Domestic burning of biomass fuel is one of the most important risk factors for the development of respiratory diseases and infant mortality. The fuel which causes the highest level of disease is dung. In the rural areas of developing countries some 80% of households rely on biomass fuels for cooking and often heating as well and so suffer high indoor air pollution. Even when the fire or stove is outside the home those near it are still exposed to the smoke. In areas where the winters are long and cold the problem is aggravated since the fire or stove is indoors for many months of the year. The consequence of biomass burning is a level of morbidity in those exposed to the smoke as well as mortality. The rural areas of Turkey are among many in the world where biomass is the major fuel source. In this case report 8 patients from rural areas, particularly Anatolia, who used biomass are presented. Many of these are non-smoking, female patients who have respiratory complaints and a clinical picture of the chronic lung diseases which would have been expected if they had been heavy smokers. Typically patients cook on the traditional 'tandir' stove using dung and crop residues as the fuel. Ventilation systems are poor and they are exposed to a high level of smoke pollution leading to cough and dyspnoea. Anthracosis is a common outcome of this level of exposure and several of the patients developed lung tumours. The findings from clinical examination of 8 of these patients (2 M, 6 F) are presented together with their outcome where known, Copyright (C) 2003 S. Karger AG, Basel.