Lung function variability and the burden of COPD and lung restriction in South Africa and Burkina Faso: results from the AWI-Gen study

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Abstract Background Population–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. Methods We 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 (FEV 1 ) and forced vital capacity (FVC). COPD was defined as FEV 1 /FVC<0.70 and lung restriction as FEV 1 /FVC<0.70, with FVC<80% predicted. We used multivariable models to test factors associated with lung function measurements (FEV 1 , FVC and FEV 1 /FVC), COPD and lung restriction. Results Median FEV 1 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 FEV 1 , FVC and FEV 1 /FVC. HIV infection was associated with higher COPD odds (OR 1.67, 95% CI 1.01—2.72) and lower FEV 1 /FVC. Hypertension was associated with higher lung restriction odds (OR 1.46, 95% CI 1.07—2.00) and lower FEV 1 and FVC. Diabetes was associated with lower COPD odds (OR 0.50, 95% CI 0.24—0.94), lower FVC and higher FEV 1 /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). Conclusion This 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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