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Eur Respir J. 2019 Feb 7;53(2). pii: 1801193. doi: 10.1183/13993003.01193-2018. Print 2019 Feb.

High COPD prevalence at high altitude: does household air pollution play a role?

Author information

1
Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
2
Pulmonary Dept, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
3
Dept of General Practice and Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
4
International Primary Care Respiratory Group (IPCRG), London, UK.

Abstract

Studies comparing chronic obstructive pulmonary disease (COPD) prevalence across altitudes report conflicting results. However, household air pollution (HAP), a major COPD risk factor, was mostly not accounted for in previous analyses and never objectively measured. We aimed to compare the prevalence of COPD and its risk factors between low-resource highlands and lowlands, with a particular focus on objectively measured HAP.We conducted a population-based, observational study in a highland (∼2050 m above sea level) and a lowland (∼750 m above sea level) setting in rural Kyrgyzstan. We performed spirometry in randomly selected households, measured indoor particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) and administered a questionnaire on other COPD risk factors. Descriptive statistics and multivariable logistic regressions were used for analyses.We included 392 participants: 199 highlanders and 193 lowlanders. COPD was more prevalent among highlanders (36.7% versus 10.4%; p<0.001). Their average PM2.5 exposure was also higher (290.0 versus 72.0 µg·m-3; p<0.001). In addition to high PM2.5 exposure (OR 3.174, 95% CI 1.061-9.493), the altitude setting (OR 3.406, 95% CI 1.483-7.825), pack-years of smoking (OR 1.037, 95% CI 1.005-1.070) and age (OR 1.058, 95% CI 1.037-1.079) also contributed to a higher COPD prevalence among highlanders.COPD prevalence and HAP were highest in the highlands, and were independently associated. Preventive interventions seem warranted in these low-resource, highland settings. With this study being one of the first spirometry-based prevalence studies in Central Asia, generalisability needs to be assessed.

PMID:
30464013
DOI:
10.1183/13993003.01193-2018
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Conflict of interest statement

Conflict of interest: E.A. Brakema has nothing to disclose. Conflict of interest: A. Tabyshova has nothing to disclose. Conflict of interest: M.J. Kasteleyn has nothing to disclose. Conflict of interest: E. Molendijk has nothing to disclose. Conflict of interest: R.M.J.J. van der Kleij has nothing to disclose. Conflict of interest: J.F.M. van Boven has nothing to disclose. Conflict of interest: B. Emilov has nothing to disclose. Conflict of interest: M. Akmatalieva has nothing to disclose. Conflict of interest: M. Mademilov has nothing to disclose. Conflict of interest: M.E. Numans has nothing to disclose. Conflict of interest: S. Williams has nothing to disclose. Conflict of interest: T. Sooronbaev has nothing to disclose. Conflict of interest: N.H. Chavannes has nothing to disclose.

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