The prevalence, burden and risk factors associated with chronic obstructive pulmonary disease in Commonwealth of Independent States (Ukraine, Kazakhstan and Azerbaijan): results of the CORE study

Prevalence and Associated Factors of Chronic Obstructive Pulmonary Disease Among Adults in Neno District, Malawi: A Cross-Sectional Analytical Study

Introduction

Chronic obstructive pulmonary disease (COPD) continues to pose a global public health challenge. However, literature is scarce on the burden of COPD in Malawi. We assessed the prevalence and risk factors for COPD among adults in Neno, Malawi.

Methodology

We conducted a population-based analytical cross-sectional study in Neno District between December 2021 and November 2022. Using a multi-stage sampling technique, we included 525 adults aged≥40 years. All participants underwent spirometry according to the American Thoracic Society (ATS) guidelines and were interviewed using the IMPALA questionnaire. For this study, we utilized the definition of COPD as a post-bronchodilator FEV1/FVC <0.70. We collected data using Kobo collect, exported to Microsoft Excel, and analysed using R software. We used descriptive statistics and logistic regression analysis; a p-value of <0.05 was considered statistically significant.

Results

Out of 525 participants, 510 participants were included in the final analysis. Fifty-eight percent of the participants were females (n=296), and 62.2% (n=317) were between 40 and 49 years with a median (IQR) age of 46 (40-86). For patient characteristics, 15.1% (n=77) were current smokers, and 4.1% (n=21) had a history of pulmonary tuberculosis (PTB). Cough was the most commonly reported respiratory symptom (n=249, 48.8%). The prevalence of COPD was 10.0% (n=51) and higher (15.0%) among males compared to females (6.4%). Factors significantly associated with COPD were age 60 years and above (adjusted odds ratio [aOR] = 3.27, 95% CI: 1.48-7.34, p<0.004), ever smoked (aOR = 6.17, 95% CI:1.89-18.7, p<0.002), current smoker (aOR = 17.6, 95% CI: 8.47-38.4, p<0.001), and previous PTB (aOR = 4.42, 95% CI: 1.16-15.5, p<0.023).

Conclusion

The cross-sectional prevalence of COPD in rural Malawi is high, especially among males. Factors significantly associated were older age (60 years and above), cigarette smoking, and previous PTB. Longitudinal studies are needed to better understand disease etiology and progression in this setting.

Efficacy and safety of physical therapy in patients with stage III COPD during ambulatory rehabilitation

This study aimed to determine the efficacy of a combined physical therapy and pharmacological treatment for patients recovering from stage III COPD exacerbation. The efficacy of the rehabilitation program was assessed using anthropological parameters, physical condition, respiratory system function, and functional endurance capacity. Data were collected from 39 patients with stage III COPD who underwent the rehabilitation program. Physical and anthropometric assessments were conducted using the Quetelet Body Mass Index, the Pignet Index, and the Vital Capacity Index (VCI). The functional capacities of the cardiorespiratory system were measured before and after the rehabilitation program using the Ruffier and Ruffier-Dickson tests and the hypoxic Shtange and Genchi tests. Exercise tolerance was evaluated using the Harvard Step Test and the Six-Minute Walk Distance Test (6MWD). Statistical analysis was conducted using the non-parametric Mann-Whitney U test for independent and dependent groups. Participants were randomly divided into two groups for rehabilitation: Group I received standard therapy and a routine physical therapy program, while Group II was given standard therapy along with a modified physical therapy regimen. There was a slight improvement in patient condition during the rehabilitation period for both groups. However, there was a low compliance rate for smoking cessation among the majority of patients, with some reducing their daily cigarette intake. Further long-time research is required to determine the efficacy of the proposed physical therapy program in combination with basic pharmacological therapy. The study suggests incorporating psychotherapeutic sessions and occupational therapy into future rehabilitation programs.

Review of Some Applications of Unmanned Aerial Vehicles Technology in the Resource-Rich Country

The use of unmanned aerial vehicles (UAVs) in various spheres of human activity is a promising direction for countries with very different types of economies. This statement refers to resource-rich economies as well. The peculiarities of such countries are associated with the dependence on resource prices since their economies present low diversification. Therefore, the employment of new technologies is one of the ways of increasing the sustainability of such economy development. In this context, the use of UAVs is a prospect direction, since they are relatively cheap, reliable, and their use does not require a high-tech background. The most common use of UAVs is associated with various types of monitoring tasks. In addition, UAVs can be used for organizing communication, search, cargo delivery, field processing, etc. Using additional elements of artificial intelligence (AI) together with UAVs helps to solve the problems in automatic or semi-automatic mode. Such UAV is named intelligent unmanned aerial vehicle technology (IUAVT), and its employment allows increasing the UAV-based technology efficiency. However, in order to adapt IUAVT in the sectors of economy, it is necessary to overcome a range of limitations. The research is devoted to the analysis of opportunities and obstacles to the adaptation of IUAVT in the economy. The possible economic effect is estimated for Kazakhstan as one of the resource-rich countries. The review consists of three main parts. The first part describes the IUAVT application areas and the tasks it can solve. The following areas of application are considered: precision agriculture, the hazardous geophysical processes monitoring, environmental pollution monitoring, exploration of minerals, wild animals monitoring, technical and engineering structures monitoring, and traffic monitoring. The economic potential is estimated by the areas of application of IUAVT in Kazakhstan. The second part contains the review of the technical, legal, and software-algorithmic limitations of IUAVT and modern approaches aimed at overcoming these limitations. The third part—discussion—comprises the consideration of the impact of these limitations and unsolved tasks of the IUAVT employment in the areas of activity under consideration, and assessment of the overall economic effect.

Mechanisms, Pathophysiology and Currently Proposed Treatments of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is one of the leading global causes of morbidity and mortality. A hallmark of COPD is progressive airflow obstruction primarily caused by cigarette smoke (CS). CS exposure causes an imbalance favoring pro- over antioxidants (oxidative stress), leading to transcription factor activation and increased expression of inflammatory mediators and proteases. Different cell types, including macrophages, epithelial cells, neutrophils, and T lymphocytes, contribute to COPD pathophysiology. Alteration in cell functions results in the generation of an oxidative and inflammatory microenvironment, which contributes to disease progression. Current treatments include inhaled corticosteroids and bronchodilator therapy. However, these therapies do not effectively halt disease progression. Due to the complexity of its pathophysiology, and the risk of exacerbating symptoms with existing therapies, other specific and effective treatment options are required. Therapies directly or indirectly targeting the oxidative imbalance may be promising alternatives. This review briefly discusses COPD pathophysiology, and provides an update on the development and clinical testing of novel COPD treatments.

Association between body mass index and patient-reported-outcome questionnaire scores (CAT™, ACT™, mMRC dyspnoea scale, IPAQ) in Ukraine, Kazakhstan and Azerbaijan: results of the CORE study

Background

The overweight/obese population (evaluated by a body mass index, BMI) represents a global health problem and contributes to the development of various chronic diseases. In this epidemiological study we evaluated this relationship by analyzing patient-reported questionnaires related to respiratory function, physical activity and BMI.

Methods

In 2013–2015, adult residents of selected cities were enrolled to this study in: Ukraine (M/F: 403/561), Kazakhstan (M/F = 348/597) and Azerbaijan (M/F: 389/544). Height was measured using a vertical measuring board, and body weight was measured by using portable digital scales. All participants were interviewed using CAT™, mMRC scale and IPAQ; respondents who also reported wheezing or whistling chest sounds during the previous 12 months additionally ACT™.

Results

45.4% of respondents in Ukraine, 47.6% in Kazakhstan and 54.9% of respondents in Azerbaijan were found to be overweight/obese (BMI ≥ 25 kg/m²). The mean CAT™ total score among this population versus those respondents with a normal weight was 5.2 versus 3.6 (Ukraine, p < 0.001), 4.2 versus 2.9 (Kazakhstan, p < 0.001) and 5.9 versus 4.3 (Azerbaijan, p < 0.001). The number of respondents without airflow limitations (mMRC score 0) among overweight/obese respondents versus normal weight respondents was 298 (68.2%) versus 456 (86.7%) in Ukraine, 261 (58.1%) versus 387 (78.2%) in Kazakhstan and 343 (67.1%) versus 345 (82.3%) in Azerbaijan. The ACT™ total score between overweight/obese respondents and normal weight respondents was not statistically different. IPAQ showed a tendency towards a higher proportion of “low activity” results (compared to “moderate” and “high”) in the overweight/obese subgroup (24.7% vs. 23.8% in Kazakhstan, 18.5% vs. 14.6% in Azerbaijan), and in Ukraine this difference was significant (12.4% vs. 5.2%, p < 0.001).

Conclusion

CAT™ and mMRC are widely used tools for respiratory function assessment. Despite CAT™ scores being close to a normal value (< 5), the relationship of both CAT™ and mMRC scores with being overweight/obese was demonstrated in the general adult population of three CIS countries. IPAQ may also be a useful instrument for measuring activity level however, more objective studies are required to evaluate the relationship between BMI and physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-021-01542-2.

Pulmonary tuberculosis as a risk factor for chronic obstructive pulmonary disease: a systematic review and meta-analysis

Background

Prior pulmonary tuberculosis (TB) can cause permanent changes in lung anatomy and is associated with lung function loss. However, it remains unclear whether pulmonary function impairment owing to TB is associated with airflow obstruction, the hallmark of chronic obstructive pulmonary disease (COPD). The aim of this systematic review and meta-analysis was to assess the association and quantify the magnitudes of association between pulmonary TB and COPD, and to evaluate the prevalence of COPD in patients with prior pulmonary TB.

Methods

We searched the PubMed, Embase, and Web of Science databases for studies published from inception to January 1, 2020. Pooled effect sizes were calculated according to a random effects model or fixed effect model depending on heterogeneity. Specific subgroups (different diagnostic criteria, smoking status, income level) were examined.

Results

A total of 23 articles were included in this study. Compared with controls, patients with pulmonary TB had an odds ratios (ORs) of 2.59 [95% confidence interval (CI): 2.12-3.15; P<0.001] for developing COPD. In jackknife sensitivity analyses, the increased risk of prior pulmonary TB remained consistent for COPD; when the meta-analysis was repeated and one study was omitted each time, the ORs and corresponding 95% CIs were greater than 2. Funnel plots of ORs with Egger's linear regression (t=2.00, P=0.058) and Begg's rank correlation (Z=0.75, P=0.455) showing no significant publication bias. Subgroup analysis showed that the same conclusion was still present in never smokers (ORs 2.41; 95% CI: 1.74-3.32; P<0.001), patients with pulmonary TB diagnosed using chest X-ray (ORs 2.47; 95% CI: 1.23-4.97; P<0.001), and low- and middle-income country (LMIC) settings (ORs 2.70; 95% CI: 2.08-3.51; P<0.001). The pooled prevalence of COPD in patients with prior pulmonary TB was 21% (95% CI: 16-25%; P<0.001).

Conclusions

Individuals with prior pulmonary TB have an increased risk and high prevalence of COPD. Future studies identifying the underlying mechanisms for TB-associated COPD and therapeutic strategies are required.

Air Quality and Industrial Emissions in the Cities of Kazakhstan

Industrial emissions are of major concern, especially in developing countries. Hence, there is a need for studies that investigate the trends in industrial emissions in these countries. The purpose of this study is to discuss trends in industrial emissions in Kazakhstan and the air pollution level in its industrial cities. Data on emission limit values from the permitting documents of twenty-one power plants and nine metallurgical enterprises of Kazakhstan were analyzed. Eight cities (out of fourteen) had a “high” level of atmospheric air pollution according to the Air Pollution Index in 2019. Most of the considered enterprises increased their emission limit values compared to the previous permitting period. In some cities there is a lack of monitoring stations, indicating the need for improving the spatial coverage of the air quality monitoring network in the industrial cities of Kazakhstan. The location of industrial plants far outside the cities could reduce the exposure of the urban population to air pollution. Kazakhstan urgently needs to adopt stringent emissions standards for coal-fired power plants and heavy industrial plants. The national air quality standards and definitions of air pollutants need to be updated based on the latest scientific knowledge.

Occupational Burden of Chronic Obstructive Pulmonary Disease in the Commonwealth of Independent States: Systematic Review and Meta-Analysis

Background: Population-based studies from the Russian Federation and neighboring countries on the occupational burden of chronic obstructive pulmonary disease (COPD) are seldom or not included in the systematic reviews. The aim of this review was to summarize published population-based studies from the Commonwealth of Independent States (CIS) in order to ascertain the occupational burden of COPD. Methods: We systematically searched www.elibrary.ru and PubMed for population-based studies on the epidemiology of COPD in nine countries using PRISMA. Quality of studies was assessed using the original tool. The odds of COPD in the included studies from vapors, gases, dusts, and fumes (VGDF) was pooled using meta-analysis (fixed effects model), whereas the population attributable fraction percent (PAF%) was pooled with meta-proportion using the random effects model in Stata 14.2. Results: Five studies, three from Russia, one from Kazakhstan, and one more from Azerbaijan and Kazakhstan (total N = 18,908) with moderate to high quality and published from 2014 to 2019 (none from Armenia, Belarus, Kyrgyzstan, Moldova, Tajikistan, and Uzbekistan), were included. Spirometry-defined COPD was the outcome in four of them. The pooled odds ratio (OR) of COPD from VGDF was 1.69 [95% confidence interval (CI) 1.34;2.13], greater in Kazakhstan [OR 1.96 (95% CI 1.35;2.85, N = 2 studies)] compared to Russia [OR 1.52 (95% CI 1.13;2.05, N = 2 studies)]. The pooled PAF% was 6% (95% CI 2; 14%) from three studies. Conclusions: Population-based studies in the CIS get little attention with very few studies published. Although the effect was greater in Kazakhstan compared to Russia, the overall effect did not differ from studies published in the rest of the world. Research capacity to study occupational risks of COPD should be strengthened to produce more evidence of higher quality.

Prevalence and Risk Factors for COPD at High Altitude: A Large Cross-Sectional Survey of Subjects Living Between 2,100-4,700 m Above Sea Level

Aim of Study: Four hundred million people live at high altitude worldwide. Prevalence and risk factors for COPD in these populations are poorly documented. We examined the prevalence and risk factors for COPD in residents living at an altitude of 2,100–4,700 m.

Methods: We performed a cross-sectional survey in Xinjiang and Tibet autonomous region. A multistage stratified sampling procedure was used to select a representative population aged 15 years or older from eight high altitude regions. All participants underwent pre- and post-bronchodilator measurement of forced expiratory volumes. COPD was diagnosed according to 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria.

Results: Between June, 2015 and August 2016, 4,967 subjects were included. Median age was 38.0 years (range: 15–91 years; inter-quartile range: 28–49 years); 51.4% participants were female. Overall prevalence of spirometry-defined COPD was 8.2% (95% CI 7.4–8.9%): 9.3% in male (95% CI 8.2–10.4%), and 7.1% in female (95% CI 6.1–8.2%). By multivariable logistic regression analysis, COPD was significantly associated with being aged ≥40 years (odds ratio: 2.25 [95% CI 1.72–2.95], P < 0.0001), exposure to household air pollution (OR: 1.34 [95% CI 1.01–1.79], P = 0.043), and a history of tuberculosis (OR: 1.79 [95% CI 1.23–2.61], P = 0.030), while living at a higher altitude (OR: 0.45 [95% CI 0.33–0.61], P < 0.0001) and having a higher educational level (OR: 0.64 [95% CI 0.43–0.95], P = 0.025) were associated with a lower prevalence of COPD.

Conclusions: Our results show that the spirometry-defined COPD is a considerable health problem for residents living at high altitudes and COPD prevalence was inversely correlated with altitude. Preventing exposure to household air pollution and reducing the incidence of tuberculosis should be public health priorities for high altitude residents.

Trends and health impacts of major urban air pollutants in Kazakhstan

The air quality in cities in Kazakhstan has been poorly investigated despite the worsening conditions. This study evaluates national air pollution monitoring network data (Total Suspended Particle-TSP, NO₂, SO₂, and O₃) from Kazakhstan cities and provides estimates of excess mortality rates associated with PM_2.5 exposure using the Global Exposure Mortality Model (GEMM) concentration-response function. Morbidity rates associated with PM₁₀ exposure were also estimated. Annual average (2015-2017) population-weighted concentrations were Kazakhstan cities was 157, 51, 29, and 41 μg m^-3 for TSP, NO₂, SO₂, and O₃ respectively. We estimated a total of 8134 adult deaths per year attributable to PM_2.5 (average over 2015-2017) in the selected 21 cities of Kazakhstan. The leading causes of death were ischemic heart disease (4080), stroke (1613), lower respiratory infections (662), chronic obstructive pulmonary disease (434), lung cancer (332). The per capita mortality rate attributable to ambient air pollution (per 10⁵ adults per year) was less than 150 in nine cities, between 150 and 204 in nine cities, and between 276 and 373 in three industrial cities (Zhezkazgan, Temirtau, and Balkhash). Implications: Quantitative information on the health impacts of air pollution can be useful for decision-makers in Kazakhstan to justify environmental policies and identify policy and funding priorities for addressing air pollution issues. This information can also be useful for policymakers by improving the quality of government-funded environmental reports and strategic documents, as they have many shortcomings in terms of the selection of air quality indicators, identification of priority pollutants, and identification of sources of pollution. This study has high significance due to the lack of data and knowledge in Central Asia, especially Kazakhstan.

Prevalence and Economic Burden of Respiratory Diseases in Central Asia and Russia: A Systematic Review

Prevalence data of respiratory diseases (RDs) in Central Asia (CA) and Russia are contrasting. To inform future research needs and assist government and clinical policy on RDs, an up-to-date overview is required. We aimed to review the prevalence and economic burden of RDs in CA and Russia. PubMed and EMBASE databases were searched for studies that reported prevalence and/or economic burden of RDs (asthma, chronic obstructive pulmonary disease (COPD), cystic fibrosis, interstitial lung diseases (ILD), lung cancer, pulmonary hypertension, and tuberculosis (TB)) in CA (Kyrgyzstan, Uzbekistan, Tajikistan, Kazakhstan, and Turkmenistan) and Russia. A total of 25 articles (RD prevalence: 18; economics: 7) were included. The majority (n = 12), mostly from Russia, reported on TB. TB prevalence declined over the last 20 years, to less than 100 per 100,000 across Russia and CA, yet in those, multidrug-resistant tuberculosis (MDR-TB) was alarming high (newly treated: 19–26%, previously treated: 60–70%). COPD, asthma (2–15%) and ILD (0.006%) prevalence was only reported for Russia and Kazakhstan. No studies on cystic fibrosis, lung cancer and pulmonary hypertension were found. TB costs varied between US$400 (Tajikistan) and US$900 (Russia) for drug-susceptible TB to ≥US$10,000 for MDR-TB (Russia). Non-TB data were scarce and inconsistent. Especially in CA, more research into the prevalence and burden of RDs is needed.

Spirometry practice and the impact of a phase 1 training workshop among health workers in southern Nigeria: a cross-sectional study

BACKGROUND

Global standards require that spirometry should be performed by trained and experienced personnel, who would be able to assess the correct performance of tests by patients and assure good quality of the result. The complete achievement of this requires a two-step assessment where competency in both knowledge and skills are tested. This study aims to assess the impact of a one-day hands-on spirometry training (Phase1), on the knowledge and application of spirometry among health workers.

METHODS

This was a descriptive cross-sectional study, which describes a one-day (seven hours) spirometry training and skills impartation done at two conference city locations in Enugu and Calabar in the southern part of Nigeria. All the verbally consenting attendees who completed the training assessment tests constituted the study population. The assessment of the spirometry knowledge base before and after the theory and practical sessions, on the various aspects of spirometry, according to international best practices, quality assurance and the interpretation of results, was done and the outcome was analyzed. Factors that could affect the outcome were also assessed.

RESULTS

There were 64 consenting participants of whom 54.7% (35/64) were females. Theparticipants demonstrated much improved post-intervention knowledge and could satisfactorily perform spirometry, calibration, interpretation of test results and quality control as evidenced by the post test scores after practical sessions were conducted. Pre-test mean scores improved by a mean difference of 12% (p < 001) and were affected by the year of academic graduation and availability of spirometers at the place of work, an effect that was no longer seen at post-test following the hands-on spirometry training.

CONCLUSION

The present study has shown that a one-day spirometry workshop significantly improved the knowledge of spirometry practice. There is need to set up more frequent locally-organized spirometry workshops since a one-day seven-hour effective knowledge and practical training would most likely have significant impact on participants' spirometry practice with its expected positive outcome on respiratory health in Nigeria.

The global impact of Aspergillus infection on COPD

Background

Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Aspergillus sensitisation may worsen symptoms in COPD.

Methods

We identified published papers between January 2000 and May 2019 with > 50 subjects and GOLD criteria for grade II, III or IV (FEV1/FVC < 70% and FEV1 < 80%) using standardised criteria in multiple countries, to re-estimate the prevalence of COPD. Hospitalised COPD patients develop IA in 1.3–3.9%, based on positive cultures of Aspergillus spp. and radiological findings. Given limited data on per-patient annual hospitalisation rates, we assumed a conservative 10.5% estimate. Annual IA mortality in COPD was estimated using the literature rates of 43–72%. A separate literature search assessed the impact of Aspergillus sensitisation on severity of COPD (by FEV1).

Results

We re-estimated the global prevalence of COPD GOLD stages II-IV at 552,300,599 people (7.39% of the population) with 339,206,893 (8.58%) in Asia, 85,278,783 (8.52%) in the Americas, 64,298,051 (5.37%) in Africa, 59,484,329 (7.77%) in Europe and 4,032,543 (10.86%) in Oceania. An estimated 57,991,563 (10.5%) people with COPD are admitted to hospital annually and of these 753,073 (1.3%) – 2,272,322 (3.9%) develop IA and 540,451–977,082 deaths are predicted annually. Aspergillus sensitisation prevalence in COPD was 13.6% (7.0–18.3%) and not related to lower predicted FEV1% (P > 0.05).

Conclusions

The prevalence of COPD is much higher than previously estimated. Overall COPD mortality may be higher than estimated and IA probably contributes to many deaths. Improved rapid diagnosis of IA using culture and non-culture based techniques is required in COPD hospital admissions to reduce mortality.

Burden of Obstructive Lung Disease in Iran: Prevalence and Risk Factors for COPD in North of Iran

BACKGROUND

Globally chronic obstructive pulmonary disease (COPD) was reported as the fourth leading cause of death (5.1%) in 2004 and is projected to occupy the third position (8.6%) in 2030. The goal of the present project is to describe the prevalence and risk factors of COPD in a province in the north of Iran.

METHODS

This study followed a stratified cluster sampling strategy with proportional allocation within strata. The stratification of the sample according to the 31 provinces of Iran is incorporated in the sampling process. The single most important outcome measure obtained as part of this protocol was spirometry before and after the administration of 200 mg (2 puffs) of salbutamol. The descriptive statistics for categorical variables included the number and percent and for continues variables included the mean ± SD.

RESULTS

A total of 1007 subjects were included in the study. Among all participants, 46 (5%) subjects had COPD on the basis of symptoms and 43 (8.3%) subjects had COPD on the basis of spirometry criteria. In univariate analysis, urban inhabitants in comparison with rural inhabitants had lower COPD risk (OR: 0.48; 95% CI: 0.24-0.95), smoker had higher risk compared with nonsmokers (OR: 1.97; 95% CI: 1.01-3.82), and subjects with exposure to dust (OR: 2.07; 95% CI: 1.09-3.94) had higher risk compared with contrary status.

CONCLUSIONS

This study showed that occupational and environmental smoke exposure was associated with COPD. A new design of preventive measures must be taken to control cooking energy and cooking stoves, particularly in rural areas.

Lifetime Occupational History, Respiratory Symptoms and Chronic Obstructive Pulmonary Disease: Results from a Population-Based Study

Purpose

To ascertain the effect of lifelong occupational history, ambient air pollution, and biochemically verified smoking status on chronic obstructive pulmonary disease (COPD) in a general population of one the largest cities in Central Asia, Almaty.

Patients and methods

1500 adults (median age 49, interquartile range (IQR) 28 years), 50% females, were randomly selected from a registry of enlisted population of a primary care facility in Almaty, Kazakhstan and they filled in the questionnaire on demographics, respiratory symptoms (CAT and mMRC), smoking status, verified by exhaled carbon monoxide, and detailed lifetime occupational history. COPD was defined as postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) below lower limit of normal (LLN) using Belintelmed MAS-2 spirometer (Belarus).

Results

230 (15%) subjects had CAT≥10; 136 (9%) participants had mMRC score ≥2. Greater CAT score was associated with age, smaller income, and less exercise, but not with smoking or living closer to a major road. 26% of the population was ever exposed to vapors, gases, dusts, and fumes (VGDF). In age group 40 years and above (N=1024), COPD was found in 57 participants (prevalence 5.6%), more in men (8.7% vs 3.4%). In the multivariate model adjusted for age, sex, ever-smoking, income, and exercise, any exposure to VGDF increased the odds of COPD (odds ratio (OR) 1.71; 95% confidence interval (CI) 1.03; 2.84), more in the highest exposure category (OR 2.36 (95% CI 1.20; 4.66)).

Conclusion

Lifetime exposure to VGDF, found in ¼ of the general population, increased the odds of COPD independent of smoking by 71%.

Prevalence of chronic obstructive pulmonary disease (COPD) and its associated factors among adults in Abeshge District, Ethiopia: a cross sectional study

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is one of the major public health problems worldwide. Despite an increasing burden of COPD in the world, it is often a neglected disease in low income countries and COPD prevalence studies are rare in Sub-Saharan Africa. The objective of this study was to determine the prevalence of COPD and its associated factors among adults in Ethiopia.

METHODS

A community based cross sectional study was conducted from February 5 to May 20, 2019 in Abeshge district, Southern Ethiopia. A total of 734 adults aged at least 30 years were selected using multistage cluster sampling technique and included in the study. All participants were interviewed about socio-demographic characteristics, respiratory symptoms, smoking status and clinical characteristics. Moreover, all participants underwent spirometry. We defined COPD as a post-bronchodilator FEV1/FVC of less than 70%. Data were entered into Epi-data manager 4.4 and analyzed using SPSS version 23. Descriptive statistics and binary logistic regression analysis were used and p-value < 0.05 was considered as significant.

RESULTS

Of the 779 adults invited to participate, 734 adults (421 men and 313 women) were participated in this study. The mean (SD) age of the participants was 39.15 (± 9.36) years, within the age range of 30-75 years. The prevalence of COPD was 17.8% (95% confidence interval [CI], 15.1-20.6). Factors significantly associated with COPD were age above 50 years (adjusted odds ratio [AOR] = 1.91, 95% CI [1.10, 3.30]), being smoker (AOR = 4.54, 95% CI [2.69, 7.66]), Exposed to biomass smoke (AOR = 2.05, 95% CI [1.06, 3.95]) and poor ventilated kitchen (AOR = 4.12, 95% CI [2.67, 6.34]).

CONCLUSION

It is evident from this study that the prevalence of COPD in Ethiopia is high. Factors such as old age, cigarette smoking, exposure to biomass smoke and poor kitchen ventilation plays a role in the development of COPD.

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

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.