Prevalence of airflow obstruction and reduced forced vital capacity in an Aboriginal Australian population: the cross-sectional BOLD study

Nathania A. J. B. Cooksley*, David Atkinson, Guy B. Marks, Brett G. Toelle, David Reeve, David P. Johns, Michael J. Abramson, Deborah L. Burton, Alan L. James, Richard Wood-Baker, E. Haydn Walters, A. Sonia Buist, Graeme P. Maguire

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Background and objective: Mortality and hospital separation data suggest a higher burden of chronic obstructive pulmonary disease (COPD) in indigenous than non-indigenous subpopulations of high-income countries. This study sought to accurately measure the true prevalence of post-bronchodilator airflow obstruction and forced vital capacity reduction in representative samples of Indigenous and non-Indigenous Australians.

Methods: This study applies cross-sectional population-based survey of Aboriginal and non-Indigenous residents of the Kimberley region of Western Australia aged 40 years or older, following the international Burden Of Lung Disease (BOLD) protocol. Quality-controlled spirometry was conducted before and after bronchodilator. COPD was defined as Global initiative for chronic Obstructive Lung Disease (GOLD) Stage 2 and above (post-bronchodilator forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio

Results: Complete data were available for 704 participants. The prevalence of COPD, adjusted for age, gender and body weight in Aboriginal participants (7.2%, 95% confidence interval (CI) 3.9 to 10.4) was similar to that seen in non-Indigenous Kimberley participants (8.2%, 95% CI 5.7 to 10.7) and non-Indigenous residents of the remainder of Australia (7.1%, 95% CI 6.1 to 8.0). The prevalence of low FVC (<

80% predicted) was substantially higher in Aboriginal compared with non-Indigenous participants (74.0%, 95% CI 69.1 to 78.8, vs 9.7%, 95% CI 7.1 to 12.4).

Conclusions: Low FVC, rather than airflow obstruction, characterizes the impact of chronic lung disease previously attributed to COPD in this population subject to significant social and economic disadvantage. Environmental risk factors other than smoking as well as developmental factors must be considered. These findings require further investigation and have implications for future prevention of chronic lung disease in similar populations.

In Aboriginal Australians and similar populations subject to significant social and environmental disadvantage, differences in FVC may be so great that they translate to a clinically relevant reduction in baseline respiratory reserve. Low FVC may therefore characterize the impact of chronic lung disease previously attributed to COPD in Aboriginal Australians.

Original languageEnglish
Pages (from-to)766-774
Number of pages9
JournalRespirology
Volume20
Issue number5
DOIs
Publication statusPublished - Jul 2015
Externally publishedYes

Keywords

  • chronic obstructive pulmonary disease
  • indigenous population
  • race
  • respiratory function test
  • vital capacity

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