High COPD prevalence at high altitude: does household air pollution play a role?. Issue 2 (7th February 2019)

• Record Type: Journal Article
• Authors: Brakema, Evelyn A.; Tabyshova, Aizhamal; Kasteleyn, Marise J.; Molendijk, Eveline; van der Kleij, Rianne M.J.J.; van Boven, Job F.M.; Emilov, Berik; Akmatalieva, Meerim; Mademilov, Maamed; Numans, Mattijs E.; Williams, Sian; Sooronbaev, Talant; Chavannes, Niels H.
• Is Part Of: European respiratory journal. Volume 53:Issue 2(2019)
• Publication Date: 2019-02-07
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01193-2018
• Languages: English
• ISSNs: 0903-1936

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. High indoor PM 2.5 levels could explain elevated COPD prevalence in rural, high-altitude settings: prevention is key! http://ow.ly/hvC930mFEKJ