Research

Five-year follow-up of participants diagnosed with chronic airflow obstruction in a South African Burden of Obstructive Lung Disease (BOLD) survey

B W Allwood, R Gillespie, M Bateman, H Olckers, L Taborda-Barata, G L Calligaro, R van Zyl-Smit, C B Cooper, N Beyers, E D Bateman

Abstract


Background. A community-based prevalence survey performed in two suburbs in Cape Town, South Africa (SA), in 2005, using the international Burden of Obstructive Lung Disease (BOLD) method, confirmed a prevalence of chronic airflow obstruction (CAO) in 23.1% of adults aged >40 years.

Objectives. To study the clinical course and prognosis over 5 years of patients with CAO identified in the 2005 survey.

Methods. Patients with CAO in 2005 were invited to participate. Standard BOLD and modified questionnaires were completed. Spirometry was performed using spirometers of the same make as in 2005.

Results. Of 196 eligible participants from BOLD 2005, 45 (23.0%) had died, 8 from respiratory causes, 10 from cardiovascular causes and 6 from other known causes, while in 21 cases the cause of death was not known. On multivariate analysis, only age and Global initiative for Obstructive Lung Disease (GOLD) stage 4 disease at baseline were significantly associated with death. Of the 151 survivors, 11 (5.6% of the original cohort) were unavailable and 33 (16.8%) declined or had medical exclusions. One hundred and seven survivors were enrolled in the follow-up study (54.6%, median age 63.1 years, 45.8% males). Post-bronchodilator spirometry performed in 106 participants failed to confirm CAO, defined as a forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of <0.7, in 16 participants (15.1%), but CAO was present in 90. The median decline in FEV1 was 28.9 mL/year (interquartile range –54.8 - 0.0) and was similar between GOLD stages. The median total decline in FVC was 75 mL, and was significantly greater in GOLD stage 1 (–350 mL) than in stages 2 or 3 (–80  mL and +140 mL, respectively; p<0.01). Fifty-eight participants with CAO in 2005 (64.4%) remained in the same GOLD stage, while 21 (23.3%) deteriorated and 11 (12.2%) improved by ≥1 stage. Only one-third were receiving any treatment for chronic obstructive pulmonary disease (COPD).

Conclusions. The prevalence, morbidity and mortality of CAO and COPD in SA are high and the level of appropriate treatment is very low, pointing to underdiagnosis and inadequate provision of and access to effective treatments and preventive strategies for this priority chronic non-communicable disease.

 


Authors' affiliations

B W Allwood, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa; Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

R Gillespie, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa

M Bateman, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa

H Olckers, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa

L Taborda-Barata, CICS – Health Sciences Research Centre, University of Beira Interior, Portugal

G L Calligaro, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa

R van Zyl-Smit, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa

C B Cooper, David Geffen School of Medicine, University of California, Los Angeles, USA; and Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

N Beyers, David Geffen School of Medicine, University of California, Los Angeles, USA; and Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

E D Bateman, Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Cape Town Lung Institute, South Africa

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Keywords

Chronic obstructive lung disease; Burden of Obstructive Lung Disease; BOLD; Follow-up; Progression; Tuberculosis; lung function

Cite this article

South African Medical Journal 2018;108(2):138-143. DOI:10.7196/SAMJ.2018.v108i2.12688

Article History

Date submitted: 2018-02-01
Date published: 2018-02-01

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