PT - JOURNAL ARTICLE AU - Evelyn A. Brakema AU - Aizhamal Tabyshova AU - Marise J. Kasteleyn AU - Eveline Molendijk AU - Rianne M.J.J. van der Kleij AU - Job F.M. van Boven AU - Berik Emilov AU - Meerim Akmatalieva AU - Maamed Mademilov AU - Mattijs E. Numans AU - Sian Williams AU - Talant Sooronbaev AU - Niels H. Chavannes TI - High COPD prevalence at high altitude: does household air pollution play a role? AID - 10.1183/13993003.01193-2018 DP - 2019 Feb 01 TA - European Respiratory Journal PG - 1801193 VI - 53 IP - 2 4099 - http://erj.ersjournals.com/content/53/2/1801193.short 4100 - http://erj.ersjournals.com/content/53/2/1801193.full SO - Eur Respir J2019 Feb 01; 53 AB - 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 PM2.5 levels could explain elevated COPD prevalence in rural, high-altitude settings: prevention is key! http://ow.ly/hvC930mFEKJ