33 research outputs found
Respiratory symptoms and chronic obstructive pulmonary disease : prevalence and risk factors in a predominantly low-income urban area of Cape Town, South Africa
No full textIncludes bibliographical references.The continuing worldwide increase in the incidence of chronic obstructive pulmonary disease (COPD) has led to international initiatives to improve surveillance and identify preventable risk factors for this and related chronic lung diseases. The studies reported here aimed to examine the prevalence and risk factors for respiratory symptoms and COPD; to introduce and test surveillance methodologies; and to inform treatment and control measures for this disease. The Lung Health Survey 2002 sampled 3512 individuals aged ≥ 15 years from an urban population of 36,334 in the predominantly low-income area of Ravensmead and Uitsig, Cape Town, South Africa. Information on respiratory symptoms, risk factors and healthcare utilisation was collected using a respiratory questionnaire which included questions that had been validated elsewhere. In 2005, a subsample of 960 persons aged ≥ 40 years participated in the Burden of Obstructive Lung Disease (BOLD) study comprised of a questionnaire and pre and postbronchodilator spirometry, in order to assess the prevalence of COPD. A high prevalence of respiratory symptoms of 38.3% was reported. Tobacco smoking showed a consistent positive association with chronic bronchitis, wheeze, dyspnoea and cough. Strong associations with cannabis smoking, pulmonary tuberculosis, occupational exposures and low socioeconomic status were found. The association of cannabis smoking with respiratory symptoms suggest that it may be a risk factor for COPD. The BOLD study revealed an exceptionally high prevalence of COPD in both men and women aged 40 years and older (29% and 20%, respectively) reflecting the very high prevalence of smoking in both sexes in the test area. The majority of those affected had moderate to severe disease, that is, symptoms with spirometric impairment (GOLD Stage II and higher). Even non-smoking women had a comparatively high prevalence of CO PO (12.6%), attributable to other risk factors such as tuberculosis and occupational exposures. Previous pulmonary tuberculosis was shown to be a strong predictor of COPD, which warrants further study. Review of healthcare utilisation confirmed significant under-recognition and under-treatment within local health services. These results confirm the need to prioritise preventative and treatment strategies for obstructive lung disease in South Africa
Quality of Spirometry tests performed by 9893 adults in 14 countries: The BOLD Study
No full textSummaryObjectiveto determine the ability of participants in the Burden of Obstructive Lung Disease (BOLD) study to meet quality goals for spirometry test session quality and to assess factors contributing to good quality.MethodsFollowing 2 days of centralized training, spirometry was performed pre- and post-bronchodilator (BD) at 14 international sites, in random population-based samples of persons aged ≥40 years, following a standardized protocol. The quality of each test session was evaluated by the spirometer software and an expert reading center. Descriptive statistics were calculated for key maneuver acceptability variables. A logistic regression model identified the predictors of acceptable quality test sessions.ResultsAbout 96% of test sessions met our quality goals for a low back-extrapolated volume (BEV), time to peak flow (PEFT), and end-of-test volume (EOTV). The mean forced expiratory time (FET) was 10.4 s. Ninety percent of the maneuvers with the highest FVC had a forced expiratory time (FET) > 6.8 s. About 90% of test sessions had FEV1 and FVC which were repeatable within 150 mL. Test quality was slightly better for post-BD test sessions when compared to pre-BD. Independent predictors of adequate test quality included female sex, younger age, higher education, lack of dyspnea, higher pre-BD FEV1, less BD responsiveness, and study site.ConclusionsQuality goals for spirometry tests were met about 90% of the time in these population-based samples of adults from several countries
Risk factors for respiratory symptoms: A community survey
No full textPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: [email protected] En Kindergesondhei
Multi-ethnic reference values for spirometry for the 3-95-yr age range: The global lung function 2012 equations
No full textThe aim of the Task Force was to derive continuous prediction equations and their lower limits of normal for spirometric indices, which are applicable globally. Over 160,000 data points from 72 centres in 33 countries were shared with the European Respiratory Society Global Lung Function Initiative. Eliminating data that could not be used (mostly missing ethnic group, some outliers) left 97,759 records of healthy nonsmokers (55.3% females) aged 2.5-95 yrs. Lung function data were collated and prediction equations derived using the LMS method, which allows simultaneous modelling of the mean (mu), the coefficient of variation (sigma) and skewness (lambda) of a distribution family. After discarding 23,572 records, mostly because they could not be combined with other ethnic or geographic groups, reference equations were derived for healthy individuals aged 3-95 yrs for Caucasians (n=57,395), African-Americans (n=3,545), and North (n=4,992) and South East Asians (n=8,255). Forced expiratory value in 1 s (FEV1) and forced vital capacity (FVC) between ethnic groups differed proportionally from that in Caucasians, such that FEV1/FVC remained virtually independent of ethnic group. For individuals not represented by these four groups, or of mixed ethnic origins, a composite equation taken as the average of the above equations is provided to facilitate interpretation until a more appropriate solution is developed. Spirometric prediction equations for the 3-95-age range are now available that include appropriate age-dependent lower limits of normal. They can be applied globally to different ethnic groups. Additional data from the Indian subcontinent and Arabic, Polynesian and Latin American countries, as well as Africa will further improve these equations in the future. Copyright©ERS 2012
Through a glass darkly?': An enquiry into HIV prevalence on Stellenbosch wine farms
No full textDespite the complex and often highly specific nature of the social aspects of the HIV/AIDS pandemic, many projects working in the field do not base their strategies on local evidence, given the paucity of suitable local-level data as well as the presences of organisational constraints. A project offering HIV testing to farm-based communities in Stellenbosch is a case in point. While no prevalence data exists for this sub-population, the assumption was that there may be high levels of infection, following the organisation's experience of AIDS-related illnesses on these farms and the social conditions on wine farms which were thought to produce vulnerability for infection. Some in the organisation also thought that farm-based communities battled to access healthcare. During the first year of providing voluntary counselling and testing (VCT) on wine farms, however, the Stellenbosch Hospice's Farms Project consistently found lower than expected levels of HIV infection. This gave rise to the question being addressed in this thesis - which is what can be 'known' about HIV prevalence in a sub-population for whom there is no evidence-based prevalence data. In practical terms, if modestly-funded local-level organisations1 were able to undertake accessible forms of research, what would they be able to surmise about HIV prevalence among proposed beneficiaries? Taking an unusual approach to research on prevalence, this study employs a minimally positivist approach to investigate what can be 'known' about HIV prevalence on wine farms in the Stellenbosch area. It does so by 1 This term is used to include various forms of organisations - be they nongovernmental, non-profit or service organisations - which are small, relatively survivalist organisations. It may be a church-based organisation, a large communitybased healthcare organisation or a service organisation like a hospice. I do so to differentiate it from the larger, professionalised non-governmental organisations (NGO) which frequently have research capacity. My notional organisation is also not a community-based organisation (CBO), however, which are largely membership-based and whose access to their locations is usually more organic and embedded, while NPOs are invariably staffed by people who do not necessarily live in the locations in which they are intervening. vi triangulating data from the four sources that such an organisation might use, had they the capacity. These sources are published statistics and published articles, the opinions of local 'experts', and their own organisational data - in this case the first year of Farms Project's results. Significantly this does not include the more conventional surveys and statistical modelling, which is beyond this kind of organisation's capacity. After reviewing publicly available prevalence data and showing that there are none for this sub-sector, this study probes the HIV 'risk' and related prevalence data associated with issues of poverty, gender relations, 'race' and alcohol consumption on Stellenbosch wine farms. In addition it presents prevalence data from a sample of farms as well as reviews HIV 'risk' and prevalence in rural areas nationally. In doing so, it critiques the causal links often made between the kinds of social conditions found on farms and HIV infection. On the basis of the data considered and the methods used, the study finds that levels of HIV infection on farms could be expected to be lower than the average prevalence in the Stellenbosch health sub-district. It cautions, however, that this finding is not conclusive, not least as it was unable to consider some significant social conditions - like the movement of people, and effects of socially conscious farmers and the services they provide. In addition it is not generalisable to other South African farms, given the particularity of wine farms and of the Western Cape. The study concludes by noting the limited value of prevalence data to project design, given the range of factors that can affect it at any time, and that it necessarily masks variation within an area or sub-population. While prevalence is useful as a starting point in project design, it is important to disaggregate where infection lies through an analysis of key social conditions. The study concludes by highlighting the importance of this finer analysis for project design in order to avoid strategies founded on poor assumptions, while recognising the difficulty of this for modest organisations
Prevalence of COPD and tobacco smoking in Tunisia - Results from the BOLD study
No full textIn Tunisia, there is a paucity of population-based data on Chronic Obstructive Pulmonary Disease (COPD) prevalence. To address this problem, we estimated the prevalence of COPD following the Burden of Lung Disease Initiative. We surveyed 807 adults aged 40+ years and have collected information on respiratory history and symptoms, risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Six hundred and sixty one (661) subjects were included in the final analysis. The prevalence of GOLD Stage I and II or higher COPD were 7.8% and 4.2%, respectively (Lower Limit of Normal modified stage I and II or higher COPD prevalence were 5.3% and 3.8%, respectively). COPD was more common in subjects aged 70+ years and in those with a BMI < 20 kg/m2. Prevalence of stage I+ COPD was 2.3% in <10 pack years smoked and 16.1% in 20+ pack years smoked. Only 3.5% of participants reported doctor-diagnosed COPD. In this Tunisian population, the prevalence of COPD is higher than reported before and higher than self-reported doctor-diagnosed COPD. In subjects with COPD, age is a much more powerful predictor of lung function than smoking
A systematic review of the association between pulmonary tuberculosis and the development of chronic airflow obstruction in adults
No full textIncludes abstract.Includes bibliographical references.Pulmonary tuberculosis (TB) as a cause of COPD is debated, with some, but not all evidence suggesting an association between the two conditions. Aim: To systematically review evidence for the association between pulmonary tuberculosis and the development of chronic obstructive pulmonary disease. We performed a systematic review of original English language, peer-reviewed literature using the PUBMED/MEDLINE database. Chronic Airflow Obstruction was defined on spirometric data (FEV1: FVC Ratio < 0.70; or FEV1: FVC Ratio < lower limit of normal for age, with or without bronchodilator use). Conclusions: Evidence was found for an association between a past history of tuberculosis and the presence of COPD. This association is independent of cigarette smoking. Causality is likely but cannot be assumed
Bronchodilator Responsiveness From 14 Countries: Population-based Rates And Correlates From The Burden Of Obstructive Lung Disease (BOLD) Study
No full textChronic obstructive pulmonary disease mortality and prevalence: the associations with smoking and poverty—a BOLD analysis
No full textBackground Chronic obstructive pulmonary disease (COPD) is a commonly reported cause of death and associated with smoking. However, COPD mortality is high in poor countries with low smoking rates. Spirometric restriction predicts mortality better than airflow obstruction, suggesting that the prevalence of restriction could explain mortality rates attributed to COPD. We have studied associations between mortality from COPD and low lung function, and between both lung function and death rates and cigarette consumption and gross national income per capita (GNI).
Methods National COPD mortality rates were regressed against the prevalence of airflow obstruction and spirometric restriction in 22 Burden of Obstructive Lung Disease (BOLD) study sites and against GNI, and national smoking prevalence. The prevalence of airflow obstruction and spirometric restriction in the BOLD sites were regressed against GNI and mean pack years smoked.
Results National COPD mortality rates were more strongly associated with spirometric restriction in the BOLD sites (<60 years: men rs=0.73, p=0.0001; women rs=0.90, p<0.0001; 60+ years: men rs=0.63, p=0.0022; women rs=0.37, p=0.1) than obstruction (<60 years: men rs=0.28, p=0.20; women rs=0.17, p<0.46; 60+ years: men rs=0.28, p=0.23; women rs=0.22, p=0.33). Obstruction increased with mean pack years smoked, but COPD mortality fell with increased cigarette consumption and rose rapidly as GNI fell below US15 000.
Conclusions Smoking remains the single most important cause of obstruction but a high prevalence of restriction associated with poverty could explain the high ‘COPD’ mortality in poor countries
