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

Guo, Yanfei; Xing, Zhenzhen; Shan, Guangliang; Janssens, Jean–Paul; Sun, Tieying; Chai, Di; Liu, Weiming; Wang, Yuxia; Ma, Yali; Tong, Yong; Huang, Yilin; Cao, Yang; Wang, Chen

doi:10.3389/fmed.2020.581763

Cited by 30 publications

(34 citation statements)

References 44 publications

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“…In our study, although the majority of the patients had mild-to-moderate COPD, breathlessness was the predominant symptom and the proportion of patients with a CAT score ≥10 was very high (~90%), indicating that respiratory symptoms were heavy in these individuals. A large population-based study showed that more than one half of COPD individuals living at high altitude had at least one respiratory symptom and 87.2% had a CAT score ≥10, 9 which was consistent with our study. Dyspnea was the most frequent symptom in this study, but the frequency was not as high as in our study.…”

Section: Discussionsupporting

confidence: 92%

“…Dyspnea was the most frequent symptom in this study, but the frequency was not as high as in our study. 9 This may be due to different study designs. Asymptomatic mild COPD patients were less likely to visit the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Being≥40 years of age, household air pollution and a history of tuberculosis were the independent risk factors for COPD in these regions. 9 Around 3.5 million people permanently live at the Tibet Plateau and Tibetans are the major ethnics. Ethnic difference and special environmental setting may affect the clinical phenotypes of COPD.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiological Features of COPD Patients Living at ≥3000 m Above Sea Level in the Tibet Plateau

Liang¹,

Yangzom²,

Lhamo³

et al. 2021

COPD

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Background COPD at high altitude may have different risk factors and unique clinical and radiological phenotypes. We aimed to investigate the demographic data, clinical and radiological features of COPD patients permanently residing at the Tibet Plateau (≥3000 meters above sea level). Methods We conducted an observational cross-sectional study which consecutively enrolled COPD patients visiting the outpatient of Respiratory Medicine at Tibet Autonomous Region People’s Hospital from January 2018 to March 2021. All patients were Tibetan permanent residents aging ≥40 years and met the diagnosis of COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data including demographic characteristics, altitude of residence, risk factors, respiratory symptoms, comorbidities and medications, as well as computed tomography (CT) measurements were collected. Results Eighty-four patients with definite COPD were enrolled for analysis. Their mean age was 64.7 (±9.1) years. All patients lived at ≥3000 m above sea level and 34.5% of them lived at ≥4000 m. About 8.3% of the patients were current smokers and 44.0% were ex-smokers. Up to 88.1% of the patients reported long-term exposure to indoor biomass fuels. Most of the patients were classified as having mild-to-moderate (GOLD I: 27.4%; GOLD II: 51.2%) COPD, while 89.3% had a CAT score ≥10. Only 36.9% of the patients received regular long-term medications for COPD in the past year, in whom ICS/LABA and oral theophylline were the most common used pharmacological therapy. On CT scanning, the majority of our patients (70.7%) showed no or minimal emphysema, while signs of previous tuberculosis were found in 45.1% of the patients. Conclusion COPD patients living at the Tibet Plateau had a heavy respiratory symptom burden, but most of them did not receive adequate pharmacological treatment. Indoor biomass fuel exposure and previous tuberculosis were prevalent, while the emphysema phenotype was less common in this population.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Clinical and Radiological Features of COPD Patients Living at ≥3000 m Above Sea Level in the Tibet Plateau

Liang¹,

Yangzom²,

Lhamo³

et al. 2021

COPD

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“…However, altitude itself had no significant impact on COPD prevalence [ 291 , 292 ]. Importantly, subjects with airflow limitation living at high altitude reported significantly fewer respiratory symptoms compared to subjects residing at lower altitude, and high altitude residence was associated with a significantly increased risk of undiagnosed COPD [ 292 , 293 ].…”

Section: Other Clinical Forms Of Pulmonary Hypertension At High Almentioning

confidence: 99%

“…Thus, other common causes of secondary pulmonary hypertension in lowlanders may underlie and/or contribute to pulmonary hypertension in high altitude residents. The challenges of detection of the underlying causes of pulmonary hypertension in high altitude residents are related to the asymptomatic course of the disease, low educational level of highlanders, limited access to facilities for diagnosis, and high rates of unawareness and low index of suspicion by local physicians [ 293 ].…”

Section: Other Clinical Forms Of Pulmonary Hypertension At High Almentioning

confidence: 99%

Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders

Sydykov

Mamazhakypov

Maripov

et al. 2021

IJERPH

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Alveolar hypoxia is the most prominent feature of high altitude environment with well-known consequences for the cardio-pulmonary system, including development of pulmonary hypertension. Pulmonary hypertension due to an exaggerated hypoxic pulmonary vasoconstriction contributes to high altitude pulmonary edema (HAPE), a life-threatening disorder, occurring at high altitudes in non-acclimatized healthy individuals. Despite a strong physiologic rationale for using vasodilators for prevention and treatment of HAPE, no systematic studies of their efficacy have been conducted to date. Calcium-channel blockers are currently recommended for drug prophylaxis in high-risk individuals with a clear history of recurrent HAPE based on the extensive clinical experience with nifedipine in HAPE prevention in susceptible individuals. Chronic exposure to hypoxia induces pulmonary vascular remodeling and development of pulmonary hypertension, which places an increased pressure load on the right ventricle leading to right heart failure. Further, pulmonary hypertension along with excessive erythrocytosis may complicate chronic mountain sickness, another high altitude maladaptation disorder. Importantly, other causes than hypoxia may potentially underlie and/or contribute to pulmonary hypertension at high altitude, such as chronic heart and lung diseases, thrombotic or embolic diseases. Extensive clinical experience with drugs in patients with pulmonary arterial hypertension suggests their potential for treatment of high altitude pulmonary hypertension. Small studies have demonstrated their efficacy in reducing pulmonary artery pressure in high altitude residents. However, no drugs have been approved to date for the therapy of chronic high altitude pulmonary hypertension. This work provides a literature review on the role of pulmonary hypertension in the pathogenesis of acute and chronic high altitude maladaptation disorders and summarizes current knowledge regarding potential treatment options.

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Ambient particulate matter associates with asthma in high altitude region: A population-based study

Xing

Yang

Shi

et al. 2023

World Allergy Organization Journal

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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

Cited by 30 publications

References 44 publications

Clinical and Radiological Features of COPD Patients Living at ≥3000 m Above Sea Level in the Tibet Plateau

Clinical and Radiological Features of COPD Patients Living at ≥3000 m Above Sea Level in the Tibet Plateau

Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders

Ambient particulate matter associates with asthma in high altitude region: A population-based study

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