| Summary: | Chronic obstructive pulmonary disease (COPD) remains a major public health problem in the 21st century. COPD is one of the leading causes of morbidity and mortality worldwide and results in an economic and social burden that is both substantial and increasing. The development of COPD is multifactorial, and the risk factors include both genetic and environmental ones, of which tobacco remains worldwide the dominant one. It remains however unclear why some smokers develop COPD whereas others do not. In spite of the huge smoking behavior in Russia (a total of 37.3 % of all Russians are current smokers), the burden and prevalence of COPD in Russia have been underestimated, in particular, because of the high cardiovascular mortality rate. A gap between the “epidemiological†and the “clinical†definitions, uncertainty in the diagnosis over time and the potential role of different biomarkers remain key issues regarding the diagnosis of COPD. The aim of this thesis was to gain a better understanding of the prevalence, pathogenesis and symptoms of early COPD. The data for my PhD project were obtained from a population-based epidemiological study (RESPECT) that was set up as collaborative research project of three universities. The design of the study was created by the research team among whom I was one of the principal investigators and pulmonologists. The preparatory phase of the project included a pilot study, the development of the distance-learning course on spirometry (SpiroCourse), and the development of a quality control system for all spirometry data. 3133 individuals aged 35-70 years from 15 participating centers in St. Petersburg and Arkhangelsk were screened. Symptoms and risk factors were collected and pre- and post-BD spirometry was performed. The final diagnosis of COPD was based on a comprehensive assessment including a repeated spirometry with BD test and a rigorous clinical examination performed by a pulmonologist. The entire study includes three parts: a cross-sectional study (prevalence), a ...
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