Spirometry in Central Asian Lowlanders and Highlanders, a Population Based Study

Stefanie Ulrich; Michael Furian; Bermet Estebesova; Nurgul Toktogulova; Gulnara Beishekeeva; Silvia Ulrich; Peter G J Burney; Talant M Sooronbaev; Konrad E Bloch

doi:10.3389/fmed.2019.00308

Spirometry in Central Asian Lowlanders and Highlanders, a Population Based Study

Front Med (Lausanne). 2020 Jan 10:6:308. doi: 10.3389/fmed.2019.00308. eCollection 2019.

Authors

Stefanie Ulrich¹, Michael Furian¹, Bermet Estebesova², Nurgul Toktogulova³, Gulnara Beishekeeva³, Silvia Ulrich¹, Peter G J Burney⁴, Talant M Sooronbaev², Konrad E Bloch¹

Affiliations

¹ Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
² Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.
³ Therapy 1 Department, Medical Faculty, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyzstan.
⁴ Population Health and Occupational Disease, National Heart and Lung Institute & MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom.

Abstract

Introduction: The purpose of the study was to establish spirometric reference values for a Central Asian population of highlanders and lowlanders. Methods: Spirometries from a population-based cross-sectional study performed in 2013 in rural areas of Kyrgyzstan were analyzed. Using multivariable linear regression, Global Lung Function Initiative (GLI) equations were fitted separately for men and women, and altitude of residence (700-800 m, 1,900-2,800 m) to data from healthy, never-smoking Kyrgyz adults. The general GLI equation was applied: $\begin{matrix} Predicted value = e^{a_{0} + a_{1} \times ln (Height) + a_{2} \times ln (Age) + b_{1} \times ln (\frac{Age}{100}) + b_{2} \times ln {(\frac{Age}{100})}^{2} + b_{3} \times ln {(\frac{Age}{100})}^{3}} \\ ^{+ b_{4} \times ln {(\frac{Age}{100})}^{4} + b_{5} \times ln {(\frac{Age}{100})}^{5}} \end{matrix}$ Results: Of 2,784 screened Kyrgyz, 448 healthy, non-smoking highlanders (379 females) and 505 lowlanders (368 females), aged 18-91 years, were included. Predicted FVC in Kyrgyz fit best with GLI "North-East Asians," predicted FEV₁ fit best with GLI "Other/Mixed." Predicted FEV₁/FVC was lower than that of all GLI categories. Age- and sex-adjusted mean FVC and FEV₁ were higher in highlanders (+0.138l, +0.132l) than in lowlanders (P < 0.001, all comparisons), but FEV₁/FVC was similar. Conclusion: We established prediction equations for an adult Central Asian population indicating that FVC is similar to GLI "North-East Asian" and FEV₁/FVC is lower than in all other GLI population categories, consistent with a relatively smaller airway caliber. Central Asian highlanders have significantly greater dynamic lung volumes compared to lowlanders, which may be due to environmental and various other effects.

Keywords: Central Asian; altitude; highlanders; lung function; spirometry.