The Burden of Obstructive Lung Disease (BOLD), started by Dr Buist in the mid-1990s, was designed to quantify the prevalence of obstructive lung disease and to identify its risk factors across several regions in the world. It was later extended to cover most of the low-income regions of the world.
BOLD I has completed baseline data collection on over 30,000 adults from 42 sites, mostly in low- and middle-income countries. BOLD II is the follow up of participants in 20 low- and middle-income sites and 4 North European sites.
people in low-income regions of South Asia and Sub-Saharan Africa have smaller lungs than people in Europe.
airflow obstruction is most strongly associated with tobacco use and is less common in low-income regions.
other factors associated with obstruction of the airways include TB, working in a dusty job, a low body weight and poor education.
household air pollution does not explain the presence of chronic airway obstruction in low income countries.
If the lungs of people in low-income regions are small, is this because they were born with small lungs or the lungs are being damaged by the local environment?
If airway obstruction is not common in low-income regions, why are mortality rates from COPD so high?
Are the exposures associated with low lung function causing the problem or are they associated for some other reason?
Can the link between poverty and poor lung function be explained?