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

Objective: Chronic lung disease is one of the most common causes of death in the world and is particularly high in low income countries. Despite this, there is very little research on the subject and almost none in low income countries that uses adequate quality assurance for the measurement 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 in KEMHRC, VRHP was one of the sites from India. BOLD II will follow up 15,000 of those people in 20 sites (includes KEMHRC, VRHP site) in 15 low- or middle-income countries and aims to 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 BOLD II study will investigate several possible risk factors that may be important for determining lung health in low income countries focussing particularly on diet and exposure to unregulated industries. 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 were found in the baseline study. This study is supported by National Heart and Lung Institute, Imperial College London.

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