In 1993 the Tibet Autonomous Region (TAR) of China established the 300 000 km2 Chang Tang Nature Preserve on the northwestern Tibetan plateau, an action precipitated by rapidly diminishing populations of chiru (Tibetan antelope) and wild yak. Some 30 000 nomadic pastoralists use areas within this reserve for livestock grazing, with many having traditionally depended in part on hunting for supplementary subsistence and trade. Following a 1997 request from TAR leaders for international assistance in addressing the conservation issues associated with the creation of this reserve, the TAR Forestry Bureau and the Network for University Co-operation Tibet — Norway began a 3-year research collaboration program in 2000 to outline human-wildlife interactions and conservation priorities in the western part of the reserve. To date, four excursions (2-6 weeks each) have been made to the western Chang Tang region, and investigations of interactions between pastoralists and wildlife conservation objectives have been initiated in an area of about 5000 km2, including the 2300 km2 Aru basin located at 5000 m elevation at the northern edge of pastoralist inhabitation. The Aru site is unique in that nomads have only recently returned to this previously off-limits basin. But, as in surrounding areas, the people's lives are undergoing changes recently influenced by the introduction of permanent winter houses, changing international trade in shahtoosh and cashmere wool, and a move towards stricter hunting regulations. The northwestern Chang Tang, with the Aru basin as a prime site, represents one of the last strongholds of the endangered chiru and wild yak, as well as home to Tibetan gazelle, kiang, Tibetan argali, blue sheep, wolf, snow leopard and brown bear. In autumn 2000, for example, with approximately 12 000 of the wild ungulates (mostly the migratory chiru) within the Aru basin along with some 8000 domestic livestock, issues of land use overlap and possible grazing competition are clear to both local nomads and reserve managers. Whereas livestock development actions elsewhere on the Tibetan plateau are promoting increased livestock production, they are doing so at the expense of wildlife, and such an approach will not be appropriate in areas where wildlife conservation is a major priority. Although some of the ongoing livestock development programs may be adapted to the western TAR, new approaches to pastoral development will have to be developed in the reserve. The ultimate goal of enhancing the nomads' standard of living, while conserving this truly unique array of biodiversity, presents a daunting challenge

Background COPD at high altitude may have different risk factors and unique clinical and radiological phenotypes. We aimed to investigate the demographic data, clinical and radiological features of COPD patients permanently residing at the Tibet Plateau (≥3000 meters above sea level). Methods We conducted an observational cross-sectional study which consecutively enrolled COPD patients visiting the outpatient of Respiratory Medicine at Tibet Autonomous Region People’s Hospital from January 2018 to March 2021. All patients were Tibetan permanent residents aging ≥40 years and met the diagnosis of COPD according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Data including demographic characteristics, altitude of residence, risk factors, respiratory symptoms, comorbidities and medications, as well as computed tomography (CT) measurements were collected. Results Eighty-four patients with definite COPD were enrolled for analysis. Their mean age was 64.7 (±9.1) years. All patients lived at ≥3000 m above sea level and 34.5% of them lived at ≥4000 m. About 8.3% of the patients were current smokers and 44.0% were ex-smokers. Up to 88.1% of the patients reported long-term exposure to indoor biomass fuels. Most of the patients were classified as having mild-to-moderate (GOLD I: 27.4%; GOLD II: 51.2%) COPD, while 89.3% had a CAT score ≥10. Only 36.9% of the patients received regular long-term medications for COPD in the past year, in whom ICS/LABA and oral theophylline were the most common used pharmacological therapy. On CT scanning, the majority of our patients (70.7%) showed no or minimal emphysema, while signs of previous tuberculosis were found in 45.1% of the patients. Conclusion COPD patients living at the Tibet Plateau had a heavy respiratory symptom burden, but most of them did not receive adequate pharmacological treatment. Indoor biomass fuel exposure and previous tuberculosis were prevalent, while the emphysema phenotype was less common in this population.

Nomadic pastoralists live at the northern extent of human habitation within the ca. 5000 m elevation Aru basin, in the nortwestern part of the Chang Tang Nature Preserve, Tibet. These nomads herd primarily sheep and goats, a lesser number of yaks, and a few horses. Goats are increasing in importance because of the value of cashmere wool in national and international markets. Although sheep wool production is greater per animal than for the cashmere goats, the price obtained for its wool is much lower. Still, households keep more sheep than goats, primarily because sheep meat is preferred for consumption and sheep wool is important for the nomads' own use. The Aru nomads have traditionally depended on hunting to compensate for livestock lost to predators and unpredictable climatic phenomena such as blizzards. The prohibition of hunting in the reserve from 1993 has apparently resulted in a lowering of their standard of living, even with an overall rise in cashmere prices. According to the nomads, without hunting they have thus lost a safety measure important during years with heavy livestock losses. Conservation related development initiatives in the reserve should address this issue.

Background COPD patients living in Tibet are exposed to specific environments and different risk factors and probably have different characteristics of COPD from those living in flatlands. We aimed to describe the distinction between stable COPD patients permanently residing at the Tibet plateau and those in flatlands. Methods We conducted an observational cross-sectional study that enrolled stable COPD patients from Tibet Autonomous Region People’s Hospital (Plateau Group) and Peking University Third Hospital (Flatland Group), respectively. Their demographic information, clinical features, spirometry test, blood routine and high-resolution chest CT were collected and evaluated. Results A total of 182 stable COPD patients (82 from plateau and 100 from flatland) were consecutively enrolled. Compared to those in flatlands, patients in plateau had a higher proportion of females, more biomass fuel use and less tobacco exposure. CAT score and frequency of exacerbation in the past year were higher in plateau patients. The blood eosinophil count was lower in plateau patients, with fewer patients having an eosinophil count ≥300/μL. On CT examination, the proportions of previous pulmonary tuberculosis and bronchiectasis were higher in plateau patients, but emphysema was less common and milder. The ratio of diameters of pulmonary artery to aorta ≥1 was more often in plateau patients. Conclusion Patients with COPD living at Tibet Plateau had a heavier respiratory burden, lower blood eosinophil count, less emphysema but more bronchiectasis and pulmonary hypertension. Biomass exposure and previous tuberculosis were more common in these patients.