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Background/Aims Patients with muscular dystrophy usually have impaired lung function and respiratory muscle strength, leading to pneumonia and respiratory failure, which are significant causes of morbidity and mortality. Inspiratory muscle training might be a safe adjunct treatment to increase the strength and endurance of weakened respiratory muscles. The researchers have developed a new protocol for inspiratory muscle training and evaluated its effect on inspiratory muscle strength and coughing capacity. Methods A total of 12 participants diagnosed with muscle dystrophy and decreased maximal inspiratory pressure (2O) participated in this prospective study. Training was individually tailored, starting with low resistance levels and progressing according to tolerance and symptoms. The primary outcome measure was maximal inspiratory pressure. Secondary outcomes were maximal expiratory pressure, peak cough flow and the feasibility of the intervention. Results There were two participants who did not complete the study, and three were lost to follow-up; therefore, only seven patients finished the intervention. In these patients, the authors found a statistically significant improvement in the maximal inspiratory pressure (P=0.018) and peak cough flow (P=0.046) after 3 months of training. There was also an improvement in the maximal expiratory pressure, although this was not statistically significant (P=0.176). Median compliance to training was 99% (94.5–100). Conclusions This intervention led to statistically significant improvements in inspiratory muscles strength and coughing capacity in patients with muscular dystrophy. The results were significantly positive and contribute to the evidence in support of this underused, yet possibly beneficial, treatment, although larger randomised controlled trials are required to verify this.

O artigo analisa o consumo de água por famílias de agricultores em três comunidades rurais de Turmalina, semiárido do Alto Jequitinhonha, identificando possíveis estratégias de abastecimento e rearranjos para a produção de alimento e autoconsumo. A obtenção dos dados ocorreu por meio de levantamentos de campo articulados com entrevistas semiorientadas. Os resultados indicam que famílias de agricultores, que tiveram seus mananciais impactados pela mononocultura de eucalipto, procuram construir acesso à diversas águas, principalmente por meio de políticas públicas, para garantir o consumo humano. Ademais, buscaram reorganizar sistemas de produção de forma a priorizar a produção de alimentos para o autoconsumo, na busca por soberania e segurança alimentar em situações de crise hídrica.

O 2º Livro de Memórias: E se essa rua fosse nossa? é referente aos Anais do II Encontro Online de Saúde, Educação e Direitos Humanos, produzido pelos alunos do curso de Psicologia da Universidade Federal Fluminense do Campus Aterrado – Volta Redonda (RJ). A segunda edição do encontro convida à comunidade acadêmica ao debate sobre como seria se a rua fosse nossa. De pés no chão e olhos fixos para o horizonte, convocamos a todos a pensar a rua como o ponto de encontro para as travessias e peregrinações que ainda temos que enfrentar. O convite para a rua é um convite de organização de nossas lutas, é uma tímida, mas importante faísca para organizar essa revolta que há muito temos guardado dentro de nós. Sendo assim, enquanto estudantes enxergamos este momento e espaço que foi construído através de muita luta como uma resposta ética e política da nossa geração para o presente momento. Por isso, para os Anais do II Encontro Online de Saúde, Educação e Direitos Humanos, construímos eixos direcionadores para tentar pensar em conjunto temas que não costumam ser discutidos nas disciplinas, mas que o corpo discente acredita ser importante diante da realidade de uma universidade que necessita expandir seu diálogo para além das teorias e práticas tradicionalmente abordadas.

Sorghum is an off-season crop option in succession to soybean in the Cerrado region, but many producers underestimate the fertilization requirement, which can harm the productive performance of the system as a whole. Aiming to quantify the uptake and export of nutrients by grain sorghum, experiments were carried out in monocropping and intercropping with ruzigrass (Uroclhoa ruziziensis), with three levels of NPK fertilization (control without fertilization; maintenance fertilization; and maintenance + 30%). The experimental design was randomized blocks, with four replications. Sorghum plants were sampled at 33, 67 and 130 days after sowing, corresponding to the eight-leaf, flowering and physiological maturation development stages. The nutrient accumulation throughout the sorghum cycle and the respective extraction and export rates were calculated. Intercropping with ruzigrass reduces grain yield, but does not influence sorghum nutrient accumulation. Fertilization in soil with current high fertility increases biomass and nutrient accumulation, however, without any impact on grain yield. In off-season sorghum crop, nutrient uptake occurs mostly during the vegetative phase. Each ton of grain produced removes the equivalent of 14.5; 5.0; 3.5; 1.1 and 0.5 kg of N, P2O5, K2O, Mg and S, in addition to 2, 2, 25, 9 and 11 g of B, Cu, Fe, Mn and Zn, respectively. The potential for nutrient removal by grain sorghum cultivation is comparable to the patterns of the off-season maize crop, evidencing the importance of fertilization to replenish the amounts of nutrient exported.

BACKGROUND: Neuromuscular diseases are characterized by the compromise of respiratory muscles, thoracic ventilation, muscle strength and coughing capacity. Patients have low quality of life and increased morbidity and mortality mostly due to respiratory impairment. OBJECTIVE: To assess the benefits of adding inspiratory muscle training to neuromuscular patients’ treatment and their compliance to the approach. METHODS: We conducted a single-center prospective study with neuromuscular patients with decreased maximal inspiratory pressure. We developed an inspiratory muscle training protocol with three-month duration and once-daily training. The protocol had a progressive intensity that was individually tailored based on patients’ baseline characteristics and tolerance. We used Powerbreathe Medic Classic devices to perform the training. RESULTS: There were 21 patients who met the inclusion criteria and were enrolled in the study. Muscular dystrophy (n= 12, 57.3%) and amyotrophic lateral sclerosis (n= 4, 19%) were the most common diseases. After three months of training, patients increased their maximal inspiratory muscle pressure (p= 0.002) and peak cough flow (p= 0.011). Compliance to the protocol was 99 ± 5.5%. CONCLUSIONS: This protocol showed significant improvements on pulmonary muscles function and might be considered as an adjunct treatment to neuromuscular treatment. However, these positive results require larger further studies to validate the clinical benefits long-term.

This work aimed to evaluate the agronomic responses to the intensification of grain production systems under water restriction in the central region of Minas Gerias, Brazil. We studied six systems, including soybean and maize monocropping with medium investment in maintenance fertilization, and the annual alternating of these crops in medium or high investment, with inclusion or not of ruzigrass for straw increment. Soybean and maize in monocropping lose yield potential over time compared to their alternating cultivation. Greater fertilization in soil with built fertility does not increase the yield accumulated until the fourth harvest. The intercropping with ruzigrass can hamper maize yield under lower fertilization. The ruzigrass increases the average production of residues for straw formation in the soybean/maize system, approaching 8 t ha -1 year -1 . After four crop seasons, differences in soil chemical attributes are still not evident due to the diversification / intensification of the production system.

BACKGROUND: Cigarette smoking has a considerable health and economic burden in modern society, with increased risk of morbidity and mortality. Therefore, smoking cessation policies and medical treatments are essential. However, cessation rates are low and the abandonment of the consultation is common. The identification of characteristics that may predict adherence will help defining the best treatment strategy. This study aimed to identify predictors of follow-up loss in smoking cessation consultation. METHODS: We made a retrospective observational study, including a cohort of patients who started smoking cessation consultation (April-December 2018). Clinical data from consultations was collected and analyzed with IBM SPSS Statistics (SPSS, RRID:SCR_002865). RESULTS: A total of 175 patients was selected (41.1% female), with a mean age of 53±12 years. Eighty-five patients (48.6%) were discharged for abandonment. They had a median pack-year unit 38±36 (P=0.011), Fagerström and Richmond scores of 5±2 and 7±2, respectively. There was an association between women (P

Background Long-term oxygen therapy improves survival in patients with chronic obstructive pulmonary disease (COPD) and chronic severe daytime hypoxemia. However, the efficacy of oxygen th...

Submitted by Cátia Paixão (catia.paixao@ua.pt) on 2019-08-08T13:18:43Z No. of bitstreams: 1 2019_Jacome_EmbrancingTechnologies_3R_Pulmonology.pdf: 334667 bytes, checksum: 9e4330cfff2660d7c13f8e91f9e610f8 (MD5) Approved for entry into archive by Rita Gonçalves (ritaisabel@ua.pt) on 2019-08-08T15:53:58Z (GMT) No. of bitstreams: 1 2019_Jacome_EmbrancingTechnologies_3R_Pulmonology.pdf: 334667 bytes, checksum: 9e4330cfff2660d7c13f8e91f9e610f8 (MD5) Made available in DSpace on 2019-08-08T15:53:58Z (GMT). No. of bitstreams: 1 2019_Jacome_EmbrancingTechnologies_3R_Pulmonology.pdf: 334667 bytes, checksum: 9e4330cfff2660d7c13f8e91f9e610f8 (MD5) Previous issue date: 2019-05-31 This work is integrated in the project Revitalizing Pulmonary Rehabilitation (3R), SAICT-POL/23926/2016, was funded by Fundo Europeu de Desenvolvimento Regional (FEDER) – Comissão Diretiva do Programa Operacional Regional do Centro and by Fundação para a Ciência e Tecnologia (FCT) and partially funded by Programa Operacional Competitividade e Internacionalização (COMPETE), through COMPETE 2020 (POCI-01-0145-FEDER-016701) and FCT (UID/BIM/04501/2013, UID/BIM/04501/2019, and POCI-01-0145-FEDER-007628-iBiMED). CJ is a pos-doc fellow (SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT), reimbursed by Fundo Social Europeu and by national funds of MCTES. published

ObjectiveTo examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study.Design and settingCross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021.ParticipantsTotal of 1166 Australians from general population aged 18–90 years (mean 52, SD of 19).Main outcome measuresPrimary outcome: responses to question ‘If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?’.Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions.ResultsSeventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine.ConclusionsMost Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor’s recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates.

Functional status is an important and meaningful outcome in people with chronic obstructive pulmonary disease (COPD), although its measurement is not embedded in routine clinical assessments. This study described the functional status of people with COPD using the 1-min sit-to-stand test (1minSTS) over a 6-month period and the examined sociodemographic and clinical characteristics associated with this outcome. Data from a prospective study including people with COPD were analyzed. Functional status was assessed monthly with the 1minSTS over 6 months. Linear-mixed effect models assessed the 1minSTS number of repetitions mean change. One-hundred and eight participants (82.4% men; 66.9 ± 9.5 years) were included. A significantly lower number of repetitions in the 1minSTS over the 6-month period was associated with being female (estimate: −4.69, 95%CI: −8.20; −1.18), being older (estimate: −0.56, 95%CI: −0.77; −0.34), having higher BMI (estimate: −0.55, 95%CI: −0.81; −0.28) and having higher activity-related dyspnea (estimate: −2.04, 95%CI: −3.25; −0.83). Half of the participants showed improvements above three repetitions in the 1minSTS over the 6-month period, independently of their baseline impairment (1minSTS < 70% predicted: 52.5%; ≥70% predicted: 54.4%). To conclude, monthly follow-up assessments were associated with clinically relevant benefits in the functional status of people with COPD. Age, body composition, and activity-related dyspnea were the main predictors of functional status over time. Further research is needed to corroborate our findings and to support the beneficial effects of regular COPD monitoring.

INTRODUCTION: Studies suggest that people with chronic obstructive pulmonary disease (COPD) who are worse at baseline respond better to pulmonary rehabilitation (PR). Identifying treatable traits (TTs) may help to distinguish responders from non-responders. We explored the impact of PR on extra-pulmonary traits of people with COPD and whether the presence of TT influences the type of response to PR.METHODS: A comprehensive assessment of 9 TT including symptoms (dyspnoea, fatigue, anxiety and depression), functional capacity, deconditioning, balance, impact of the disease and health-related quality of life was conducted before and after a 12-week community-based PR programme. Pre-post differences between people with or without each TT at baseline were compared with independent samples t-tests or Mann-Whitney U tests. Proportion of responders between groups were explored with chi-square tests and odds ratio.RESULTS: 102 people with COPD were included (70 [65; 75] years old, 78% male, FEV1 47 [36; 60] %predicted). They had a median of 3 (out of 9) TTs per person and each patient responded on average to 5 (out of 9) outcomes of PR. People with TT were more responsive than those without them in all outcomes (p < 0.05) except for the 1-min sit-to-stand test. The presence of TT increased 4 to 20 times the likelihood of being a good responder.CONCLUSIONS: Identification of baseline extra-pulmonary TT in people with COPD showed the potential to inform on PR responsiveness and might therefore be an important strategy for patient prioritization, treatment personalisation (i.e., activation of the most suitable components) and optimisation.

Objective he Brief-Balance Evaluation Systems Test (Brief-BESTest) is a comprehensive, reliable, and valid balance test that provides valuable information to guide balance training in people with chronic obstructive pulmonary disease (COPD). Its clinical interpretability is, however, currently limited, because cutoff points to identify clinically relevant changes in people with COPD after pulmonary rehabilitation are still lacking. This study aimed to establish the responsiveness and minimal clinically important difference (MCID) for the Brief-BESTest in people with COPD after pulmonary rehabilitation (PR). Methods A secondary analysis of data from 2 previous studies was conducted. The modified British Medical Research Council (mMRC) dyspnea scale, the 6-Minute Walk Test (6-MWT), and the Brief-BESTest (0–24 points) were collected in people with COPD pre/post a 12-week PR program including balance training. The MCID was computed using anchor- and distribution-based methods. Changes in the 6-MWT and the mMRC were assessed and used as anchors. The pooled MCID was computed using the arithmetic weighted mean (2/3 anchor- and 1/3 distribution-based methods). Results Seventy-one people with COPD (69 years [SD = 8]; 76% male; FEV1 = 49.8%predicted [SD = 18%]) were included. There was a significant improvement in the Brief-BESTest after PR (mean difference = 3 points [SD = 3]). Significant correlations were found between the Brief-BESTest and the mMRC (r = −.31) and the 6-MWT (r = .37). The pooled MCID was 3.3 points. Conclusion An improvement of at least 3 points in the Brief-BESTest in people with COPD will enhance the interpretability of PR effects on balance performance of this population and guide tailored interventions. Impact The Brief-BESTest outcome measure is comprehensive, easily administered, and simple to interpret in clinical practice. This study represents a significant contribution toward the clinical interpretation of changes in balance in people with COPD following PR.

Populations respond differently to the current global pandemic of covid-19. This study explores the role of individual factors in the differential response to covid-19, by looking at the genetic background of worldwide populations. Significant SNPs (susceptibility: rs286914/rs12329760; severity: rs657152/rs11385942) were selected from the literature and their allelic frequencies used to calculate the probability of having multiple risk alleles in each population. Portuguese (n=623), Spanish (n=9761) and Italian (n=6363) populations data are observed values, whereas data for world populations are estimations based on public information. All populations, even those with European ancestry (Portuguese/Spanish/Italian), were significantly different from the European population in both covid-19 susceptibility and severity (all p-values < 0.0001)(Fig. 1). Our study highlights a genetic heterogeneity across world populations, especially within European subpopulations. There is a need to build a European genetic map so that differences in the distribution of relevant alleles can be easily accessed and used to better manage the populations, ultimately, safeguarding those under higher genetic risk. published

There is strong individual variability in both susceptibility and clinical response to covid-19 infection. People with chronic obstructive pulmonary disease (COPD) constitute one of covid-19 risk groups for poor outcomes upon infection. This study contributes to unveil the underlying reasons for such outcomes by looking at the genetic background of people with COPD. 255 people with COPD (66±9y; 72%♂; FEV1 53.01±20.31pp) and 243 controls (67±10y; 80%♂; FEV1 100.46±19.19pp) were clinically characterized and genotyped using saliva samples. Covid-19 associated SNPs from the literature (susceptibility: rs286914/rs12329760; severity: rs657152/rs11385942) were assessed and their allelic frequencies used to calculate the probability of having multiple risk alleles in both groups. Polygenic risk analysis was also conducted. No differences in genetic risk for covid-19 susceptibility or severity were found between groups (all p-values > 0.01), either considering individual risk alleles, allelic combinations or polygenic risk scores (Fig. 1). These results suggest a low genetic contribution for the poor covid-19 outcomes observed in people with COPD. published

Background Populations seem to respond differently to the global pandemic of severe acute respiratory syndrome coronavirus 2. Recent studies show individual variability in both susceptibility and clinical response to COVID-19 infection. People with chronic obstructive pulmonary disease (COPD) constitute one of COVID-19 risk groups, being already associated with a poor prognosis upon infection. This study aims contributing to unveil the underlying reasons for such prognosis in people with COPD and the variability in the response observed across worldwide populations, by looking at the genetic background as a possible answer to COVID-19 infection response heterogeneity. Methods SNPs already associated with susceptibility to COVID-19 infection (rs286914 and rs12329760) and severe COVID-19 with respiratory failure (rs657152 and rs11385942) were assessed and their allelic frequencies used to calculate the probability of having multiple risk alleles. This was performed on a Portuguese case-control COPD cohort, previously clinically characterized and genotyped from saliva samples, and also on worldwide populations (European, Spanish, Italian, African, American and Asian), using publicly available frequencies data. A polygenic risk analysis was also conducted on the Portuguese COPD cohort for the two mentioned phenotypes, and also for hospitalization and survival to COVID-19 infection. Findings No differences in genetic risk for COVID-19 susceptibility, hospitalization, severity or survival were found between people with COPD and the control group (all p-values > 0.01), either considering risk alleles individually, allelic combinations or polygenic risk scores. All populations, even those with European ancestry (Portuguese, Spanish and Italian), showed significant differences from the European population in genetic risk for both COVID-19 susceptibility and severity (all p-values < 0.0001). Conclusion Our results indicate a low genetic contribution for COVID-19 infection predisposition or worse outcomes observed in people with COPD. Also, our study unveiled a high genetic heterogeneity across major world populations for the same alleles, even within European sub-populations, demonstrating the need to build a higher resolution European genetic map, so that differences in the distribution of relevant alleles can be easily accessed and used to better manage diseases, ultimately, safeguarding populations with higher genetic predisposition to such diseases.

Background There are several reports on underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods A false positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC Results Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions False positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.

Acknowledgements: This work, was funded by Fundo Europeu de Desenvolvimento Regional (FEDER) - Comissão Diretiva do Programa Operacional Regional do Centro and by Fundação para a Ciência e Tecnologia - FCT (SAICT-POL/23926/2016 and PTDC/SAUSER/28806/2017), and partially funded by Programa Operacional Competitividade e Internacionalização (COMPETE), through COMPETE 2020 (POCI-01-0145FEDER-016701, POCI-01-0145-FEDER-007628 and POCI-01-0145-FEDER-028806) and FCT (UIDB/04501/2020). Quadriceps strength training is a key component of pulmonary rehabilitation (PR). Clinical interpretability of changes in muscle strength following PR is however limited due to the lack of cut-off values to define clinical improvement. This study estimated the minimal clinically important difference (MCID) for the isotonic and isometric quadriceps muscle strength assessed with the one-repetition maximum (1RM) and hand-held dynamometry (HHD) in people with chronic obstructive pulmonary disease (COPD) following PR. A secondary analysis of a real life non-randomised controlled study was conducted in people with COPD enrolled in a 12-week community-based PR programme. Anchor and distribution-based methods were used to compute the MCIDs. The anchors explored were the St. George's respiratory questionnaire (SGRQ) and the six-minute walk test (6MWT) using Pearson's correlations. Pooled MCIDs were computed using the arithmetic weighted mean (2/3 anchor, 1/3 distribution-based methods) and reported as absolute and/or percentage of change values. Eighty-nine people with COPD (84% male, 69.9 ± 7.9 years, FEV1 49.9 ± 18.9% predicted) were included. No correlations were found between changes in 1RM and the SGRQ neither between changes in HHD and the SGRQ and 6MWT (p > 0.05). Thus, anchor-based methods were used only in the MCID of the 1RM with the 6MWT as the anchor. The pooled MCIDs were 5.7Kg and 26.9% of change for the isotonic quadriceps muscle strength with 1RM and 5.2KgF for isometric quadriceps muscle strength assessed with HHD. The MCIDs found are estimates to improve interpretability of community-based PR effects on quadriceps muscle strength and may contribute to guide interventions. info:eu-repo/semantics/publishedVersion

Background: Acute exacerbations of COPD (AECOPD) have a negative impact on patients’ health status anddisease progression, regardless of the severity. However, their clinical presentation is heterogenous and still littleunderstood. Improving our understanding of AECOPD, during their occurrence, from patients’ own livedexperience may allow the development of person-centred interventions and enhance recovery. Thus, we aimedto explore patients’ experiences during a mild to moderate AECOPD. Methods: Semi-structured interviews with patients with a mild or moderate AECOPD treated in the communitywere conducted, at their homes, within 48h of the diagnosis. Interviews were audio recorded, transcribed in fulland analysed by deductive thematic analysis using the Web Qualitative Data Analysis software. A preliminaryanalysis focused on the impact of AECOPD was conducted and illustrated with representative quotes. Results: 11 patients (9 male, 67±10y, FEV1 41±16pp) participated. 7 subthemes demonstrating high impact ofAECOPD emerged: symptoms, limitations in activities of daily living, emotional challenges, physiological changes, limitations in recreational and social activities, work and family disturbances (Fig. 1). Conclusion: AECOPD, even when not requiring hospital admission, have a huge impact on patients’ daily lives.This study contributes with a foundation for the development of meaningful person-centred interventions during AECOPD. published

Rationale: The Global Burden of Disease program identified smoking and ambient and household air pollution as the main drivers of death and disability from chronic obstructive pulmonary disease (COPD). Objective: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged ≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a postbronchodilator FEV1-to-FVC ratio less than the lower limit of normal, and the relative risks associated with different risk factors. Local relative risks were estimated using a Bayesian hierarchical model borrowing information from across sites. From these relative risks and the prevalence of risk factors, we estimated local population attributable risks. Measurements and Main Results: The mean prevalence of CAO was 11.2% in men and 8.6% in women. The mean population attributable risk for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index, and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: Although smoking remains the most important risk factor for CAO, in some areas, poor education, low body mass index, and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.