Expeditions to help improve lung health in Nepal

A group of doctors and scientists from the University of Nottingham and the NIHR Nottingham Biomedical Research Centre are teaming up with researchers in Nepal to tackle a major public health problem in the country - chronic lung disease.

Nepal is a low income country in the Himalayas but despite global perceptions of clean mountain air, it is one of the most polluted environments in the world 1and there is a high level of respiratory disease among its 30 million people.

In the capital city, Kathmandu, poor lung health is largely caused by smoking tobacco, and exposure to pollution from traffic and industry. However, more than 80% of the country’s population lives in rural areas of Nepal where a major cause of lung disease is the use of cooking stoves that burn biomass in poorly ventilated homes.

The Nottingham team of respiratory specialists, public health experts and engineers have won a 238,000 grant from the UK government’s Global Challenges Research Fund to work with Nepalese doctors, health professionals and development leaders. Their task is to define, design and test practical interventions that could help to reduce the burden of chronic lung disease in the country.

The project is led jointly by two Nottingham-based chest physicians, Professor Ian Hall and Professor Charlotte Bolton. Ian Hall, Director of the NIHR Nottingham BRC, said: “We are thrilled to secure this substantial Global Challenges funding to work with our counterparts in Nepal on this important public health issue. I have just returned from visiting Nepal, where the two most crucial problems contributing to poor lung health are smoking - especially in the male population - and exposure to smoke and fumes produced by burning biomass on indoor cooking stoves.

“Our goal is to come up with some effective solutions that will produce a large enough reduction in exposure to these pollutants and which are culturally acceptable. Several research visits are planned for next year when we will be working closely with colleagues at Kathmandu University, Dhulikhel Hospital and the International Centre for Integrated Mountain Development in Kathmandu to help solve these problems.”

Professor Bolton added: “We will be undertaking research both at Dhulikhel Hospital and in Manekharka, a village in the foothills of the Himalaya. This village has an outreach clinic run by the hospital, and we will work alongside a team currently installing low emission stoves in village dwellings. Most people in the village currently cook using firewood on open stoves and are hence exposed to high levels of air pollution. If we can reduce exposure to indoor air pollution we should be able to reduce the risk of people developing chronic lung diseases such as chronic obstructive pulmonary disease (COPD). We are delighted to have the opportunity to work with experts form Nepal on this project.”

Professor Rajendra Koju, Dean of Kathmandu Medical School and consultant physician at Dhulikhel hospital, Nepal said “Chronic lung disease due to household air pollution and smoking is a significant problem in Nepal. It is a major cause of morbidity and emergency hospital admissions. We very much look forward to working with colleagues from Nottingham on this Global Challenges project to seek ways to improve air pollution exposure and manage lung disease”.

Associate Professor Mike Clifford, from the University’s Faculty of Engineering, said: “ Many Nepalese are dependent on wood as a fuel for cooking and for heating their homes. Unfortunately, burning wood can generate smoke which is harmful for health. Along with our partners, we have been designing stoves which produce less smoke and have already installed some across Nepal. This project is an opportunity to roll out the design to more communities and to see how improved stoves could affect health.

The research teams in Nottingham and Nepal hope that the extensive work that the GCRF funding has enabled will eventually lead to practical interventions that will increase both quality of life and life expectancy. They intend to publish several original research papers, an evidence-based report on respiratory health in Nepal and new clinical guidelines on the management of COPD specifically tailored for use in different regions, based on availability of health care resources.

The Improving Respiratory Health in Nepal research team post regular updates on Twitter @NepalLungGCRF

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