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Peer-reviewedCC BY-NC-ND 4.0NPJ Primary Care Respiratory Medicine

Prevalence and risk factors of small airway dysfunction among rural residents in Western China: a real-world cross-sectional study

  • Lu Dai1,2
  • Konglong Shen3
  • Qingqing Su1
  • Jiang Yu1
  • Lifen Li1
  • Haitong Zhao1
  • Xi Shen4
  • Xuan Zhang1,2
  • Fengming Luo1,2
4 affiliations
  1. 1Department of Pulmonary and Critical Care Medicine, Center for High Altitude Medicine, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 China
  2. 2Institute of High Altitude Medicine, High Altitude Medicine Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan 610041 China
  3. 3Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan China
  4. 4Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan China
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Abstract

Small airway dysfunction (SAD) is an early precursor to chronic obstructive pulmonary disease (COPD) and asthma but underdiagnosed, especially in rural settings. We aimed to estimate SAD prevalence and identify its risk factors among adults ≥ 40 years in rural western China. A cross-sectional survey was conducted among 11,398 rural residents aged ≥ 40 years in Mianyang, Sichuan, China. SAD was defined spirometrically as at least two of three indices below 65% of predicted values, including maximal mid-expiratory flow, forced expiratory flow at 50 and 75% of forced vital capacity. Multivariable logistic regression was used. Model 1 adjusted for age and sex; Model 2 additionally adjusted for education, smoking, household fuel use, residential dust exposure, and so forth. SAD prevalence was 49.21%. Higher risk was observed in older adults (≥60 years) and women (Model 2 OR = 1.74 [1.54–1.96]). Biomass fuel exposure (Model 1 OR = 1.29 [1.15–1.45]; Model 2 OR = 1.23 [1.07–1.41]) and coal fuel exposure (Model 1 OR = 1.23 [1.14–1.32]) were associated with SAD. Higher education and low residential dust exposure were protective. Subgroup analysis performed that in women, SAD prevalence increased with biomass fuel and secondhand smoke exposure. SAD is highly prevalent among rural adults aged ≥ 40 years in western China and is linked to multiple modifiable factors, particularly household solid fuel use. These findings suggest that routine pulmonary function screening in high-risk populations and targeted interventions, such as cleaner household energy, improved ventilation, and stratified health education, may contribute to early prevention of COPD and asthma.

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Cite

BibTeXRIS
BibTeX
@article{dai2026prevalence,
  title = {{Prevalence and risk factors of small airway dysfunction among rural residents in Western China: a real-world cross-sectional study}},
  author = {Lu Dai and Konglong Shen and Qingqing Su and Jiang Yu and Lifen Li and Haitong Zhao and Xi Shen and Xuan Zhang and Fengming Luo},
  journal = {NPJ Primary Care Respiratory Medicine},
  year = {2026},
  month = jul,
  doi = {10.1038/s41533-026-00538-x},
  url = {https://doi.org/10.1038/s41533-026-00538-x},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Prevalence and risk factors of small airway dysfunction among rural residents in Western China: a real-world cross-sectional study
AU  - Lu Dai
AU  - Konglong Shen
AU  - Qingqing Su
AU  - Jiang Yu
AU  - Lifen Li
AU  - Haitong Zhao
AU  - Xi Shen
AU  - Xuan Zhang
AU  - Fengming Luo
PY  - 2026
DA  - 2026/07/10
JO  - NPJ Primary Care Respiratory Medicine
DO  - 10.1038/s41533-026-00538-x
UR  - https://doi.org/10.1038/s41533-026-00538-x
AB  - Small airway dysfunction (SAD) is an early precursor to chronic obstructive pulmonary disease (COPD) and asthma but underdiagnosed, especially in rural settings. We aimed to estimate SAD prevalence and identify its risk factors among adults ≥ 40 years in rural western China. A cross-sectional survey was conducted among 11,398 rural residents aged ≥ 40 years in Mianyang, Sichuan, China. SAD was defined spirometrically as at least two of three indices below 65% of predicted values, including maximal mid-expiratory flow, forced expiratory flow at 50 and 75% of forced vital capacity. Multivariable logistic regression was used. Model 1 adjusted for age and sex; Model 2 additionally adjusted for education, smoking, household fuel use, residential dust exposure, and so forth. SAD prevalence was 49.21%. Higher risk was observed in older adults (≥60 years) and women (Model 2 OR = 1.74 [1.54–1.96]). Biomass fuel exposure (Model 1 OR = 1.29 [1.15–1.45]; Model 2 OR = 1.23 [1.07–1.41]) and coal fuel exposure (Model 1 OR = 1.23 [1.14–1.32]) were associated with SAD. Higher education and low residential dust exposure were protective. Subgroup analysis performed that in women, SAD prevalence increased with biomass fuel and secondhand smoke exposure. SAD is highly prevalent among rural adults aged ≥ 40 years in western China and is linked to multiple modifiable factors, particularly household solid fuel use. These findings suggest that routine pulmonary function screening in high-risk populations and targeted interventions, such as cleaner household energy, improved ventilation, and stratified health education, may contribute to early prevention of COPD and asthma.
SN  - 2055-1010
ER  -