medRxiv : the preprint server for health sciences · 2026
Lung function variability and the burden of COPD and lung restriction in South Africa and Burkina Faso: results from the AWI-Gen study.
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Adonyo Emmanuel, Chen Jing, John Catherine, Packer Richard, Ramsay Michele, Batini Chiara, van Zyl-Smit Richard, Mer Mervyn, Boua Palwende Romuald, Agongo Godfred, Gómez-Olivé F Xavier, Mashaba Reneilwe Given, Tobin Martin D, Guyatt Anna L, Micklesfield Lisa K
Аннотация
BACKGROUND: Population-based spirometry data from sub-Saharan Africa remain limited. We characterised lung function, chronic obstructive pulmonary disease (COPD), lung restriction and associated factors from two Sub-Saharan African countries.
METHODS: We performed spirometry using ndd Easy On-PC spirometers among adults aged ≥40 years from population-based cohorts in four communities in Burkina Faso and South Africa from January 2019-April 2022. We included 1,619 participants (936 women, 683 men) with repeatable forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC). COPD was defined as FEV 1 /FVC<0.70 and lung restriction as FEV 1 /FVC≥0.70, with FVC<80% predicted. We used multivariable models to test factors associated with lung function measurements (FEV 1 , FVC and FEV 1 /FVC), COPD and lung restriction.
RESULTS: Median FEV 1 and FVC ranged from 1.940-2.273L and 2.521-2.883L, respectively. COPD prevalence was 16.1% (95% CI 14.4-18.0; site range 10.8%-24.5%) and lung restriction prevalence was 21.3% (95% CI 19.4-23.4; site range 11.3%-36.2%). Prior tuberculosis was associated with higher odds of COPD (OR 2.86, 95% CI 1.75-4.59) and lower FEV 1 , FVC and FEV 1 /FVC. HIV infection was associated with higher COPD odds (OR 1.67, 95% CI 1.01-2.72) and lower FEV 1 /FVC. Hypertension was associated with higher lung restriction odds (OR 1.46, 95% CI 1.07-2.00) and lower FEV 1 and FVC. Diabetes was associated with lower COPD odds (OR 0.50, 95% CI 0.24-0.94), lower FVC and higher FEV 1 /FVC. Ever-smoking and older age were associated with higher COPD odds (OR 2.21, 95% CI 1.48-3.32; OR 1.05, 95% CI 1.03-1.07, respectively); older age was associated with higher lung restriction odds (OR 1.02, 95% CI 1.00-1.04).
CONCLUSION: This multisite study highlights substantial heterogeneity in COPD and lung restriction prevalence across African populations and identifies respiratory multimorbidity with infectious and cardiometabolic conditions. These findings provide population-based evidence to inform respiratory surveillance in sub-Saharan Africa.
METHODS: We performed spirometry using ndd Easy On-PC spirometers among adults aged ≥40 years from population-based cohorts in four communities in Burkina Faso and South Africa from January 2019-April 2022. We included 1,619 participants (936 women, 683 men) with repeatable forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC). COPD was defined as FEV 1 /FVC<0.70 and lung restriction as FEV 1 /FVC≥0.70, with FVC<80% predicted. We used multivariable models to test factors associated with lung function measurements (FEV 1 , FVC and FEV 1 /FVC), COPD and lung restriction.
RESULTS: Median FEV 1 and FVC ranged from 1.940-2.273L and 2.521-2.883L, respectively. COPD prevalence was 16.1% (95% CI 14.4-18.0; site range 10.8%-24.5%) and lung restriction prevalence was 21.3% (95% CI 19.4-23.4; site range 11.3%-36.2%). Prior tuberculosis was associated with higher odds of COPD (OR 2.86, 95% CI 1.75-4.59) and lower FEV 1 , FVC and FEV 1 /FVC. HIV infection was associated with higher COPD odds (OR 1.67, 95% CI 1.01-2.72) and lower FEV 1 /FVC. Hypertension was associated with higher lung restriction odds (OR 1.46, 95% CI 1.07-2.00) and lower FEV 1 and FVC. Diabetes was associated with lower COPD odds (OR 0.50, 95% CI 0.24-0.94), lower FVC and higher FEV 1 /FVC. Ever-smoking and older age were associated with higher COPD odds (OR 2.21, 95% CI 1.48-3.32; OR 1.05, 95% CI 1.03-1.07, respectively); older age was associated with higher lung restriction odds (OR 1.02, 95% CI 1.00-1.04).
CONCLUSION: This multisite study highlights substantial heterogeneity in COPD and lung restriction prevalence across African populations and identifies respiratory multimorbidity with infectious and cardiometabolic conditions. These findings provide population-based evidence to inform respiratory surveillance in sub-Saharan Africa.