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Introduction: Bronchial asthma continues to be a problem in the Himalayan country of Nepal. This study explored the impact of bronchial asthma on patients' lives in a hill village in Syangja district, Nepal, and obtained information about the perceived impact of the illness, knowledge of the disease, self-care behaviors and treatment among patients. Material and methods: The study site is the village of Jyamire (located at an elevation between 900 to 1200 m) Syangja district. Individuals suffering from asthma residing in the village aged 18 years or above were included. Semi-structured interviews were conducted face-to-face with the respondents at their homes using an interview guide. The interviews were audio recorded, transcribed in the Nepali language, and then translated into English for further analysis. Results: Most participants were female, between 18 to 60 years of age, and housewives. Most houses were built of mud and poorly ventilated. Gas was used for cooking though firewood was also used. Most used to get an average of three serious attacks a year both during winter and summer. The themes that emerged were the number and seasonal variation in attacks, the perceived effect of asthma on their lives and social interactions, the knowledge of the interviewee about the disease, the impact of asthma on their socioeconomic status, and treatment and self-care behaviors. Residing in a hill village required them to walk up and down several times a day and the disease seriously impacted their lives. The smoke produced during different ceremonies and during cooking also worsened their asthma. Conclusion: Findings suggest, the existence of multiple factors, a few unique to Nepal contributing to poor asthma control. Though the recent socioeconomic improvement has led to improved prevention and treatment options, asthma seriously affected the patients. [ABSTRACT FROM AUTHOR]

Biomass fuels are used by the majority of resource poor households in low-income countries. Though biomass fuels, such as dung-briquette and firewood are apparently cheaper than the modern fuels indoor pollution from burning biomass fuels incurs high health costs. But, the health costs of these conventional fuels, mostly being indirect, are poorly understood. To address this gap, this study develops probit regression models using survey data generated through interviews from households using either dung-briquette or biogas as the primary source of fuel for cooking. The study investigates factors affecting the use of dung-briquette, assesses its impact on human health, and estimates the associated household health costs. Analysis suggests significant effects of dung-briquette on asthma and eye diseases. Despite of the perception of it being a cheap fuel, the annual health cost per household due to burning dung-briquette (US$ 16.94) is 61.3% higher than the annual cost of biogas (US$ 10.38), an alternative cleaner fuel for rural households. For reducing the use of dung-briquette and its indirect health costs, the study recommends three interventions: (1) educate women and aboriginal people, in particular, and make them aware of the benefits of switching to biogas; (2) facilitate tree planting in communal as well as private lands; and (3) create rural employment and income generation opportunities. [ABSTRACT FROM AUTHOR]

Indoor air pollution from open fires affects more than half of the children in the world. An increasing database of immunotoxicologic studies, point at particle exposure as a potential causal risk factor for asthma and atopic disease. Despite the large population at risk, only a handful of studies in the world have evaluated the effect of biomass-smoke exposure on asthmatic symptoms and atopy. Two studies (papers in manuscript) from this research group have found significant trends of increasing symptoms and prevalence over increasingly polluted indoor environments in Nepal and Guatemala, with high odds ratios from 2-8. More research is needed to clarify controversies regarding pollution effects on the development of asthma and atopy. More than 90% of asthma/immunology studies have been performed in developed-countries. This restricts our understanding of the complicated web of causality for asthma and allergic diseases. From a health perspective, the largest air pollution problem probably occurs in the developing world, another powerful reason to redirect more of our research resources. Our research group is in the process of implementing a large-scale randomized intervention trial, with introduction of improved stoves into homes using open fires for cooking indoors. We schedule weekly evaluation of acute respiratory infections and wheezing symptoms in infants. As part of the preparation we are completing an extensive baseline survey with measurements of pre-intervention indoor air pollution levels. This study will give us a picture of the prevalence and severity of asthmatic disease among children who experience indoor air pollution at the expected high end of the dose-response curve. Other relevant risk factors for asthma will be collected and included in the models.Sample size is approximately 1300 children, all from an indigenous community in highland Guatemala. The children live in 500 households enrolled for the intervention trial. Exposure to woodsmoke from the open fires is being-assessed by regular use of CO passive diffusion tubes in all the houses. Extensive integrated and real-time particle levels and real-time CO-levels are being done for a 15% subgroup, and will be used to model particle exposure for all the households. Information on asthmatic and atopic symptoms and severity and additional risk factors is collected in an extensive baseline survey with standardized health questions. [ABSTRACT FROM AUTHOR]