Respiratory symptoms and illness in older Australians: the Burden of Obstructive Lung Disease (BOLD) study

Brett G Toelle, Wei Xuan, Tessa E Bird, Michael J Abramson, David N Atkinson, Deborah L Burton, Alan L James, Christine R Jenkins, David P Johns, Graeme P Maguire, A W (Bill) Musk, E Haydn Walters, Richard Wood-Baker, Michael L Hunter, Bruce J Graham, Phillipa J Southwell, William M Vollmer, A Sonia Buist and Guy B Marks
Med J Aust 2013; 198 (3): 144-148. || doi: 10.5694/mja11.11640


Objective: To measure the prevalence of chronic obstructive pulmonary disease (COPD) among people aged 40 years or older in Australia.

Design, setting and participants: A cross-sectional study of people in the community aged ≥ 40 years, selected at random using electoral rolls, in six sites chosen to reflect the sociodemographic and geographic diversity of Australia, conducted between 2006 and 2010. Standardised questionnaires were administered by interview. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio were measured by spirometry, before and after bronchodilator administration.

Main outcome measure: Prevalence of COPD, classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006 criteria.

Results: Complete data were available for 1620 men (participation rate, 26%) and 1737 women (participation rate, 28%). The prevalence of GOLD Stage II or higher COPD (defined as post-bronchodilator FEV1/FVC ratio < 0.70 and FEV1 < 80% predicted) was 7.5% (95% CI, 5.7%–9.4%) among people aged ≥ 40 years, and 29.2% (95% CI, 18.1%–40.2%) among those aged ≥ 75 years. Among people aged ≥ 40 years, the prevalence of wheeze in the past 12 months was 30.0% (95% CI, 27.5%–32.5%), and prevalence of shortness of breath when hurrying on the level or climbing a slight hill was 25.2% (95% CI, 22.7%–27.6%).

Conclusions: Symptoms and spirometric evidence of COPD are common among people aged 40 years or older and increase with age. Further research is needed to better understand the diagnosis and management of COPD in Australia, along with continuing efforts to prevent the disease.

  • Brett G Toelle1
  • Wei Xuan1
  • Tessa E Bird1
  • Michael J Abramson2
  • David N Atkinson3,4
  • Deborah L Burton5
  • Alan L James6
  • Christine R Jenkins7
  • David P Johns8
  • Graeme P Maguire9,10
  • A W (Bill) Musk11,12
  • E Haydn Walters8
  • Richard Wood-Baker8
  • Michael L Hunter11
  • Bruce J Graham13
  • Phillipa J Southwell5
  • William M Vollmer14
  • A Sonia Buist15
  • Guy B Marks1

  • 1 Department of Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, NSW.
  • 2 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 3 Rural Clinical School of WA, University of Western Australia, Broome, WA.
  • 4 Kimberley Aboriginal Medical Services Council, Broome, WA.
  • 5 School of Biomedical Sciences, Charles Sturt University, Orange, NSW.
  • 6 Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA.
  • 7 Department of Thoracic Medicine, Woolcock Institute of Medical Research, Sydney, NSW.
  • 8 School of Medicine, University of Tasmania, Hobart, TAS.
  • 9 Baker IDI Central Australia, Alice Springs, NT.
  • 10 Cairns Clinical School, James Cook University, Cairns, QLD.
  • 11 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA.
  • 12 School of Population Health, University of Western Australia, Perth, WA.
  • 13 School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW.
  • 14 Center for Health Research Northwest, Kaiser Permanente Northwest, Portland, Ore, USA.
  • 15 Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Ore, USA.


We thank the research staff at each of the study sites for recruiting and testing participants: Busselton: Elspeth Inglis, Peta Grayson; Broome: David Reeve, Matthew Yap, Mary Lane, Wendy Cavilla; Melbourne: Angela Lewis, Joan Raven, Joan Green; Rural New South Wales: Melanie Heine, Cassanne Eccleston, Julie Cooke, Brian Spurrell, Robyn Paton; Sydney: Kate Hardaker, Paola Espinel; Tasmania: Carol Phillips. Funding sources for the Australian clinical centres include the National Health and Medical Research Council, Australian Lung Foundation, Air Liquide, AstraZeneca, GlaxoSmithKline and Boehringer Ingelheim.

Competing interests:

William Vollmer and Sonia Buist served as Directors of the BOLD Operations Center, which received funding in the form of unrestricted educational grants from Boehringer Ingelheim, Pfizer, ALTANA, GlaxoSmithKline, AstraZeneca, Novartis, Chiesi, and Merck. Guy Marks, Michael Abramson and Christine Jenkins served on advisory committees for the BOLD Operations Center.

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