Burden of Obstructive Lung Disease Follow-up in low/middle income countries (BOLD II)

低/中等收入国家阻塞性肺疾病随访的负担（BOLD II）

• 批准号: MR/R011192/1
• 负责人: Peter Burney
• 金额: $ 152.65万
• 依托单位: Imperial College London
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR011192%2F1
• 关键词: Burden; Obstructive; Lung; Disease; Follow

Chronic lung disease is one of the most common causes of death in the world and is particularly high in low income countries. In spite of this there is very little research on the subject and almost none in low income countries that uses adequate quality assurance for the measurements of lung function. The baseline BOLD study measured lung function and collected information on the background, exposures, symptoms, quality of life and treatment of more than 31,000 people in 44 sites in 36 countries.The results of the study so far have shown that many of the assumptions that have been made about chronic lung disease in these countries (and in high income countries also) may be wrong. The prevalence of narrowing of the airways (obstructive spirometry) alone does not explain the high mortality estimated for these diseases in low income settings. A more likely explanation for the high mortality ascribed to chronic lung disease is the smaller size of lungs (restrictive spirometry). This pattern of lung function has largely been ignored for the last half century but a high mortality in those with low lung volumes has been observed in the United States and can explain the higher mortality seen in African Americans who also have smaller lungs on average than white Americans. Although there is no direct evidence for this at the current time, this seems to be the most likely explanation for the high recorded mortality from COPD in South Asia, South-East Asia and Sub-Saharan Africa. Understanding whether this is the case or not is, however, critical for deciding the emphasis of future research and future health policy as obstructive and restrictive diseases have different risk factors and will require different preventive and treatment strategies.This proposal, which will follow up 15,000 people in 20 sites in 15 low or middle income countries, will answer four important questions. First, how far the high mortality from Chronic Respiratory Disease is associated with narrow airways (obstructive disease) or small lungs (restrictive disease). Second how far the low level of lung function found in older people in poorer countries is due to changes in early life that they have never recovered from, or whether their lung function continues to decline more rapidly in later life. Third whether people with poor lung function in low income countries die from respiratory failure or whether the increased risk of death is also due to a higher mortality from heart disease and related problems, as seems to be the case in richer countries. Finally the study will investigate a number of possible risk factors that we believe are important for determining lung health in low income countries focussing particularly on diet and exposure to unregulated industries. Although smoking is by far the most important risk factor for chronic obstruction of the airways there are countries that have been exposed to very little tobacco and yet still have substantial problems with respiratory disease. Other risk factors that have been suggested such as smoke from cooking fires do not seem to explain this discrepancy. By collecting more detailed information in a highly standardised way and by investigating the effects of these and other risk factors on how they influence the rate of decline in lung function over time we will be able to improve considerably our ability to interpret the associations (and sometimes the lack of associations) that we have found in the earlier study.The centres included in this study cover a wide variety of environments and populations in East Asia, South Asia, Central Asia, North Africa, Sub-Saharan Africa and the Caribbean. All of the centres have shown that they are able to collect high quality data, and the co-ordinating centre at the National Heart and Lung Institute in London has a long history of managing large international studies of lung disease. An international advisory board will help to optimise dissemination of results.

慢性肺病是世界上最常见的死亡原因之一，在低收入国家尤其高。尽管如此，关于这个问题的研究很少，在低收入国家几乎没有一项研究使用足够的质量保证来测量肺功能。BOLD基线研究测量了36个国家44个地点的31，000多人的肺功能，并收集了有关背景、暴露、症状、生活质量和治疗的信息。迄今为止，研究结果表明，这些国家（以及高收入国家）对慢性肺病的许多假设可能是错误的。仅气道狭窄（阻塞性肺量计）的流行并不能解释低收入环境中这些疾病的高死亡率。慢性肺部疾病导致的高死亡率的一个更可能的解释是肺的尺寸较小（限制性肺量计）。在过去的半个世纪，这种肺功能模式在很大程度上被忽视了，但在美国观察到肺容量低的人的死亡率很高，这可以解释非洲裔美国人的死亡率高于白色美国人的原因，非洲裔美国人的肺平均也较小。虽然目前没有直接证据，但这似乎是南亚、东南亚和撒哈拉以南非洲COPD死亡率高的最可能解释。然而，了解情况是否如此，对于决定未来研究的重点和未来的卫生政策至关重要，因为阻塞性疾病和限制性疾病有不同的风险因素，需要不同的预防和治疗策略。该提案将对15个低收入或中等收入国家20个地点的15，000人进行随访，将回答四个重要问题。首先，慢性呼吸道疾病的高死亡率与狭窄的气道（阻塞性疾病）或小肺（限制性疾病）有多大的关系。第二，在较贫穷国家的老年人中发现的低水平肺功能在多大程度上是由于他们从未恢复的早期生活的变化，或者他们的肺功能是否在晚年继续更快地下降。第三，低收入国家肺功能差的人是否死于呼吸衰竭，或者死亡风险的增加是否也是由于心脏病和相关问题的死亡率较高，就像富裕国家的情况一样。最后，这项研究将调查一些可能的风险因素，我们认为这些因素对确定低收入国家的肺部健康很重要，特别是关注饮食和暴露于不受管制的行业。虽然吸烟是迄今为止造成呼吸道慢性阻塞的最重要危险因素，但有些国家接触的烟草很少，但呼吸道疾病问题仍然很严重。其他被认为的风险因素，如烹饪火灾产生的烟雾，似乎不能解释这种差异。通过以高度标准化的方式收集更详细的信息，并通过调查这些和其他风险因素对它们如何影响肺功能随时间下降的速率的影响，我们将能够大大提高我们解释相关性的能力。（有时缺乏联系）本研究中包括的中心涵盖了东亚、南亚、中亚、北非、撒哈拉以南非洲和加勒比。所有这些中心都表明，他们能够收集高质量的数据，位于伦敦的国家心肺研究所的协调中心在管理大型国际肺病研究方面有着悠久的历史。一个国际咨询委员会将有助于优化成果的传播。

项目成果

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study.

• DOI: 10.1093/ije/dyad146
• 发表时间: 2023-12-25
• 期刊: INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
• 影响因子: 7.7
• 作者: Amaral, Andre F. S.;Potts, James;Knox-Brown, Ben;Bagkeris, Emmanouil;Harrabi, Imed;Cherkaski, Hamid Hacene;Agarwal, Dhiraj;Juvekar, Sanjay;Anand, Mahesh Padukudru;Gislason, Thorarinn;Nafees, Asaad Ahmed;Mortimer, Kevin;Janson, Christer;Loh, Li Cher;Paraguas, Stefanni Nonna;Denguezli, Meriam;Al Ghobain, Mohammed;Mannino, David;Njoroge, Martin W.;Devereux, Graham;Seemungal, Terence;Barbara, Cristina;Kocabas, Ali;Ahmed, Rana;Aquart-Stewart, Althea;Studnicka, Michael;Welte, Tobias;Tan, Wan C.;van Zyl-Smit, Richard N.;Koul, Parvaiz;Garcia-Larsen, Vanessa;Minelli, Cosetta;Buist, A. Sonia;Burney, Peter
• 通讯作者: Burney, Peter

Forced Vital Capacity and Mortality in The BOLD Study: Preliminary Findings

BOLD 研究中的用力肺活量和死亡率：初步结果

• DOI: 10.1183/13993003.congress-2021.oa2870
• 发表时间: 2021
• 作者: Bagkeris E

Isolated small airways obstruction predicts future chronic airflow obstruction: a multinational longitudinal study.

• DOI: 10.1136/bmjresp-2023-002056
• 发表时间: 2023-11
• 期刊: BMJ open respiratory research
• 影响因子: 4.1

Changing lung function and associated health-related quality-of-life: A five-year cohort study of Malawian adults.

• DOI: 10.1016/j.eclinm.2021.101166
• 发表时间: 2021-11
• 期刊: EClinicalMedicine
• 影响因子: 15.1
• 作者: Njoroge MW;Mjojo P;Chirwa C;Rylance S;Nightingale R;Gordon SB;Mortimer K;Burney P;Balmes J;Rylance J;Obasi A;Niessen LW;Devereux G;IMPALA consortium
• 通讯作者: IMPALA consortium

Cohort profile: The Chikwawa lung health cohort; a population-based observational non-communicable respiratory disease study of adults in Malawi.

• DOI: 10.1371/journal.pone.0242226
• 发表时间: 2020
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Njoroge MW;Rylance S;Nightingale R;Gordon S;Mortimer K;Burney P;Rylance J;Obasi A;Niessen L;Devereux G;IMPALA Consortium
• 通讯作者: IMPALA Consortium