Comparison of Clinical Features of Asthma Patients Admitted in High Altitude Regions of Qinghai and Tibet_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Xuan ^1,2,3 , CHEN ling ^2,3 , WANG Ji ^1,2 , TUO Yajun ⁴ , MEILANG Qucuo ⁵ , WANG Gang ^1,2 ,  LUO Fengming ^1,2,3

1. Department of Respiratory and Critical Care Medicine/Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610200, P.R.China;
3. Department of High Altitude Medicine, Center for High Altitude Medicine, West China Hospital, Sichuan University Chengdu 610041, China;
4. Department of Respiratory and Critical Care Medicine, Qinghai People’s Hospital, Xining 810000, P.R.China;
5. Department of Respiratory and Critical Care Medicine, Tibetan Autonomous Region People's Hospital, Lasha 850000, P.R.China;

Corresponding author：

LUO Fengming, Email: fengmingluo@outlook.com

Keywords：

Asthma; Hospitalized patients; High altitude areas; Clinical features; Risk factors.

DOI：

10.7507/1671-6205.202411097

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Objective To explore the clinical features, treatment measures, disease outcomes, and differences in patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau, and further analyze the risk factors. Methods A retrospective analysis was conducted on the clinical data of 297 patients with asthma admitted to Qinghai Provincial People’s Hospital and Tibet Autonomous Region People’s Hospital from 2015 to 2021. A standardized case report form (CRF) was designed and used to collect patients’ general information, International Classification of Diseases (ICD-10), clinical symptoms, treatment, laboratory examination, and pulmonary function test data. The clinical features of the patients were described, and the risk factors of the clinical features of asthma patients admitted to hospitals in Qinghai and Tibetan Plateau were analyzed by using a stepwise Logistic regression model. Results A total of 297 patients with asthma admitted to hospitals in Qinghai and Tibetan Plateau were included in this study. The overall pulmonary function of asthma patients admitted to hospitals in Qinghai was worse than that in Tibetan Plateau (FEV1/FVC%: 73.22±13.59 vs. 80.70±18.36, P<0.001; TLC: 101.50 vs. 163.00, P=0.001). The incidence of related clinical symptoms in asthma patients admitted to hospitals in Qinghai were higher than those in Tibetan Plateau (dyspnea: 98.0% vs. 66.0%, P<0.001; cyanosis: 82.0% vs. 34.0%, P<0.001; pulmonary rales: 80.7% vs. 70.7%, P=0.046). There was no significant difference in treatment measures between patients in Qinghai and Tibetan Plateau (P>0.05). The main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence (OR=0.94, 95%CI: 0.91-0.98, P=0.004) and the co-existence of allergic diseases (OR=9.47, 95%CI: 2.68-3347.07, P=0.012).Conclusions Compared with Tibet, the incidence of asthma symptoms and poorer lung function were higher among inpatients with asthma in Qinghai; there was no significant difference in treatment measures between the two regions, but there was a significant difference in prognosis; the main factors contributing to the differences in clinical characteristics between the two regions were the altitude of residence and the co-existence of allergic diseases.

Citation： ZHANG Xuan, CHEN ling, WANG Ji, TUO Yajun, MEILANG Qucuo, WANG Gang, LUO Fengming. Comparison of Clinical Features of Asthma Patients Admitted in High Altitude Regions of Qinghai and Tibet. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(12): 843-849. doi: 10.7507/1671-6205.202411097 Copy

1.	Global Initiative for Asthma. Global Strategy for Asthma Managementand Prevention (2024 update). https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf. 2024-05-22/2024-7-11.
2.	Roth GA, Abate D, Abate KH, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018, 392(10159): 1736–1788.
3.	Huang K, Yang T, Xu J, et al. China Pulmonary Health (CPH) Study Group. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet. 2019, 394(10196): 407-418.
4.	高芬, 杨庆娟, 张海国. 2006至2007年青海省支气管哮喘患病率调查. 中华结核和呼吸杂志, 2011, 34(3): 165-168.
5.	AL-GHAMDI B R, MAHFOUZ A A, ABDELMONEIM I, et al. Altitude and bronchial asthma in south-western Saudi Arabia. East Mediterr Health J, 2008, 14(1): 17-23.
6.	Hu X, Cowl CT, Baqir M, et al. Air travel and pneumothorax. Chest, 2014, 145(4): 688-694.
7.	周语嫣, 梁斌苗, 梁宗安. 高空、高原、地下空间环境对呼吸功能的影响. 中国呼吸与危重监护杂志, 2020, 19(02): 198-202.
8.	Rijssenbeek-Nouwens LH, Bel EH. High-altitude treatment: a therapeutic option for patients with severe, refractory asthma? Clin Exp Allergy, 2011, 41(6): 775-782.
9.	Matsui EC. Environmental control for asthma: recent evidence. Curr Opin Allergy Clin Immunol, 2013, 13(4): 417-425.
10.	Massimo T, Blank C, Strasser B, et al. Does climate therapy at moderate altitudes improve pulmonary function in asthma patients? A systematic review. Sleep Breath, 2014, 18(1): 195-206.
11.	Vinnikov D, Khafagy A, Blanc PD, et al. High-altitude alpine therapy and lung function in asthma: systematic review and metaanalysis. ERJ Open Res, 2016, 2(2): 1-12.
12.	Hashimoto S, Rijssenbeek-Nouwens LH, Fieten KB, et al. Predictors of benefit from high-altitude climate therapy in adults with severe asthma. Neth J Med, 2018, 76(5): 218-225.
13.	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(7): 1991-2024.
14.	Basler L, Saxer S, Schneider SR, et al. Asthma rehabilitation at high vs. low altitude and its impact on exhaled nitric oxide and sensitization patterns: Randomized parallel-group trial. Respir Med. 2020, 170: 106040.
15.	Pesce G, Bugiani M, Marcon A, et al. Geo-climatic heterogeneity in self-reported asthma, allergic rhinitis and chronic bronchitis in Italy. The Science of the total environment, 2016, 544(1): 645-652.
16.	Garcia-Almaraz RG. Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study. BMJ Open, 2020, 7(1): e000658.
17.	Vargas MH, Becerril-Ángeles M, Medina-Reyes IS, et al. Altitude above 1500 m is a major determinant of asthma incidence. An ecological study . Respir Med 2018, 135: 1-7.
18.	边巴琼达, 徐钰, 黄丽萍, 等. 高原地区藏族居民脉氧饱和度和血红蛋白含量分析. 中国呼吸与危重监护杂志, 2018, 17(3): 271-274.
19.	Zubieta-Calleja G, Zubieta-DeUrioste N. The oxygen transport triad in high-altitude pulmonary edema: a perspective from the high Andes. Int J Environ Res Public Health, 2021, 18(14): 7619.
20.	廖霞, 罗凤鸣. 高原人群肺动脉高压与血红蛋白浓度的相关研究进展. 中国呼吸与危重监护杂志, 2022, 21(03): 225-228.
21.	Fieten KB, Rijssenbeek-Nouwens LH, Hashimoto S, et al. Less exacerbations and sustained asthma control 12 months after high altitude climate treatment for severe asthma. Allergy 2019, 74: 628–30.
22.	Oğhan F, Erdim I. Associations among high altitude, allergic rhinitis, and bronchial hyperreactivity. ENT Updates, 2017, 7: 47-52.
23.	Mahima Luthra , S S Bist , Sarita Mishra, et al. Evaluation of Association of Allergic Rhinitis with Bronchial Asthma[J], Indian J Otolaryngol Head Neck Surg. 2019 Nov, 71(Suppl 3): 1687- 1691.
24.	J. V. Fahy, Type2 inflammation in asthma-present in most, absentinmany . Nat Rev Immunol. 2015, 15: 57-65.
25.	Bradley E Chipps, Tmirah Haselkorn, Brandee Paknis, et al. More than a decade follow-up in patients with severe or difficult-to-treat asthma: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) II. J Allergy Clin Immunol, 2018, 141(5): 1590-1597.
26.	Paiva Ferreira LKD, Paiva Ferreira LAM, Monteiro TM, et al. Combined allergic rhinitis and asthma syndrome (CARAS). Int Immunopharmacol, 2019, 74: 105718.
27.	Mao Z, Shi Y, Cao Q, et al. Transcriptional regulation on the gene expression signature in combined allergic rhinitis and asthma syndrome. Epigenomics. 2018, 10(2): 119‐131.
28.	李亥兰. 过敏性鼻炎-哮喘综合征的中医体质特点研究. 北京中医药大学, 2021.

1. Global Initiative for Asthma. Global Strategy for Asthma Managementand Prevention (2024 update). https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf. 2024-05-22/2024-7-11.
2. Roth GA, Abate D, Abate KH, et al. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018, 392(10159): 1736–1788.
3. Huang K, Yang T, Xu J, et al. China Pulmonary Health (CPH) Study Group. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet. 2019, 394(10196): 407-418.
4. 高芬, 杨庆娟, 张海国. 2006至2007年青海省支气管哮喘患病率调查. 中华结核和呼吸杂志, 2011, 34(3): 165-168.
5. AL-GHAMDI B R, MAHFOUZ A A, ABDELMONEIM I, et al. Altitude and bronchial asthma in south-western Saudi Arabia. East Mediterr Health J, 2008, 14(1): 17-23.
6. Hu X, Cowl CT, Baqir M, et al. Air travel and pneumothorax. Chest, 2014, 145(4): 688-694.
7. 周语嫣, 梁斌苗, 梁宗安. 高空、高原、地下空间环境对呼吸功能的影响. 中国呼吸与危重监护杂志, 2020, 19(02): 198-202.
8. Rijssenbeek-Nouwens LH, Bel EH. High-altitude treatment: a therapeutic option for patients with severe, refractory asthma? Clin Exp Allergy, 2011, 41(6): 775-782.
9. Matsui EC. Environmental control for asthma: recent evidence. Curr Opin Allergy Clin Immunol, 2013, 13(4): 417-425.
10. Massimo T, Blank C, Strasser B, et al. Does climate therapy at moderate altitudes improve pulmonary function in asthma patients? A systematic review. Sleep Breath, 2014, 18(1): 195-206.
11. Vinnikov D, Khafagy A, Blanc PD, et al. High-altitude alpine therapy and lung function in asthma: systematic review and metaanalysis. ERJ Open Res, 2016, 2(2): 1-12.
12. Hashimoto S, Rijssenbeek-Nouwens LH, Fieten KB, et al. Predictors of benefit from high-altitude climate therapy in adults with severe asthma. Neth J Med, 2018, 76(5): 218-225.
13. 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(7): 1991-2024.
14. Basler L, Saxer S, Schneider SR, et al. Asthma rehabilitation at high vs. low altitude and its impact on exhaled nitric oxide and sensitization patterns: Randomized parallel-group trial. Respir Med. 2020, 170: 106040.
15. Pesce G, Bugiani M, Marcon A, et al. Geo-climatic heterogeneity in self-reported asthma, allergic rhinitis and chronic bronchitis in Italy. The Science of the total environment, 2016, 544(1): 645-652.
16. Garcia-Almaraz RG. Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study. BMJ Open, 2020, 7(1): e000658.
17. Vargas MH, Becerril-Ángeles M, Medina-Reyes IS, et al. Altitude above 1500 m is a major determinant of asthma incidence. An ecological study . Respir Med 2018, 135: 1-7.
18. 边巴琼达, 徐钰, 黄丽萍, 等. 高原地区藏族居民脉氧饱和度和血红蛋白含量分析. 中国呼吸与危重监护杂志, 2018, 17(3): 271-274.
19. Zubieta-Calleja G, Zubieta-DeUrioste N. The oxygen transport triad in high-altitude pulmonary edema: a perspective from the high Andes. Int J Environ Res Public Health, 2021, 18(14): 7619.
20. 廖霞, 罗凤鸣. 高原人群肺动脉高压与血红蛋白浓度的相关研究进展. 中国呼吸与危重监护杂志, 2022, 21(03): 225-228.
21. Fieten KB, Rijssenbeek-Nouwens LH, Hashimoto S, et al. Less exacerbations and sustained asthma control 12 months after high altitude climate treatment for severe asthma. Allergy 2019, 74: 628–30.
22. Oğhan F, Erdim I. Associations among high altitude, allergic rhinitis, and bronchial hyperreactivity. ENT Updates, 2017, 7: 47-52.
23. Mahima Luthra , S S Bist , Sarita Mishra, et al. Evaluation of Association of Allergic Rhinitis with Bronchial Asthma[J], Indian J Otolaryngol Head Neck Surg. 2019 Nov, 71(Suppl 3): 1687- 1691.
24. J. V. Fahy, Type2 inflammation in asthma-present in most, absentinmany . Nat Rev Immunol. 2015, 15: 57-65.
25. Bradley E Chipps, Tmirah Haselkorn, Brandee Paknis, et al. More than a decade follow-up in patients with severe or difficult-to-treat asthma: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) II. J Allergy Clin Immunol, 2018, 141(5): 1590-1597.
26. Paiva Ferreira LKD, Paiva Ferreira LAM, Monteiro TM, et al. Combined allergic rhinitis and asthma syndrome (CARAS). Int Immunopharmacol, 2019, 74: 105718.
27. Mao Z, Shi Y, Cao Q, et al. Transcriptional regulation on the gene expression signature in combined allergic rhinitis and asthma syndrome. Epigenomics. 2018, 10(2): 119‐131.
28. 李亥兰. 过敏性鼻炎-哮喘综合征的中医体质特点研究. 北京中医药大学, 2021.

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