Indoor air pollution exposure effects on lung and cardiovascular health in the High Himalayas, Nepal: An observational study

Published:October 31, 2018DOI:


      • Indoor air pollution (IAP) is a cause of morbidity and mortality in the population of the poorest countries.
      • The effects of IAP on cardiovascular and pulmonary diseases 'is not well known.
      • Poor indoor air quality induces an impairment of airways function and cardiovascular damage.
      • Long term IAP exposure is associated to substantial burden of COPD and of cardiovascular dysfunction.
      • The use of clean cook stoves and fuels could dramatically reduce IAP and the associated adverse health effects.



      Exposure to indoor biomass fuel smoke is associated with increased morbidity and mortality. The aim of this study is to evaluate the association between exposure to indoor biomass burning and early pulmonary and cardiovascular damage.


      The indoor levels of particulate matter (PM) [PM10, PM2.5] and black carbon (BC) were monitored in 32 houses in a Himalayan village. Seventy-eight subjects were submitted to spirometry and cardiovascular evaluation [carotid to femoral pulse wave velocity (PWV) and echocardiography].


      Peak indoor BC concentration up to 100 μg m−3 and PM10 - PM2.5 up to 1945–592 μg m−3 were measured. We found a non-reversible bronchial obstruction in 18% of subjects ≥40 yr; mean forced expiratory flow between 25% and 75% of the forced vital capacity (FEF25–75) <80% in 54% of subjects, suggestive of early respiratory impairment, significantly and inversely related to age. Average BC was correlated with right ventricular-right atrium gradient (R = 0.449,p = .002), total peripheral resistances (TPR) (R = 0.313,p = .029) and PWV (R = 0.589,p < .0001) especially in subjects >30 yr. In multiple variable analysis, BC remained an independent predictor of PWV (β = 0.556,p = .001), and TPR (β = 0.366;p = .018).


      Indoor pollution exposure is associated to early pulmonary and cardiovascular damages, more evident for longer duration and higher intensity exposure.



      BC (black carbon), BMI (body mass index), COPD (chronic obstructive pulmonary disease), DBP (diastolic blood pressure), FVC (forced vital capacity), FEF25–75 (forced vital capacity), FEV1 (forced expiratory volume in one second), FRS (Framingham risk score), IAP (indoor air pollution), PM (particulate matter), PVR (Pulmonary vascular resistance), PWV (carotid to femoral pulse wave velocity), RV-RA gradient (pressure gradient between the right ventricle and the right atrium), SBP (systolic blood pressure), sPAP (systolic pulmonary artery pressure), TPR (total peripheral resistances), WHO (World Health Organization)
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