Respiratory abnormalities and ventilatory capacity in a Papua New Guinea Island community

On Karkar Island, off the coast of Papua New Guinea, 87 per cent of the 1,026 resident adults of 3 villages were surveyed for respiratory abnormalities. The prevalence of abnormalities suggestive of chronic lung disease was similar for each sex and increased with age. After 35 years of age, the combined rates were: adventitious breath sounds, 29 per cent; positive loose cough sign, 33 per cent; chronic cough, 11 per cent; and shortness of breath on exertion, 12 per cent. All of these abnormalities were associated with an obstructive ventilatory defect. Smoking began in late adolescence and was established in more than 90 per cent of both sexes by 25 years of age. Most persons smoked a home-grown variety of Nicotiana tabacum. The nonsmoking group was too small to allow adequate comparison; but among smokers, inhalation was related to both respiratory abnormalities and reduced lung function. The prevalence of respiratory abnormalities appeared to be at least as high as in some developed western societies, despite the fact that smoking habits resembled those of cigar smokers elsewhere, and that atmospheric and occupational exposures were absent. Among persons more than 35 years of age, 4 per cent had a history of pulmonary tuberculosis, and 5 per cent showed evidence of localized lung disease in a 70-mm chest radiograph. The predominant condition resembled the chronic nonspecific lung disease of developed societies. Unless this population is unusually susceptible to the effect of cigar-type smoking, other etiologic factors must be considered. These might include repeated acute chest infections, the indirect effects of pulmonary tuberculosis, larval migrations of intestinal parasites, or impaired host response as a result of poor nutrition. A wide spectrum of severity coexisted with a uniform environment and smoking pattern, which suggests that individual susceptibility is important.