Chronic Obstructive Pulmonary Disease (COPD) is currently defined by the findings of a spirometry test. It is vastly under-diagnosed in low- and middle-income countries, but the WHO estimates show that 64 million people had COPD in 2004, and 3 million people died – 90% of them in low-income countries. Smoking is the primary cause, so when the number of tobacco uses increases, so does the burden of COPD.
While the disease-specific prevalence of respiratory diseases varies from one region to another, they are present in all regions and account for 15 to 20% of the global burden of disease, in terms of DALYs lost. The WHO projects that COPD will become the 3rd most common cause of death by 2030. Respiratory diseases are among the five most frequent causes of seeking care in the health services in every location.
The Burden of Lung Disease (BOLD) Initiative
The BOLD Initiative was launched by a team of international researchers to address the lack of data on the health, economic and social impact of Chronic Obstructive Lung Disease (COPD), with emphasis on low- and middle-income countries. The initiative developed a platform that provides a basis for local studies with standardised methods and a coordinated approach.
BOLD's objectives are to measure the global prevalence and burden of COPD; assess its main causes in different environments; assess the burden in relation to impaired quality of life, limitations on activity, respiratory symptoms and use of health services; provide input for an economic model of COPD; and assess the appropriateness of care provided.
The principal investigators for BOLD are Prof Sonia Buist of Oregon Health and Science University (USA) Prof Peter Burney and Dr Richard Hooper from Imperial College (UK), and Prof Nadia Aït-Khaled of The Union. Prof Aït-Khaled also serves on the Executive Committee, and The Union's Dr Chiang Chen-Yuan serves on the Advisory Board of this important study.
COPD Working Groups
The Union's Lung Health Scientific Section established a "COPD in the Maghreb Working Group" which conducted a prevalence survey of COPD in Annaba, Algeria. They found a 17% prevalence of the disease in this city.
Another outcome of this working group was the creation of a second Union working group on this topic: " COPD in low- and middle-income countries" led by Prof Peter Burney to promote inclusion of these countries in the BOLD study. Four investigators from the COPD in the Maghreb began the BOLD study (2 centres in Algeria, 1 in Tunisia and 1 in Morocco).