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Small airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study

2023-01Journal article Open access
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dc.contributor.authorKnox-Brown, Ben
dc.contributor.authorPatel, Jaymini
dc.contributor.authorPotts, James
dc.contributor.authorAhmed, Rana
dc.contributor.authorAquart-Stewart, Althea
dc.contributor.authorCherkaski, Hamid Hacene
dc.contributor.authorDenguezli, Meriam
dc.contributor.authorElbiaze, Mohammed
dc.contributor.authorElsony, Asma
dc.contributor.authorFranssen, Frits M E
dc.contributor.authorGhobain, Mohammed Al
dc.contributor.authorHarrabi, Imed
dc.contributor.authorJanson, Christer
dc.contributor.authorJõgi, Rain
dc.contributor.authorJuvekar, Sanjay
dc.contributor.authorLawin, Herve
dc.contributor.authorMannino, David
dc.contributor.authorMortimer, Kevin
dc.contributor.authorNafees, Asaad Ahmed
dc.contributor.authorNielsen, Rune
dc.contributor.authorObaseki, Daniel
dc.contributor.authorParaguas, Stefanni Nonna M
dc.contributor.authorRashid, Abdul
dc.contributor.authorLoh, Li-Cher
dc.contributor.authorSalvi, Sundeep
dc.contributor.authorSeemungal, Terence
dc.contributor.authorStudnicka, Michael
dc.contributor.authorTan, Wan C.
dc.contributor.authorWouters, Emiel E.
dc.contributor.authorBarbara, Cristina
dc.contributor.authorGislason, Thorarinn
dc.contributor.authorGunasekera, Kirthi
dc.contributor.authorBurney, Peter
dc.contributor.authorAmaral, Andre F.
dc.contributor.authorBOLD Collaborative Research Group
dc.contributor.authorDias, Hermínia Brites
dc.date.accessioned2023-05-23T08:41:35Z
dc.date.available2023-05-23T08:41:35Z
dc.date.issued2023-01
dc.description.abstractBackground: 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.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationKnox-Brown B, Patel J, Potts J, Ahmed R, Aquart-Stewart A, Cherkaski HH, et al; BOLD Collaborative Research Group [Dias HB]. Small airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study. Lancet Glob Health. 2023;11(1):e69-e82.pt_PT
dc.identifier.doi10.1016/S2214-109X(22)00456-9pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.21/16108
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00456-9/fulltextpt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectChronic obstructive pulmonary diseasept_PT
dc.subjectSmall airways obstructionpt_PT
dc.subjectForced expiratory volumept_PT
dc.subjectBronchodilator agentspt_PT
dc.subjectVital capacitypt_PT
dc.subjectRisk factorspt_PT
dc.subjectSpirometrypt_PT
dc.subjectAdverse effectspt_PT
dc.titleSmall airways obstruction and its risk factors in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPagee82pt_PT
oaire.citation.issue1pt_PT
oaire.citation.startPagee69pt_PT
oaire.citation.titleThe Lancet Global Healthpt_PT
oaire.citation.volume11pt_PT
person.familyNameDias
person.givenNameMaria Hermínia Monteiro Brites
person.identifier.ciencia-idE211-FB1B-04E3
person.identifier.orcid0000-0003-1257-8734
person.identifier.ridAFL-8310-2022
person.identifier.scopus-author-id55671930200
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationb7b7e7d9-83b2-4d63-9176-4ed73cf6b939
relation.isAuthorOfPublication.latestForDiscoveryb7b7e7d9-83b2-4d63-9176-4ed73cf6b939

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