title: Prevalence of chronic airflow limitation in Kashmir, North India: results from the BOLD study.
abstract: Data on spirometrically defined chronic airflow limitation (CAL) are scarce in developing countries.
  
  
  
  To estimate the prevalence of spirometrically defined CAL in Kashmir, North India.
  
  
  
  Using Burden of Obstructive Lung Disease survey methods, we administered questionnaires to randomly selected adults aged ⩾40 years. Post-bronchodilator spirometry was performed to estimate the prevalence of CAL and its relation to potential risk factors.
  
  
  
  Of 1100 participants initially recruited, 953 (86.9%) responded and 757 completed acceptable spirometry and questionnaires. The prevalence of a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio less than the lower limit of normal was 17.3% (4.5) in males and 14.8% (2.1) in females. Risk factors for CAL included higher age, cooking with wood and lower educational status. The prevalence of current smoking was 61% in males and 22% in females; most smoked hookahs. CAL was found equally in non-smoking males and females, and was independently associated with the use of the hookah, family history of respiratory disease and poor education. A self-reported doctor's diagnosis of chronic obstructive pulmonary disease was reported in 8.4/1000 (0.9% of females and 0.8% of males).
  
  
  
  Spirometrically confirmed CAL is highly prevalent in Indian Kashmir, and seems to be related to the high prevalence of smoking, predominantly in the form of hookah smoking.
authors.affiliation: Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: P A
authors.initials: PA
authors.lastname: Koul
authors.affiliation: Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: N A
authors.initials: NA
authors.lastname: Hakim
authors.affiliation: Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: S A
authors.initials: SA
authors.lastname: Malik
authors.affiliation: Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
authors.forename: U H
authors.initials: UH
authors.lastname: Khan
authors.affiliation: National Heart & Lung Institute (NHLI), Imperial College, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Patel
authors.affiliation: National Heart & Lung Institute (NHLI), Imperial College, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Gnatiuc
authors.affiliation: Department of Respiratory Epidemiology and Public Health, NHLI, Imperial College London, London, UK.
authors.forename: P G J
authors.initials: PG
authors.lastname: Burney
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D013147:Spirometry; D011795:Surveys and Questionnaires; D014797:Vital Capacity; D000073867:Water Pipe Smoking / Q000009:adverse effects / Q000453:epidemiology