Lung function variability and the burden of COPD and lung restriction in South Africa and Burkina Faso: results from the AWI-Gen study
- 1Division of Public Health and Epidemiology, School of Medical Sciences, University of Leicester, UK
Abstract
BackgroundPopulation-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.
MethodsWe 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 (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC<0.70 and lung restriction as FEV1/FVC[≥]0.70, with FVC<80% predicted. We used multivariable models to test factors associated with lung function measurements (FEV1, FVC and FEV1/FVC), COPD and lung restriction.
ResultsMedian FEV1 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 FEV1, FVC and FEV1/FVC. HIV infection was associated with higher COPD odds (OR 1.67, 95% CI 1.01-2.72) and lower FEV1/FVC. Hypertension was associated with higher lung restriction odds (OR 1.46, 95% CI 1.07-2.00) and lower FEV1 and FVC. Diabetes was associated with lower COPD odds (OR 0.50, 95% CI 0.24-0.94), lower FVC and higher FEV1/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).
ConclusionThis 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.
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BibTeX
@misc{adonyo2026lung,
title = {{Lung function variability and the burden of COPD and lung restriction in South Africa and Burkina Faso: results from the AWI-Gen study}},
author = {E. Adonyo and J. Chen and C. John and R. Packer and M. Ramsay and C. Batini and R. v. Zyl-Smit and M. Mer and P. R. Boua and G. Agongo and F. X. Gomez-Olive and R. G. Mashaba and M. D. Tobin and A. L. Guyatt and L. Micklesfield},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.22.26363668},
url = {https://www.medrxiv.org/content/10.64898/2026.09.22.26363668v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Lung function variability and the burden of COPD and lung restriction in South Africa and Burkina Faso: results from the AWI-Gen study
AU - E. Adonyo
AU - J. Chen
AU - C. John
AU - R. Packer
AU - M. Ramsay
AU - C. Batini
AU - R. v. Zyl-Smit
AU - M. Mer
AU - P. R. Boua
AU - G. Agongo
AU - F. X. Gomez-Olive
AU - R. G. Mashaba
AU - M. D. Tobin
AU - A. L. Guyatt
AU - L. Micklesfield
PY - 2026
DA - 2026/09/22
PB - medRxiv
DO - 10.64898/2026.09.22.26363668
UR - https://www.medrxiv.org/content/10.64898/2026.09.22.26363668v1
AB - BackgroundPopulation-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. MethodsWe 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 (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC<0.70 and lung restriction as FEV1/FVC[≥]0.70, with FVC<80% predicted. We used multivariable models to test factors associated with lung function measurements (FEV1, FVC and FEV1/FVC), COPD and lung restriction. ResultsMedian FEV1 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 FEV1, FVC and FEV1/FVC. HIV infection was associated with higher COPD odds (OR 1.67, 95% CI 1.01-2.72) and lower FEV1/FVC. Hypertension was associated with higher lung restriction odds (OR 1.46, 95% CI 1.07-2.00) and lower FEV1 and FVC. Diabetes was associated with lower COPD odds (OR 0.50, 95% CI 0.24-0.94), lower FVC and higher FEV1/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). ConclusionThis 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.
ER -