High COPD prevalence at high altitude:

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Karolien van den Broek
5 jaren geleden
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High COPD prevalence at high altitude: does household air

Evelyn Brakema 1 A Tabyshova 2 M Kasteleyn 1 E Molendijk 1 RMJJ

Mademilov 2 ME Numans 1 S Williams 4 T Sooronbaev 2 NH Chavannes 1

Center of Cardiology and Internal Medicine, Kyrgyzstan; 3

1 High COPD prevalence at high altitude: does household air pollution play a role? Evelyn Brakema 1 A Tabyshova 2 M Kasteleyn 1 E Molendijk 1 RMJJ van der Kleij 1 JF van Boven 3 B Emilov 2 M Akmatalieva 2 M Mademilov 2 ME Numans 1 S Williams 4 T Sooronbaev 2 NH Chavannes 1 1 Leiden University Medical Center, the Netherlands; 2 National Center of Cardiology and Internal Medicine, Kyrgyzstan; 3 University Medical Center Groningen & ARTEG, the Netherlands; 4 International Primary Care Respiratory Group, UK A project funded by: 1

2 Rationale COPD 3 rd cause of death: Institute for Health Metrics and Evaluation. GBD Compare Data Visualization [cited 2018 Apr 4]. Available from: Household air pollution main contributor, especially in low-resource settings: 1) Gordon SB, Bruce NG, Grigg J, Hibberd PL et al. Respiratory risks from household air pollution in low and middle income countries. Lancet Respir Med 2014; 2: ) World Health Organization. Chronic obstructive pulmonary disease (COPD) Nov [cited 2018 Apr 4]. Available from: Conflicting results on COPD & altitude: 1) Caballero A, Torres-Duque CA, Jaramillo C, et al. Prevalence of COPD in five Colombian cities situated at low, medium, and high altitude (PREPOCOL study). Chest 2008; 133: ) Jaganath D, Miranda JJ, Gilman RH et al. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru. Respir Res 2015;16: 40. 3) Menezes AM, Perez-Padilla R, Jardim JR et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005; 366: ) Laniado-Laborin R, Rendon A, Batiz F, Alcantar-Schramm JM et al. High altitude and chronic obstructive pulmonary disease prevalence: a casual or causal correlation? Arch Bronconeumol 2012; 48: ) Aaron SD, Gershon AS, Gao Y et al. Influence of country-level differences on COPD prevalence. Int J Chron Obstruct Pulmon Dis 2016; 11: ) Horner A, Soriano JB, Puhan MA, et al. Altitude and COPD prevalence: analysis of the PREPOCOL-PLATINO-BOLD-EPI-SCAN study. Respir Res 2017; 18: 162.

3 Aim To compare COPD and its risk factors between high- and low altitude areas with a special focus on household air pollution 3

4 Kyrgyzstan

5 Methods - setting Rural highlands: Naryn 2050 m Rural lowlands: Chui 750 m

6 Methods - design Observational Cross-sectional Population-based Risk Factors + 6

7 Methods - analysis High- vs lowlands: Descriptive statistics COPD risk factors: Logistic regressions, Generalized estimating equations (GEE) 7

8 Results - demographics Male, n (%) Age (years), mean (SD) BMI (kg/m 2 ), mean (SD) Higher education*, n (%) Profession, n (%) - Primary sector - Secondary sector - Tertiary/quaternary sector Lowlands n = 193 Highlands n = 199 p-value - Housewife/man Smoker (ever), n (%) Male, n (%) Smoking years, median [IQR] Tuberculosis (ever), n (%) *The highest level of completed education is > secondary education. Tuberculosis had 46 missing values for the highlanders. Highlanders were older, had lower SES indicators and were less often smoker 8

9 Results - Household air pollution (average PM 2.5 ) 9

10 Results COPD prevalence 10

11 Results predictors of COPD Multivariable analysis Significant multivariable predictors were age, altitude and high HAP 11

12 Conclusion 1) Highlands: COPD + household air pollution! 2) Risk factors COPD: Pollution, age, altitude other factors? 12

13 Differences to our habits

14 14

15 Thank you! A project funded by: e.a.brakema@lumc.nl Conflicts of interest: none Funding: Healthy Lungs for Life by the European Lung Foundation

16 Losse aantekeningen Noord-Hollandse Schoorl, uitgevoerd door het Energieonderzoek Centrum Nederland in 2009, bleek dat houtrook verantwoordelijk was voor 30 tot 39 procent aan PM 2,5. Vroegtijdige sterfgevallen door slechte lucht in Nederland: Uit onderzoek blijkt dat 10 procent van de mensen ernstige hinder van houtrook ondervindt en 50 procent in lichte mate. longpatiënten, hebben last van fijnstof die door open haarden, barbecues en tuinhaarden wordt uitgestoten. klachten & exacerbaties Verkeer: grootste verspreider van fijnstof, maar door een toenemend gebruik van roetfilters en de invoering van milieuzones neemt dit aandeel af. Het aandeel van houtrook wordt hierdoor juist groter. Volgens Emissieregistratie, verbonden aan het RIVM, is de uitstoot van fijnstof door houtgestookte toestellen bijna gelijk aan de uitstoot door uitlaatgassen van het Nederlandse verkeer. Helemaal waterdicht is deze bevinding niet. Uit onderzoek blijkt dat 87 procent van alle stokers bereid is iets te doen om de overlast te beperken. Dat cijfer is hoopgevend. 16

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20 Kyrgyz hospitality (after focus group) 20 Insert > Header & footer

21 Smoking

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