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Browsing by Author "Amaral, Andre F."

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  • Chronic airflow obstruction and ambient particulate air pollution
    Publication . Amaral, Andre F.; Burney, Peter G.; Patel, Jaymini; Minelli, Cosetta; Mejza, Filip; Mannino, David M.; Seemungal, Terence A.; Mahesh, Padukudru Anand; Lo, Li Cher; Janson, Christer; Juvekar, Sanjay; Denguezli, Meriam; Harrabi, Imed; Wouters, Emiel F.; Cherkaski, Hamid; Mortimer, Kevin; Jogi, Rain; Bateman, Eric D.; Fuertes, Elaine; Al Ghobain, Mohammed; Tan, Wan; Obaseki, Daniel O.; El Sony, Asma; Studnicka, Michael; Aquart-Stewart, Althea; Koul, Parvaiz; Lawin, Herve; Nafees, Asaad Ahmed; Awopeju, Olayemi; Erhabor, Gregory E.; Gislason, Thorarinn; Welte, Tobias; Gulsvik, Amund; Nielsen, Rune; Gnatiuc, Louisa; Kocabas, Ali; Marks, Guy B.; Sooronbaev, Talant; Mbatchou Ngahane, Bertrand Hugo; Barbara, Cristina; Buist, A. Sonia; BOLD Collaborative Research Group; Dias, Hermínia Brites
    Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed the sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita, and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improving understanding of the link between CAO and poverty should be prioritized.
    2021-12Journal article Open access Show more
  • Geographical variation in lung function: results from the multicentric cross-sectional BOLD study
    Publication . Burney, Peter G.; Potts, James; Knox-Brown, Ben; Erhabor, Gregory; Hacene Cherkaski, Hamid; Mortimer, Kevin; Anand, Mahesh Padukudru; Mannino, David M.; Cardoso, Joao; Ahmed, Rana; Elsony, Asma; Barbara, Cristina; Nielsen, Rune; Bateman, Eric; Paraguas, Stefanni Nonna; Cher Loh, Li; Rashid, Abdul; Wouters, Emiel F.; Franssen, Frits M.; Dias, Hermínia Brites; Gislason, Thorarinn; Ghobain, Mohammed A.; Biaze, Mohammed El; Agarwal, Dhiraj; Juvekar, Sanjay; Rodrigues, Fatima; Obaseki, Daniel O.; Koul, Parvaiz A.; Harrabi, Imed; Nafees, Asaad A; Seemungal, Terence; Janson, Christer; Vollmer, William M; Amaral, Andre F.; Buist, A Sonia
    Spirometry is used to determine what is "unusual" lung function compared with what is "usual" for healthy non-smokers. This study aimed to investigate regional variation in the forced vital capacity (FVC) and in the forced expiratory volume in one second to FVC ratio (FEV1/FVC) using cross-sectional data from all 41 sites of the multinational Burden of Obstructive Lung Disease study. Participants (5,368 men; 9,649 women), aged ≥40 years, had performed spirometry, had never smoked and reported no respiratory symptoms or diagnoses. To identify regions with similar FVC, we conducted a principal component analysis (PCA) on FVC with age, age2 and height2, separately for men and women. We regressed FVC against age, age2 and height2, and FEV1/FVC against age and height2, for each sex and site, stratified by region. Mean age was 54 years (both sexes), and mean height was 1.69 m (men) and 1.61 m (women). The PCA suggested four regions: 1) Europe and richer countries; 2) the Near East; 3) Africa; and 4) the Far East. For the FVC, there was little variation in the coefficients for age, or age2, but considerable variation in the constant (men: 2.97 L in the Far East to 4.08 L in Europe; women: 2.44 L in the Far East to 3.24 L in Europe) and the coefficient for height2. Regional differences in the constant and coefficients for FEV1/FVC were minimal (<1%). The relation of FVC with age, sex and height varies across and within regions. The same is not true for the FEV1/FVC ratio.
    2025Journal article Open access Show more
  • Small airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study
    Publication . Knox-Brown, Ben; Patel, Jaymini; Potts, James; Ahmed, Rana; Aquart-Stewart, Althea; Cherkaski, Hamid Hacene; Denguezli, Meriam; Elbiaze, Mohammed; Elsony, Asma; Franssen, Frits M E; Ghobain, Mohammed Al; Harrabi, Imed; Janson, Christer; Jõgi, Rain; Juvekar, Sanjay; Lawin, Herve; Mannino, David; Mortimer, Kevin; Nafees, Asaad Ahmed; Nielsen, Rune; Obaseki, Daniel; Paraguas, Stefanni Nonna M; Rashid, Abdul; Loh, Li-Cher; Salvi, Sundeep; Seemungal, Terence; Studnicka, Michael; Tan, Wan C.; Wouters, Emiel E.; Barbara, Cristina; Gislason, Thorarinn; Gunasekera, Kirthi; Burney, Peter; Amaral, Andre F.; BOLD Collaborative Research Group; Dias, Hermínia Brites
    Background: Small airway obstruction is a common feature of obstructive lung diseases. Research is scarce on small airway obstruction, its global prevalence, and risk factors. We aimed to estimate the prevalence of small airway obstruction, examine the associated risk factors, and compare the findings for two different spirometry parameters. Methods: The Burden of Obstructive Lung Disease study is a multinational cross-sectional study of 41 municipalities in 34 countries across all WHO regions. Adults aged 40 years or older who were not living in an institution were eligible to participate. To ensure a representative sample, participants were selected from a random sample of the population according to a predefined site-specific sampling strategy. We included participants' data in this study if they completed the core study questionnaire and had acceptable spirometry according to predefined quality criteria. We excluded participants with a contraindication for lung function testing. We defined small airways obstruction as either mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF25-75) less than the lower limit of normal or forced expiratory volume in 3 s to forced vital capacity ratio (FEV3/FVC ratio) less than the lower limit of normal. We estimated the prevalence of pre-bronchodilator (ie, before administration of 200 μg salbutamol) and post-bronchodilator (ie, after administration of 200 μg salbutamol) small airways obstruction for each site. To identify risk factors for small airway obstruction, we performed multivariable regression analyses within each site and pooled estimates using random-effects meta-analysis. Findings: 36 618 participants were recruited between Jan 2, 2003, and Dec 26, 2016. Data were collected from participants at recruitment. Of the recruited participants, 28 604 participants had acceptable spirometry and completed the core study questionnaire. Data were available for 26 443 participants for FEV3/FVC ratio and 25 961 participants for FEF25-75. Of the 26 443 participants included, 12 490 were men and 13 953 were women. Prevalence of pre-bronchodilator small airways obstruction ranged from 5% (34 of 624 participants) in Tartu, Estonia, to 34% (189 of 555 participants) in Mysore, India, for FEF25-75, and for FEV3/FVC ratio it ranged from 5% (31 of 684) in Riyadh, Saudi Arabia, to 31% (287 of 924) in Salzburg, Austria. The prevalence of post-bronchodilator small airway obstruction was universally lower. Risk factors significantly associated with an FEV3/FVC ratio less than the lower limit of normal included increasing age, low BMI, active and passive smoking, low level of education, working in a dusty job for more than 10 years, previous tuberculosis, and family history of chronic obstructive pulmonary disease. Results were similar for FEF25-75, except for increasing age, which was associated with reduced odds of small airway obstruction. Interpretation: Despite the wide geographical variation, small airway obstruction is common and more prevalent than chronic airflow obstruction worldwide. Small airway obstruction shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether small airway obstruction is also associated with respiratory symptoms and lung function decline. Funding: National Heart and Lung Institute and Wellcome Trust. Translations: For the Dutch, Estonian, French, Icelandic, Malay, Marathi, Norwegian, Portuguese, Swedish, and Urdu translations of the abstract see the Supplementary Materials section.
    2023-01Journal article Open access Show more