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Despite its high disease burden, few existing estimates of the prevalence of obstructive lung disease in India are based on high-quality data sources. To our knowledge, prior studies at the national level have not included objective measurements of lung function. The Longitudinal Aging Study in India administered spirometry to adults 45 years and older (N = 31,103). We estimated inverse probability weights to account for sample selection processes and quantified the prevalence of obstructive lung disease overall and by region, age, and gender. We investigated the overlap among objective rates of obstructive lung disease, respiratory symptoms, and self-reported diagnoses. Additionally, we evaluated associations between obstructive lung disease and pertinent risk factors. The overall prevalence of obstructive lung disease was 14.4% (95% confidence interval [CI] 13.4–15.4). Prevalence was higher among men than women (p < 0.001) and increased with age (p < 0.001). Disease awareness was low, with only 12.0% (95% CI 9.9–14.5) of men and 11.0% (95% CI 8.6–14.0) of women with obstructive lung disease reporting prior diagnoses of lung disease. We observed heterogeneity by region (p < 0.001), which largely remained after accounting for differences in demographic and risk factors. High prevalence and low disease awareness highlight important challenges in the prevention and management of obstructive lung disease in India. Multifaceted approaches are needed to address this disease burden, including understanding and lowering exposure to risk factors and improving infrastructure and resources for diagnosing and managing obstructive lung disease.

Arsenic is associated with lung disease and experimental models suggest that arsenic-induced degradation of the chloride channel CFTR (cystic fibrosis transmembrane conductance regulator) is a mechanism of arsenic toxicity. We examined associations between arsenic exposure, sweat chloride concentration (measure of CFTR function), and pulmonary function among 269 adults in Bangladesh. Participants with sweat chloride ≥ 60 mmol/L had higher arsenic exposures than those with sweat chloride < 60 mmol/L (water: median 77.5 µg/L versus 34.0 µg/L, p = 0.025; toenails: median 4.8 µg/g versus 3.7 µg/g, p = 0.024). In linear regression models, a one-unit µg/g increment in toenail arsenic was associated with a 0.59 mmol/L higher sweat chloride concentration, p < 0.001. Among the entire study population, after adjusting for covariates including age, sex, smoking, education, and height, toenail arsenic concentration was associated with increased odds of airway obstruction (OR: 1.97, 95%: 1.06, 3.67, p = 0.03); however, sweat chloride concentration did not mediate this association. Our findings suggest that sweat chloride concentration may serve as novel biomarker for arsenic exposure, warranting further investigation in diverse populations, and that arsenic likely acts on the lung through mechanisms other than inducing CFTR dysfunction. Alternative mechanisms by which environmental arsenic exposure may lead to obstructive lung disease, such as arsenic-induced direct lung injury and/or increase lung proteinase activity, require additional exploration in future work.

Background Low blood absolute lymphocyte count (ALC) may predict severe COVID-19 outcomes. Knowledge gaps remain regarding the relationship of ALC trajectory with clinical outcomes and factors associated with lymphopenia. Methods Our post hoc analysis of the Therapeutics for Inpatients with COVID-19 platform trial utilized proportional hazards models to assess relationships between Day (D) 0 lymphopenia (ALC < 0.9 cells/uL), D0 severe lymphopenia (ALC < 0.5 cells/uL) or lymphopenia trajectory between D0 and D5 with mortality and secondary infections, and with sustained recovery using Fine-Gray models. Logistic regression was used to assess relationships between clinical variables and D0 lymphopenia or lymphopenia trajectory. Results D0 lymphopenia (1426/2579) and severe lymphopenia (636/2579) were associated with increased mortality (aHR 1.48; 1.08, 2.05, p  = 0.016 and aHR 1.60; 1.20, 2.14, p  = 0.001) and decreased recovery (aRRR 0.90; 0.82, 0.99, p  = 0.033 and aRRR 0.78; 0.70, 0.87, p  < 0.001 respectively). Trial participants with persistent D5 lymphopenia had increased mortality, and increased secondary infections, and participants with persistent or new lymphopenia had impaired recovery, as compared to participants with no lymphopenia. Persistent and new lymphopenia were associated with older age, male sex; prior immunosuppression, heart failure, aspirin use, and normal body mass index; biomarkers of organ damage (renal and lung), and ineffective immune response (elevated IL-6 and viral nucleocapsid antigen levels). Similar results were observed with severe lymphopenia. Conclusions Lymphopenia was predictive of severe COVID-19 outcomes, particularly when persistent or new during hospitalization. A better understanding of the underlying risk factors for lymphopenia will help illuminate disease pathogenesis and guide management strategies.

Air pollution poses a significant threat to global public health, with African megacities facing its severe consequences due to rapid urbanization, industrialization, and transportation challenges. In Africa, air pollution is responsible for 1.1 million deaths annually, with household air pollution accounting for two‐third and ambient air pollution one‐third of this burden. However, these percentages are likely to change in the near future due to the projected rapid urbanization and industrialization in the region. In the next 25 to 50 years African megacities are projected to grow rapidly and therefore experience a significant increase in air pollution‐related health risks. Poor policy prioritization, limited monitoring infrastructure and conflicting interests and priorities further complicate the problem. In this paper, the key drivers of air pollution are discussed in African megacities, including urbanization, industrialization, transportation, and energy use. Further it is highlighted that there are significant challenges and barriers, as well as a pressing need for air quality monitoring, coordinated policies and effective air quality management to ensure sustainable development, mitigate the adverse health impacts of pollution and improve the quality of life across the continent. Africa's world fastest growing population and unregulated rapid urbanization and industrialization are posing serious air quality challenges. This perspective discusses the barriers to effective air quality monitoring and regulation, highlighting the need for well‐designed frameworks to support sustainable development, improve public health, and reduce health inequalities across African megacities.

Synonyms were used to look for articles that address the AP region (i.e., \"Asia,\" \"Pacific,\" and \"Asia Pacific\"), air pollution (i.e., \"air,\" \"air pollution,\" \"atmosphere,\" \"environment,\" \"outdoor,\" \"outdoor air pollution,\" \"particulate matter,\" and \"PM2.5\"), and potential respiratory consequences of air pollution (i.e., \"respiratory,\" \"asthma,\" \"COPD,\" \"hospitalizations,\" \"influenza,\" \"lower respiratory tract infection,\" \"lung cancer,\" \"lung function,\" \"obstructive lung disease,\" \"spirometry,\" \"tuberculosis,\" and \"wheeze\"). According to the 2016 Global Burden of Disease report, air pollution is responsible for an estimated 6.1 million deaths annually and 163 million disabilityadjusted life-years (DALYs) globally (12, 29). According to the most recent Global Burden of Disease estimates, the highest burden of COPD-related DALYs in the world occur in India, Nepal, Bangladesh, Bhutan, and Papua New Guinea (.2,000 age-adjusted DALYs per 100,000 people), whereas China, Myanmar, Laos, Vietnam, and the Philippines also experience extremely high COPD disability in the global context (32). In Hong Kong and China, for example, air quality improvement is being achieved through a multimodality approach that includes a comprehensive motor vehicle emission control program, reducing marine vessel emissions with fuel regulations, instituting emissions caps for power plants, and government subsidies and other financial support for the transition from coal to cleaner fuels and renewable energy.

Isolation guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are largely derived from data collected prior to the emergence of the delta variant. We followed a cohort of ambulatory patients with postvaccination breakthrough SARS-CoV-2 infections with longitudinal collection of nasal swabs for SARS-CoV-2 viral load quantification, whole-genome sequencing, and viral culture. All delta variant infections in our cohort were symptomatic, compared with 64% of non-delta variant infections. Symptomatic delta variant breakthrough infections were characterized by higher initial viral load, longer duration of virologic shedding by PCR, greater likelihood of replication-competent virus at early stages of infection, and longer duration of culturable virus compared with non-delta variants. The duration of time since vaccination was also correlated with both duration of PCR positivity and duration of detection of replication-competent virus. Nonetheless, no individuals with symptomatic delta variant infections had replication-competent virus by day 10 after symptom onset or 24 hours after resolution of symptoms. These data support US CDC isolation guidelines as of November 2021, which recommend isolation for 10 days or until symptom resolution and reinforce the importance of prompt testing and isolation among symptomatic individuals with delta breakthrough infections. Additional data are needed to evaluate these relationships among asymptomatic and more severe delta variant breakthrough infections.

Background Sex-based differences in cardiovascular disease (CVD) burden are widely acknowledged, with male sex considered a risk factor in high-income settings. However, these relationships have not been examined in sub-Saharan Africa (SSA). We aimed to apply the American Heart Association (AHA) ideal cardiovascular health (CVH) tool modified by the addition of C-reactive protein (CRP) to examine potential sex-based differences in the prevalence of CVD risk in rural Uganda. Methods In a cross-sectional study nested within a population-wide census, 857 community-living adults completed physical and laboratory-based assessments to calculate individual ideal CVH metrics including an eight category for CRP levels. We summarized sex-specific ideal CVH indices, fitting ordinal logistic regression models to identify correlates of improving CVH. As secondary outcomes, we assessed subscales of ideal CVH behaviours and factors . Models included inverse probability of sampling weights to determine population-level estimates. Results The weighted-population mean age was 39.2 (1.2) years with 52.0 (3.7) % females. Women had ideal scores in smoking (80.4% vs. 68.0%; p  < 0.001) and dietary intake (26.7% vs. 16.8%; p  = 0.037) versus men, but the opposite in body mass index (47.3% vs. 84.4%; p  < 0.001), glycated hemoglobin (87.4% vs. 95.2%; p  = 0.001), total cholesterol (80.2% vs. 85.0%; p  = 0.039) and CRP (30.8% vs. 49.7%; p  = 0.009). Overall, significantly more men than women were classified as having optimal cardiovascular health (6–8 metrics attaining ideal level) (39.7% vs. 29.0%; p  = 0.025). In adjusted models, female sex was correlated with lower CVH health factors sub-scales but higher ideal CVH behaviors. Conclusions Contrary to findings in much of the world, female sex in rural SSA is associated with worse ideal CVH profiles, despite women having better indices for ideal CVH behaviors. Future work should assess the potential role of socio-behavioural sex-specific risk factors for ideal CVH in SSA, and better define the downstream consequences of these differences.

Background Most of the global burden of pollution-related morbidity and mortality is believed to occur in resource-limited settings, where HIV serostatus and sex may influence the relationship between air pollution exposure and respiratory morbidity. The lack of air quality monitoring networks in these settings limits progress in measuring global disparities in pollution-related health. Personal carbon monoxide monitoring may identify sub-populations at heightened risk for air pollution-associated respiratory morbidity in regions of the world where the financial cost of air quality monitoring networks is prohibitive. Methods From September 2015 through May 2017, we measured 48-h ambulatory carbon monoxide (CO) exposure in a longitudinal cohort of HIV-infected and uninfected adults in rural southwestern Uganda. We fit generalized mixed effects models to identify correlates of CO exposure exceeding international air quality thresholds, quantify the relationship between CO exposure and respiratory symptoms, and explore potential effect modification by sex and HIV serostatus. Results Two hundred and sixty study participants completed 419 sampling periods. Personal CO exposure exceeded international thresholds for 50 (19%) participants. In covariate-adjusted models, living in a home where charcoal was the main cooking fuel was associated with CO exposure exceeding international thresholds (adjusted odds ratio [AOR] 11.3, 95% confidence interval [95%CI] 4.7–27.4). In sex-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among women (AOR 3.3, 95%CI 1.1–10.0) but not men (AOR 1.3, 95%CI 0.4–4.4). In HIV-stratified models, higher CO exposure was associated with increased odds of respiratory symptoms among HIV-infected (AOR 2.5, 95%CI 1.01–6.0) but not HIV-uninfected (AOR 1.4, 95%CI 0.1–14.4) participants. Conclusions In a cohort in rural Uganda, personal CO exposure frequently exceeded international thresholds, correlated with biomass exposure, and was associated with respiratory symptoms among women and people living with HIV. Our results provide support for the use of ambulatory CO monitoring as a low-cost, feasible method to identify subgroups with heightened vulnerability to pollution-related respiratory morbidity in resource-limited settings and identify subgroups that may have increased susceptibility to pollution-associated respiratory morbidity.

Despite formidable barriers to designing, implementing, and completing clinical trials in the midst of a pandemic, there are ways to ensure that the selected trials are structured to maximize the chance that the key research questions will be definitively answered.

Background Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure. Methods We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV 1 ) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status. Results Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV 1 was associated with increased cIMT (β = 0.006 per 200 mL FEV 1 decrease; 95% CI 0.002 to 0.011, p  = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV 1 and cIMT. Conclusions Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.