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Mueller A, Wouters EFM, Koul P, et al., 2024, Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study, Pulmonology, ISSN: 2531-0429
Nafees AA, Ali Y, Sadia A, et al., 2024, Assessing the Feasibility of a Multifaceted Intervention Package for Improving Respiratory Health of Textile Workers: Findings From the MultiTex Pilot Study in Karachi, Pakistan., Asia Pac J Public Health, Vol: 36, Pages: 202-209
We piloted the development and implementation of a multifaceted intervention package for improving respiratory health among textile workers using a pre-post design at six mills in Karachi. The intervention, implemented following a baseline survey (n = 498), included health and safety training of workers and managers, promotion of cotton dust control measures, and the provision of facemasks. Follow-up surveys were conducted at 1, 6, and 12 months post-intervention. Knowledge, attitude, and practice (KAP) scores and respiratory symptoms were assessed through a questionnaire and spirometry was conducted. The intervention was provided to 230 workers and led to an improvement in KAP scores that was more likely among workers with a higher educational status, spinners, smokers, those with a permanent employment status, working in morning shifts, and with ⩾5 years of textile experience. We found the intervention acceptable and feasible in these textile mills henceforth, trials are required to determine its effectiveness.
Abozid H, Patel J, Burney P, et al., 2024, Prevalence of chronic cough, its risk factors and population attributable risk in the Burden of Obstructive Lung Disease (BOLD) study: a multinational cross-sectional study, EClinicalMedicine, Vol: 68, ISSN: 2589-5370
Background:Chronic cough is a common respiratory symptom with an impact on daily activities and quality of life. Global prevalence data are scarce and derive mainly from European and Asian countries and studies with outcomes other than chronic cough. In this study, we aimed to estimate the prevalence of chronic cough across a large number of study sites as well as to identify its main risk factors using a standardised protocol and definition.Methods:We analysed cross-sectional data from 33,983 adults (≥40 years), recruited between Jan 2, 2003 and Dec 26, 2016, in 41 sites (34 countries) from the Burden of Obstructive Lung Disease (BOLD) study. We estimated the prevalence of chronic cough for each site accounting for sampling design. To identify risk factors, we conducted multivariable logistic regression analysis within each site and then pooled estimates using random-effects meta-analysis. We also calculated the population attributable risk (PAR) associated with each of the identifed risk factors.Findings:The prevalence of chronic cough varied from 3% in India (rural Pune) to 24% in the United States of America (Lexington,KY). Chronic cough was more common among females, both current and passive smokers, those working in a dusty job, those with a history of tuberculosis, those who were obese, those with a low level of education and those with hypertension or airflow limitation. The most influential risk factors were current smoking and working in a dusty job.Interpretation:Our findings suggested that the prevalence of chronic cough varies widely across sites in different world regions. Cigarette smoking and exposure to dust in the workplace are its major risk factors.Funding:Wellcome Trust.
Bhakta NR, Bime C, Kaminsky DA, et al., 2024, Reply to Haynes and to Wang., Am J Respir Crit Care Med, Vol: 209, Pages: 118-119
Nafees AA, Allana A, Kadir MM, et al., 2024, A cluster randomised controlled trial to reduce respiratory effects of cotton dust exposure among textile workers: the MultiTex RCT study., Eur Respir J, Vol: 63
BACKGROUND: We determined the effectiveness of an intervention to reduce cotton dust-related respiratory symptoms and improve lung function of textile workers. METHODS: We undertook a cluster randomised controlled trial at 38 textile mills in Karachi, Pakistan. The intervention comprised: training in occupational health for workers and managers, formation of workplace committees to promote a health and safety plan that included wet mopping and safe disposal of cotton dust, provision of simple face masks, and further publicity about the risks from cotton dust. Participating mills were randomised following baseline data collection. The impact of the intervention was measured through surveys at 3, 12 and 18 months using questionnaires, spirometry and dust measurements. The primary outcomes were 1) changes in prevalence of a composite respiratory symptom variable, 2) changes in post-bronchodilator percentage predicted forced expiratory volume in 1 s (FEV1) and 3) changes in cotton dust levels. These were assessed using two-level mixed effects linear and logistic regression. RESULTS: Of 2031 participants recruited at baseline, 807 (40%) were available at the third follow-up. At that point, workers in the intervention arm were more likely to report an improvement in respiratory symptoms (OR 1.58, 95% CI 1.06-2.36) and lung function (FEV1 % pred: β 1.31%, 95% CI 0.04-2.57%). Personal dust levels decreased, more so in intervention mills, although we did not observe this in adjusted models due to the small number of samples. CONCLUSION: We found the intervention to be effective in improving the respiratory health of textile workers and recommend scaling-up of such simple and feasible interventions in low- and middle-income countries.
Amaral A, Potts J, Knox-Brown B, et al., 2023, Cohort profile: Burden of Obstructive Lung Disease (BOLD) study, International Journal of Epidemiology, Vol: 52, Pages: e364-e373, ISSN: 0300-5771
Knox-Brown B, Potts J, Quintero Santofimio V, et al., 2023, Isolated small airways obstruction predicts future chronic airflow obstruction: A multinational longitudinal study, BMJ Open Respiratory Research, Vol: 10, ISSN: 2052-4439
Background Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life.Methods We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF25–75) if a result was less than the lower limit of normal (<LLN) in the presence of a normal forced expiratory volume in 1 s to FVC ratio (FEV1/FVC). We also used the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) to define small airways obstruction. We defined chronic airflow obstruction as post-bronchodilator FEV1/FVC<LLN. We performed mixed effects regression analyses to model the association between baseline isolated small airways obstruction and chronic airflow obstruction at follow-up. We assessed discriminative and predictive ability by calculating the area under the receiver operating curve (AUC) and Brier score. We replicated our analyses in 26 512 participants of the UK Biobank study.Results Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF25-75 less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV3/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF25-75 was better than the FEV3/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study.Conclusion Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.
Ahmed R, Osman R, Nightingale R, et al., 2023, Prevalence and determinants of chronic respiratory diseases in adults in rural Sudan, International Journal of Tuberculosis and Lung Disease, Vol: 27, Pages: 841-849, ISSN: 1027-3719
BACKGROUND: Chronic respiratory diseases (CRDs) greatly contribute to worldwide mortality. Despite new data emerging from Africa, prevalence estimates and determinants of CRDs in rural settings are limited. This study sought to extend the existing research conducted in urban Sudan by conducting a rural comparison.METHODS: Participants aged ≥18 years (n = 1,850), living in rural Gezira State completed pre-and post-bronchodilator spirometry and a questionnaire. Prevalence of respiratory symptoms and spirometric abnormalities were reported. Regression analyses were used to identify risk factors for CRDs.RESULTS: Prevalence of chronic airflow obstruction (CAO) was 4.1% overall and 5.5% in those aged ≥40 years. Reversibility was seen in 6.4%. Low forced vital capacity (FVC) was seen in 58.5%, and at least one respiratory symptom was present in 40.7% of the participants. CAO was more common among people aged 60–69 years (OR 2.07, 95% CI 1.13–3.82) and less common among highly educated participants (OR 0.50, 95% CI 0.27–0.93). Being underweight was associated with lower FVC (OR 3.07, 95% CI 2.24–4.20).CONCLUSIONS: A substantial burden of CRD exists among adults in rural Sudan. Investment in CRD prevention and management strategies is needed.
Patel J, Amaral A, Minelli C, et al., 2023, Chronic airflow obstruction attributable to poverty in the multinational Burden of Obstructive Lung Disease study, Thorax, Vol: 78, Pages: 942-945, ISSN: 0040-6376
Poverty is strongly associated with all-cause and chronic obstructive pulmonary disease (COPD) mortality. Less is known about the contribution of poverty to spirometrically defined chronic airflow obstruction (CAO) – a key characteristic of COPD. Using cross-sectional data from an asset-based questionnaire to define poverty in 21 sites of the Burden of Obstructive Lung Disease study, we estimated the risk of CAO attributable to poverty. Up to 6% of the population over 40 years had CAO attributable to poverty. Understanding the relationship between poverty and CAO might suggest ways to improve lung health, especially in low- and middle-income countries.
Burney P, Knox-Brown B, Amaral A, 2023, Addressing the origins and health effects of small lungs – Authors' reply, The Lancet Respiratory Medicine, Vol: 11, Pages: e74-e74, ISSN: 2213-2600
Knox-Brown B, Patel J, Potts J, et al., 2023, The association of spirometric small airways obstruction with respiratory symptoms, cardiometabolic diseases, and quality of life: Results from the Burden of Obstructive Lung Disease (BOLD) study, Respiratory Research, Vol: 24, ISSN: 1465-9921
Background:Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown.Methods:Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF25-75) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV1/FVC ≥ LLN).Results:Almost a fifth of the participants had spirometric SAO (19% for FEF25-75; 17% for FEV3/FVC). Using FEF25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77–2.70), chronic cough (OR = 2.56, 95% CI 2.08–3.15), chronic phlegm (OR = 2.29, 95% CI 1.77–4.05), wheeze (OR = 2.87, 95% CI 2.50–3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11–1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV3/FVC. Isolated spirometric SAO (10% for FEF25-75; 6% for FEV3/FVC), was also associated with respiratory symptoms and cardiovascular disease.Conclusion:Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF25-75 and FEV3/FVC, in addition to traditional spirometry parameters.
Burney P, Knox-Brown B, Amaral A, 2023, Small lung syndrome: the need to re-classify chronic lung disease, The Lancet Respiratory Medicine, Vol: 11, Pages: 405-406, ISSN: 2213-2600
Bhakta NR, Bime C, Kaminsky DA, et al., 2023, Race and Ethnicity in Pulmonary Function Test Interpretation An Official American Thoracic Society Statement, AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, Vol: 207, Pages: 978-995, ISSN: 1073-449X
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Nafees AA, Muneer MZ, Irfan M, et al., 2023, Byssinosis and lung health among cotton textile workers: baseline findings of the MultiTex trial in Karachi, Pakistan, OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, Vol: 80, Pages: 129-136, ISSN: 1351-0711
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Ratanachina J, Amaral A, De Matteis S, et al., 2023, Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study, European Respiratory Journal, Vol: 60, Pages: 1-16, ISSN: 0903-1936
Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study.We analysed cross-sectional data from 28,823 adults (≥40years) in 34 countries. Eleven occupations were considered and grouped by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, FEV1/FVC and FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income (GNI).Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20years were more likely to have chronic cough (OR=1.52, 95%CI 1.19-1.94), wheeze (OR=1.37, 95%CI 1.16-1.63), and dyspnoea (OR=1.83, 95%CI 1.53-2.20), but not lower FVC (β=0.02L, 95%CI -0.02L to 0.06L) or lower FEV1/FVC (β=0.04%, 95%CI -0.49% to 0.58%). Some findings differed by sex and GNI. In summary, at a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they associate with more respiratory symptoms. As not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.
Knox-Brown B, Patel J, Potts J, et al., 2023, Prevalence of small airways obstruction and its risk factors in the multinational Burden of Obstructive Lung Disease (BOLD) study, The Lancet Global Health, Vol: 11, Pages: e69-e82, ISSN: 2214-109X
Background:Small Airways Obstruction (SAO) is a common feature of obstructive lung diseases. There is limited research on SAO, its global prevalence and risk factors.Methods:Using data from 41 sites in the cross-sectional Burden of Obstructive Lung Disease study (N=26,448), we defined SAO as either: 1) mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FEF25-75) less than lower limit of normal (LLN), or 2) forced expiratory volume in three seconds to forced vital capacity ratio (FEV3/FVC) less than the LLN. We estimated the prevalence of pre- and post-bronchodilator SAO for each site. To identify risk factors for SAO, we performed multivariable regression analyses within each site, and pooled estimates using random effects meta-analysis.Findings:Prevalence of pre-bronchodilator SAO ranged from 5% (34/624) in Tartu (Estonia) to 34% (189/555) in Mysore (India) for FEF25-75, while for FEV3/FVC it ranged from 5% (31/667) in Riyadh (Saudi Arabia) to 31% (287/981) in Salzburg (Austria). Prevalence of post-bronchodilator SAO was universally lower. Risk factors associated with FEV3/FVC included increasing age, low body mass index, active and passive smoking, low level of education, working in a dusty job for more than 10 years, and previous tuberculosis. Results were similar for FEF25-75, except for increasing age, which was associated with reduced odds of SAO.Interpretation:Despite the wide geographical variation, SAO is common and more prevalent than chronic airflow obstruction worldwide. SAO shows the same risk factors as chronic airflow obstruction. However, further research is required to investigate whether it also associates with respiratory symptoms and lung function decline.Funding:National Heart and Lung Institute; Wellcome Trust (085790/Z/08/Z).
Ahmed R, Osman N, Noory B, et al., 2022, Prevalence and determinants of chronic respiratory diseases in adults in Khartoum State, Sudan, International Journal of Tuberculosis and Lung Disease, ISSN: 1027-3719
Background:Chronic respiratory diseases are considered a significant cause of morbidity and mortality worldwide, although data from Africa are limited. This study aimed to determine the prevalence and determinants of chronic respiratory diseases in Khartoum, Sudan.Methods:Data was collected from 516 participants, aged ≥ 40, who had completed a questionnaire and undertook pre- and post-bronchodilator spirometry testing. Trained field workers conducted questionnaires and spirometry. Survey-weighted prevalence of respiratory symptoms and spirometric abnormalities were estimated. Regression analysis models were used to identify risk factors for chronic lung diseases.Results:Using the NHANESIII reference equations, the prevalence of Chronic Airflow Obstruction (CAO) was 10%. The main risk factor was older age 60-69 years (Odds ratio 3.16, 95% Confidence Interval 1.20 – 8.31). Lower education, high body mass index and a history of tuberculosis were also identified as significant risk factors. The prevalence of a low forced vital capacity (FVC) using NHANES III was 62.7% [SE 2.2] and 11.3% [SE 1.4] using locally derived values.Conclusion:The prevalence of spirometric abnormality mainly (low FVC); was high suggesting that chronic respiratory disease is of substantial public health importance in urban Sudan. Strategies for the prevention and control of these problems are needed.
Knox-Brown B, Patel J, Burney P, et al., 2022, THE ASSOCIATION OF SMALL AIRWAYS OBSTRUCTION WITH RESPIRATORY SYMPTOMS, CARDIOMETABOLIC DISEASE, AND QUALITY OF LIFE: RESULTS FROM THE BURDEN OF OBSTRUCTIVE LUNG DISEASE (BOLD) STUDY, Winter Meeting of the British-Thoracic-Society (BTS), Publisher: BMJ PUBLISHING GROUP, Pages: A64-A65, ISSN: 0040-6376
Knox-Brown B, Patel J, Burney P, et al., 2022, Prevalence and risk factors for small airways obstruction: Results from the Burden of Obstructive Lung Disease (BOLD) study., Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Binegdie AB, Brenac S, Devereux G, et al., 2022, Post-TB lung disease in three African countries, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 26, Pages: 891-893, ISSN: 1027-3719
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Hsan S, Lakhdar N, Harrabi I, et al., 2022, Reduced forced vital capacity is independently associated with, aging, height and a poor socioeconomic status: a report from the Tunisian population-based BOLD study, BMC PULMONARY MEDICINE, Vol: 22, ISSN: 1471-2466
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Knox-Brown B, Amaral A, Burney P, 2022, Concerns about PRISm, The Lancet Respiratory Medicine, Vol: 10, Pages: e51-e52, ISSN: 2213-2600
Denguezli M, Lakhdar N, Harrabi I, et al., 2022, UNDIAGNOSED COPD IN ADULTS 40 YEARS AND OLDER: REPORTS FROM THE TUNISIAN POPULATION-BASED BURDEN OF OBSTRUCTIVE LUNG DISEASE STUDY, CHEST Congress, Publisher: ELSEVIER, Pages: 363A-363A, ISSN: 0012-3692
Burney P, 2022, Genetic ancestry has the same major problems as phenotypic ancestry, American Journal of Respiratory and Critical Care Medicine, Vol: 206, Pages: 797-798, ISSN: 1073-449X
Binegdie AB, Haile T, Worku A, et al., 2022, Chronic Respiratory Diseases in Ethiopia: Risk Factors and Determinants of Pulmonary Function Impairment. Hospital Based Cross-Sectional Study, International Conference of the American-Thoracic-Society, Publisher: AMER THORACIC SOC, ISSN: 1073-449X
Burney P, 2022, Genetic ancestry has the same major problems as phenotypic ancestry, American Journal of Respiratory and Critical Care Medicine, ISSN: 1073-449X
Nafees A, De Matteis S, Amaral A, et al., 2022, Impact of using different predictive equations on the prevalence of chronic byssinosis in textile workers in Pakistan, Occupational and Environmental Medicine, Vol: 79, Pages: 242-244, ISSN: 1351-0711
Objective Byssinosis remains a significant problem among textile workers in low/middle-income countries. Here we share our experience of using different prediction equations for assessing ‘chronic’ byssinosis according to the standard WHO classification using measurements of forced expiratory volume in 1 s (FEV1).Methods We enrolled 1910 workers in a randomised controlled trial of an intervention to improve the health of textile workers in Pakistan. We included in analyses the 1724 (90%) men who performed pre-bronchodilator spirometry tests of acceptable quality. We compared four different equations for deriving lung function percentage predicted values among those with symptoms-based byssinosis: the third US National Health and Nutrition Examination Survey (NHANES-III, with ‘North Indian and Pakistani’ conversion factor); the Global Lung Function Initiative (GLI, ‘other or mixed ethnicities’); a recent equation derived from survey of a western Indian population; and one based on an older and smaller survey of Karachi residents.Results 58 men (3.4%) had symptoms-based byssinosis according to WHO criteria. Of these, the proportions with a reduced FEV1 (<80% predicted) identified using NHANES and GLI; Indian and Pakistani reference equations were 40%, 41%, 14% and 12%, respectively. Much of this variation was eliminated when we substituted FEV1/forced vital capacity (FVC) ratio (<lower limit of normality) as a measure of airway obstruction.Conclusion Accurate measures of occupational disease frequency and distribution require approaches that are both standardised and meaningful. We should reconsider the WHO definition of ‘chronic’ byssinosis based on changes in FEV1, and instead use the FEV1/FVC.
Kulbacka-Ortiz K, Triest F, Franssen F, et al., 2022, Restricted spirometry and cardiometabolic comorbidities: Results from the international population based BOLD study, Respiratory Research, Vol: 23, ISSN: 1465-9921
Background:Whether restricted spirometry, i.e. low Forced Vital Capacity (FVC), predicts chronic cardiometabolic disease is not definitely known. In this international population-based study, we assessed the relationship between restricted spirometry and cardiometabolic comorbidities.Methods:A total of 23,623 subjects (47.5% males, 19.0% current smokers, age: 55.1 ± 10.8 years) from five continents (33 sites in 29 countries) participating in the Burden of Obstructive Lung Disease (BOLD) study were included. Restricted spirometry was defined as post-bronchodilator FVC < 5th percentile of reference values. Self-reports of physician-diagnosed cardiovascular disease (CVD; heart disease or stroke), hypertension, and diabetes were obtained through questionnaires.Results:Overall 31.7% of participants had restricted spirometry. However, prevalence of restricted spirometry varied approximately ten-fold, and was lowest (8.5%) in Vancouver (Canada) and highest in Sri Lanka (81.3%). Crude odds ratios for the association with restricted spirometry were 1.60 (95% CI 1.37–1.86) for CVD, 1.53 (95% CI 1.40–1.66) for hypertension, and 1.98 (95% CI 1.71–2.29) for diabetes. After adjustment for age, sex, education, Body Mass Index (BMI) and smoking, the odds ratios were 1.54 (95% CI 1.33–1.79) for CVD, 1.50 (95% CI 1.39–1.63) for hypertension, and 1.86 (95% CI 1.59–2.17) for diabetes.Conclusion:In this population-based, international, multi-site study, restricted spirometry associates with cardiometabolic diseases. The magnitude of these associations appears unattenuated when cardiometabolic risk factors are taken into account.
Nafees AA, De Matteis S, Burney P, et al., 2022, Contemporary prevalence of byssinosis in low- and middle-income countries: a systematic review, Asia-Pacific Journal of Public Health, Vol: 34, Pages: 483-492, ISSN: 1010-5395
We aimed to identify the contemporary prevalence of byssinosis through a systematic review. We used Medline, Web of Science, Embase, and Global Health databases to identify studies published in any language between 2000 and 2019, reporting primary data on byssinosis among adults. We used the Joanna Briggs Institute checklist to estimate the risk of bias in studies and undertook a qualitative, narrative data analysis. The review considered the prevalence of byssinosis, chest tightness, and airflow obstruction in textile workers in low- and middle-income countries (LMICs). We found 26 relevant studies that included 6930 workers across 12 countries. Most of the studies (n = 19) were from Asia, and 7 from African countries. Twenty-five studies were cross-sectional surveys while 1 was a cohort study. The prevalence of byssinosis was reported by 18 studies, and ranged from 8% to 38%, without any clear associations, at the group level, between the prevalence of byssinosis and durations of workers’ exposures. Prevalence of chest tightness ranged between 4% and 58% and that of airflow obstruction between 10% and 30%. We found a strong correlation (r = 0.72) between prevalence of byssinosis and cotton dust levels. Our findings indicate that byssinosis remains a significant, contemporary problem in some parts of the textile sector in LMICs.
Binegdie AB, Meme H, El Sony A, et al., 2022, Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study, INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, Vol: 26, Pages: 18-+, ISSN: 1027-3719
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