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

Evelyn A. Brakema, Aizhamal Tabyshova, Marise J. Kasteleyn, Eveline Molendijk, Rianne M.J.J. van der Kleij, Job F.M. van Boven, Berik Emilov, Meerim Akmatalieva, Maamed Mademilov, Mattijs E. Numans, Sian Williams, Talant Sooronbaev, Niels H Chavannes
European Respiratory Journal 2018; DOI: 10.1183/13993003.01193-2018
Evelyn A. Brakema
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Aizhamal Tabyshova
2Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
3Department of General Practice & Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Marise J. Kasteleyn
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Eveline Molendijk
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Rianne M.J.J. van der Kleij
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Job F.M. van Boven
3Department of General Practice & Elderly Care Medicine, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Berik Emilov
2Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Meerim Akmatalieva
2Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Maamed Mademilov
2Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Mattijs E. Numans
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Sian Williams
4International Primary Care Respiratory Group (IPCRG), London, United Kingdom
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Talant Sooronbaev
2Pulmonary Department, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Niels H Chavannes
1Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Abstract

Studies comparing COPD prevalence across altitudes report conflicting results. Yet, household air pollution, 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 household air pollution.

We conducted a population-based, observational study in a highland (∼2050 m) and lowland (∼750 m) setting in rural Kyrgyzstan. We performed spirometry in randomly selected households, measured indoor particulate matter <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). Also, their average PM2.5-exposure was higher (290.0 versus 72.0 µg·m−3, p<0.001). Besides high PM2.5-exposure (OR 3.174; 95% CI 1.061–9.493), the altitude setting (3.406; 1.483–7.825), pack years (1.037; 1.005–1.070), and age (1.058; 1.037–1.079) also contributed to a higher COPD prevalence among highlanders.

COPD prevalence and household air pollution 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.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Drs. Brakema has nothing to disclose.

Conflict of interest: Dr Tabyshova has nothing to disclose.

Conflict of interest: Dr Kasteleyn has nothing to disclose.

Conflict of interest: Drs. Molendijk has nothing to disclose.

Conflict of interest: Dr. van der Kleij has nothing to disclose.

Conflict of interest: Dr. van Boven has nothing to disclose.

Conflict of interest: Dr Emilov has nothing to disclose.

Conflict of interest: Drs Akmatalieva has no disclosures.

Conflict of interest: Dr Mademilov has nothing to disclose.

Conflict of interest: Prof Numans has no disclosures.

Conflict of interest: Ms Williams has nothing to disclose.

Conflict of interest: Dr Sooronbaev has nothing to disclose.

Conflict of interest: Prof Chavannes has no disclosures.

This is a PDF-only article. Please click on the PDF link above to read it.

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High COPD prevalence at high altitude: does household air pollution play a role?
Evelyn A. Brakema, Aizhamal Tabyshova, Marise J. Kasteleyn, Eveline Molendijk, Rianne M.J.J. van der Kleij, Job F.M. van Boven, Berik Emilov, Meerim Akmatalieva, Maamed Mademilov, Mattijs E. Numans, Sian Williams, Talant Sooronbaev, Niels H Chavannes
European Respiratory Journal Jan 2018, 1801193; DOI: 10.1183/13993003.01193-2018

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High COPD prevalence at high altitude: does household air pollution play a role?
Evelyn A. Brakema, Aizhamal Tabyshova, Marise J. Kasteleyn, Eveline Molendijk, Rianne M.J.J. van der Kleij, Job F.M. van Boven, Berik Emilov, Meerim Akmatalieva, Maamed Mademilov, Mattijs E. Numans, Sian Williams, Talant Sooronbaev, Niels H Chavannes
European Respiratory Journal Jan 2018, 1801193; DOI: 10.1183/13993003.01193-2018
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