularly where waste services are inadequate. This narrative review aimed to synthesize evidence on the scale and drivers of open waste burning, emission toxicology, mechanisms of lung injury, respiratory effects, clinical management, and public-health implications, with relevance to Indonesia. PubMed/MEDLINE, Scopus, ScienceDirect, Google Scholar, and relevant institutional sources were searched. Evidence was classified into three tiers: direct waste-burning evidence, analogous combustion-exposure evidence, and broader air-pollution evidence. Open waste burning releases particulate matter, black carbon, polycyclic aromatic hydrocarbons, volatile organic compounds, metals, dioxins, and furans, which may promote oxidative stress, epithelial barrier dysfunction, impaired mucociliary defense, immune activation, and airway remodeling. Available evidence indicates potential acute respiratory symptoms and exacerbation of existing respiratory disease, although direct epidemiological evidence remains limited. No exposure-specific biomarker or treatment protocol has been established. Clinical management should therefore emphasize exposure history, syndrome-based care, and exposure reduction, while public-health measures should prioritize improved waste services and source control. The review is limited by heterogeneous evidence and the scarcity of exposure-linked human studies. Prospective studies are needed to quantify respiratory burden and evaluate intervention benefits.