Publications

Purpose: Until recently, reports on chronic obstructive pulmonary disease (COPD) in Kazakhstan have been sporadic and reflected the disease burden in only one largest city, Almaty. We, therefore, aimed to characterize the prevalence and risk factors of COPD confirmed with a high-quality spirometry in a nationwide population-based study.

Patients and Methods: We enrolled 5058 subjects, and hereinafter analyzed complete data for 4626 (age 47; interquartile range (IQR) 31;60 years) participants from the general population from five cities in Kazakhstan representing the West, North, South, East and the central part to fill in a questionnaire and undergo spirometry with bronchodilation. COPD was confirmed when postbronchodilation forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) was below −1.64 z-scores. The association of selected predictors with COPD was tested in multivariate regression models.

Results: Seven percent of the entire group (9% in men vs 6% in women) had COPD. The corresponding prevalence in the group 40 years and older was 10.7% (14.5% in men and 7.6% in women). For ΔFVC, 78% could achieve A or B quality, whereas 83% could attain A or B quality for ΔFEV1. Only 30% of COPD patients were told they had it before. Ever-smoking (OR 2.44; 95% CI 1.81;3.33), low educational level (OR 1.80; 95% CI 1.42;2.28), exposure to vapors, gases, dusts and fumes (VGDF) (OR 1.41; 95% CI 1.10;1.82) and tuberculosis in the past (OR 4.12. 95% CI 2.19;7.45), adjusted for each other, age, sex and physical activity put subjects at risk for COPD.

Conclusion: COPD in Kazakhstan remains a highly underdiagnosed disease. Most COPD patients do not yet have a timely diagnosis and remain untreated. Smoking, occupational exposures and even tuberculosis in the past significantly increase the risk of this disease.

Keywords: spirometry, occupational, smoking, respiratory, population-based

Purpose: Performing yoga exercises in addition to basic training helps athletes to improve their results. At the same time, yoga exercises, including Hatha yoga, which involves controlling one’s breathing, are integrated into the training process. This work is devoted to study the influence of breathing exercises, with the decrease and increase in the minute volume of breathing with corresponding changes in gas exchange, on peripheral blood flow, spirometry, and gas analysis in anatomically different areas: the skin of the forehead, fingers and toes.

Methods: Volunteers performed full breathing exercises, which led to the decrease and increase in the minute volume of breathing with corresponding changes in gas exchange. Blood microcirculation was recorded using laser Doppler flowmetry (LDM) analyzers in the skin of the forehead, fingers and toes. Additionally, spirometry and gas analysis were used.

Results: It was found that 5-min practices of full breathing among experienced volunteers led to similar changes in microcirculation parameters, namely, an increase in the skin blood perfusion in all areas, as well as an increase in nutritive blood flow only in the extremities (fingers and toes). Reducing the minute volume of breathing leads to an increase in amplitudes of endothelial and neurogenic oscillations during the recovery period, but increasing the minute volume of breathing leads to an increase in amplitudes of neurogenic oscillations during that same period.

Conclusions: The study of the blood microcirculation behavior during breathing exercises and its correlation is useful both for obtaining fundamental knowledge of oxygen delivery to biological tissues in various breathing modes and for evaluating the efficacy of breathing exercises in sports training and rehabilitation. Changes in lung ventilation and the corresponding shifts in gas exchange affect the active mechanisms of blood microcirculation regulation. This stimulation occurs through endothelial mechanisms during reduced minute volume of breathing with hypoxia and hypercapnia, as well as neurogenic mechanisms both in increased and decreased lung ventilation.

Background: Asthma control, patients’ awareness level and adherence to treatment in Kazakhstan have never been studied. The aim of this study was to verify the prevalence of controlled, poorly controlled and uncontrolled asthma in a large sample of three largest cities of Kazakhstan.

Methods: We recruited 600 (median age 54 (interquartile range (IQR) 22) years, 64% females) patients with diagnosis confirmed earlier in the outpatient facilities in Almaty, Astana and Shymkent in 2020–2021. We offered a structured questionnaire on asthma control and risk factors as of GINA and performed spirometry. We report the prevalence of asthma control, knowledge and skills and pharmacological treatment with 95% confidence interval (CI) and the association of selected predictors with asthma control.

Results: With the median of 9 (IQR 13) years of diagnosis, 40% of patients had comorbid COPD and 42% had allergic rhinitis, whereas 32% lived with pets. Asthma was well-controlled in only 12.3% (95% CI 9.7–15.0), partly controlled in 29.8% (95% CI 26.2–33.5) and uncontrolled in 57.8% (95% CI 53.9–61.8) patients. ACQ-5 score (range 0–5.8, median 2) equaled 0.2 (IQR 0.85) in well-controlled asthma patients, 1.4 (IQR 1) in partly controlled and 2.8 (IQR 1.4) in uncontrolled asthma patients. Knowledge and skills levels were very low. Only 54% were on inhaled corticosteroids (52.2% of them used budesonide/formoterol and 39.5% used fluticasone/salmeterol). 39% used steroids per os or parenterally within a period of 12 months (51% of patients with uncontrolled asthma).

Conclusions: Asthma control, knowledge and skills levels of asthma patients in the largest cities of Kazakhstan remain unacceptably low, whereas pharmacological treatment is far from optimal. Urgent action should be taken to support doctors’ training, and we call to launch a national asthma program to coordinate asthma care in Kazakhstan.

KEYWORDS: Prevalence, Inhaled steroids, Peakflowmetry, GINA