https://doi.org/10.4081/monaldi.2024.2937
Spirometry findings of chronic lung disease in high-altitude residents of Ladakh (>11,000 feet above sea level)
Submitted: January 30, 2024
Accepted: May 2, 2024
Published: July 24, 2024
Accepted: May 2, 2024
Abstract Views: 348
PDF_EARLY VIEW: 93
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Ladakh is a hilly Himalayan dry desert, situated at an altitude of >11000 feet. Studies have demonstrated that the spirometric values of high-altitude residents are significantly higher than those of low-landers. This is a retrospective observational study that analyzes the spirometry pattern in chronic lung diseases among people from Ladakh. Enrolled subjects were clinic-radiologically diagnosed and had at least one spirometry report. The spirometric parameters were analyzed for normal and abnormal patterns of lung function. The abnormal patterns were further classified into types of ventilator defects and their severity. A total of 122 cases were included, with 67 (55%) men. The mean age was 52.2±15.4 years. The most common diseases were chronic obstructive pulmonary disease (COPD) in 51 cases (41%), and asthma in 41 (33%). The median predicted percentage of forced vital capacity (FVC) was 116% (63-179%) with >100% in 105 (85%) patients. The median predicted percentage of the forced expiratory volume in the 1st second (FEV1) was 113% (99-175%) with >100% in 90 (74%) patients. FVC was reduced in 9 (7%) cases, normal in 62 (51%), and more than normal in 49 (42%), with 11 (9%) cases having >150% of the predicted percentage. FEV1 was reduced in 9 (8%) cases, normal in 67 (55%), and more than normal in 46 (37%) cases, with >150% predicted seen in 10 (8%) cases. Similarly, overall, the predicted percentages of both FVC and FEV1 were >100% in all obstructive airway diseases as well as in the separate COPD and asthma subgroups. FVC and FEV1 amongst chronic lung disease patients from Ladakh were more than normal in the majority. These higher values of spirometry led to incorrect disease severity classifications and disease patterns. We propose that studies should be done to devise local reference equations for spirometry for Himalayan high-altitude residents of India.
Paralikar SJ, Paralikar JH. High-altitude medicine. Indian J Occup Environ Med 2010;14:6-12.
DOI: https://doi.org/10.4103/0019-5278.64608
District Leh, Union Territory of Ladakh. District at a glance. Available from: https://leh.nic.in/about-district/ataglance/. Accessed on: 4/09/2023.
Grocott M, Montgomery H, Vercueil A. High-altitude physiology and pathophysiology: implications and relevance for intensive care medicine. Crit Care 2007;11:203.
DOI: https://doi.org/10.1186/cc5142
Fiori G, Facchini F, Ismagulov O, et al. Lung volume, chest size, and hematological variation in low-, medium-, and high-altitude central Asian populations. Am J Biol Anthropol 2000;113:47-59.
DOI: https://doi.org/10.1002/1096-8644(200009)113:1<47::AID-AJPA5>3.3.CO;2-B
Talaminos-Barroso A, Roa-Romero LM, Ortega-Ruiz F, et al. Effects of genetics and altitude on lung function. Clin Respir J 2020;15:247-56.
DOI: https://doi.org/10.1111/crj.13300
Weinstein KJ. Thoracic skeletal morphology and high-altitude hypoxia in Andean prehistory. Am J Phys Anthropol 2007;134:36-49.
DOI: https://doi.org/10.1002/ajpa.20619
Gaur P, Saini S, Ray K, et al. Influence of altitude on pulmonary function. DLSJ 2020;5:3-9.
DOI: https://doi.org/10.14429/dlsj.5.14644
Zhuang J, Droma T, Sun S, Janes C, et al. Hypoxic ventilatory responsiveness in Tibetan compared with Han residents of 3,658 m. J Appl Physiol 1993;74:303-11.
DOI: https://doi.org/10.1152/jappl.1993.74.1.303
Janmeja AK, Mohapatra PR, Gupta R, Aggarwal D. Spirometry reference values and equations in North Indian geriatric population. Indian J Chest Dis Allied Sci 2022;59:125-30.
DOI: https://doi.org/10.5005/ijcdas-59-3-125
Chhabra SK, Kumar R, Gupta U, et al. Prediction equations for spirometry in adults from Northern India. Indian J Chest Dis Allied Sci 2022;56:221-9.
DOI: https://doi.org/10.5005/ijcdas-56-4-221
Desai U, Joshi JM, Chhabra SK, Rahman M. Prediction equations for spirometry in adults in western India. Indian J Tuberc 2016;63:176-82. Erratum in: Indian J Chest Dis Allied Sci 2015;57:204.
DOI: https://doi.org/10.1016/j.ijtb.2016.08.005
Shukla A. The Ladakh scouts, Indian Army’s Snow Warriors. 2017. Available from: https://www.rediff.com/news/special/the-ladakh-scouts-indian-armys-snow-warriors/20170821.htm. Accessed on: 6/09/2023.
Aggarwal AN, Agarwal R, Dhooria S, et al. Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry. Lung India 2019;36:S1-35.
DOI: https://doi.org/10.4103/lungindia.lungindia_300_18
Bartsch P, Saltin B. General introduction to altitude adaptation and mountain sickness. Scand J Med Sci Sports 2008;18:1-10.
DOI: https://doi.org/10.1111/j.1600-0838.2008.00827.x
Fieten KB, Drijver-Messelink MT, Cogo A, et al. Alpine altitude climate treatment for severe and uncontrolled asthma: an EAACI position paper. Allergy 2022;77:1991-2024.
DOI: https://doi.org/10.1111/all.15242
Moudgil R, Michelakis ED, Archer SL. Hypoxic pulmonary vasoconstriction. J Appl Physiol 2005;98:390-403.
DOI: https://doi.org/10.1152/japplphysiol.00733.2004
Luks AM, Swenson ER, Bärtsch P. Acute high-altitude sickness. Eur Respir Rev 2017;26:160096.
DOI: https://doi.org/10.1183/16000617.0096-2016
Dünnwald T, Gatterer H, Faulhaber M, et al. Body composition and body weight changes at different altitude levels: a systematic review and meta-analysis. Front Physiol 2019;10:430.
DOI: https://doi.org/10.3389/fphys.2019.00430
Grissom CK, Jones BE. Respiratory health benefits and risks of living at moderate altitude. High Alt Med Biol 2017;19:109-15.
DOI: https://doi.org/10.1089/ham.2016.0142
Staub K, Haeusler M, Bender N, et al. Hemoglobin concentration of young men at residential altitudes between 200 and 2000 m mirrors Switzerland's topography. Blood 2020;135:1066-9.
DOI: https://doi.org/10.1182/blood.2019004135
Chhabra SK. Interpretation of spirometry: selection of predicted values and defining abnormality. Indian J Chest Dis Allied Sci 2015;57:91-105.
DOI: https://doi.org/10.5005/ijcdas-57-2-91
Aggarwal AN, Gupta D, Jindal SK. Comparison of Indian reference equations for spirometry interpretation. Respirology 2007;12:763-8.
DOI: https://doi.org/10.1111/j.1440-1843.2007.01123.x
Chhabra SK. Regional variations in vital capacity in adult males in India: comparison of regression equations from four regions and impact on interpretation of spirometric data. Indian J Chest Dis Allied Sci 2009;51:7-13.
Saleem S, Shah S, Gailson L, et al. Normative spirometric values in adult Kashmiri population. Indian J Chest Dis Allied Sci 2012;54:227-33.
DOI: https://doi.org/10.5005/ijcdas-54-4-227
Ortiz-Prado E, Encalada S, Mosquera J, et al. A comparative analysis of lung function and spirometry parameters in genotype-controlled natives living at low and high altitude. BMC Pulm Med 2022;22:100.
DOI: https://doi.org/10.1186/s12890-022-01889-0
Weitz CA, Garruto RM, Chin CT. Larger FVC and FEV1 among Tibetans compared to Han born and raised at high altitude. Am J Phys Anthropol 2016;159:244-55.
DOI: https://doi.org/10.1002/ajpa.22873
Weitz CA, Garruto RM, Chin CT, et al. Lung function of Han Chinese born and raised near sea level and at high altitude in Western China. Am J Hum Biol 2002;14:494-510.
DOI: https://doi.org/10.1002/ajhb.10063
Havryk AP, Gilbert M, Burgess KR. Spirometry values in Himalayan high altitude residents (Sherpas). Respir Physiol Neurobiol 2002;132:223-32.
DOI: https://doi.org/10.1016/S1569-9048(02)00072-1
Azad P, Stobdan T, Zhou D, et al. High-altitude adaptation in humans: from genomics to integrative physiology. J Mol Med (Berl) 2017;95:1269-82.
DOI: https://doi.org/10.1007/s00109-017-1584-7
Ortiz-Prado E, Portilla D, Mosquera-Moscoso J, et al. Hematological parameters, lipid profile, and cardiovascular risk analysis among genotype-controlled indigenous Kiwcha men and women living at low and high altitudes. Front Physiol 2021;12:749006.
DOI: https://doi.org/10.3389/fphys.2021.749006
Xi H, Chen Z, Li W, et al. Chest circumference and sitting height among children and adolescents from Lhasa, Tibet compared to other high altitude populations. Am J Hum Biol 2016;28:197-202.
DOI: https://doi.org/10.1002/ajhb.22772
Beall CM, Strohl KP, Blangero J, et al. Ventilation and hypoxic ventilatory response of Tibetan and Aymara high altitude natives. Am J Phys Anthropol 1997;104:427-47.
DOI: https://doi.org/10.1002/(SICI)1096-8644(199712)104:4<427::AID-AJPA1>3.0.CO;2-P
Norboo T, Angchuck PT, Yahya M, et al. Silicosis in a Himalayan village population: role of environmental dust. Thorax 1991;46:341‑3.
DOI: https://doi.org/10.1136/thx.46.5.341
Spalgais S, Gothi D, Jaiswal A, Gupta K. Nonoccupational anthracofibrosis/anthracosilicosis from Ladakh in Jammu and Kashmir, India: a case series. Indian J Occup Environ Med 2015;19:159-66.
DOI: https://doi.org/10.4103/0019-5278.173995
How to Cite
Spalgais, Sonam, Siddharth Raj Yadav, Parul Mrigpuri, and Raj Kumar. 2024. “Spirometry Findings of Chronic Lung Disease in High-Altitude Residents of Ladakh (>11,000 Feet above Sea Level)”. Monaldi Archives for Chest Disease, July. https://doi.org/10.4081/monaldi.2024.2937.
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