National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 3 2025 07 01 Persons at High-Risk and Low-Risk for Chronic Obstructive Pulmonary Disease: Results from the BOLD Study in Iran 252 260 739076 EN Hooman Sharifi Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0001-6448-046X Makan Sadr Virology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-8781-8176 Maryam Akhtari Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-5342-3440 Maryam Tavanarezaei Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0009-0009-2529-4360 Zahra Hesami Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Eslaminejad Chronic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-8788-4544 Mostafa Ghanei Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Journal Article <strong><span lang="EN-US">Background:</span></strong> <span lang="EN-US">Chronic obstructive pulmonary disease (COPD) is a common, heterogeneous, and largely preventable respiratory condition that is frequently undiagnosed until advanced stages. We estimated the prevalence of COPD risk categories in Iran and examined factors associated with high-risk status.</span><br><strong><span lang="EN-US">Materials and Methods: </span></strong><span lang="EN-US">A population-based survey using stratified cluster sampling was conducted in five major Iranian provinces, representing approximately 36% of the national population. Non-institutionalized adults aged ≥18 years completed standardized questionnaires, SF-12 health-related quality-of-life assessments, and pre- and post-bronchodilator spirometry under the tailored Burden of Lung Disease protocol. Participants were classified as diagnosed COPD (DN), high risk (HR; ≥10 years of tobacco use plus ≥1 respiratory symptom), or low risk (LR).</span><br><strong><span lang="EN-US">Results: </span></strong><span lang="EN-US">Among 533 participants (mean age, 53.2 ± 1.83 years; 43.9% men), 5.0% (95% CI: 3.17–6.83) had diagnosed COPD, 13.2% (95% CI: 12.92–13.48) were high risk, and 81.8% (95% CI: 78.55–85.05) were low risk. Dyspnea on exertion (43.6%), productive cough (27.1%), and frequent shortness of breath (32.1%) were common and occurred more frequently in DN and HR groups. High-risk status was more prevalent among men, current smokers, and adults aged >45 years. Tobacco use for ≥10 years was strongly associated with HR classification. Smoking patterns and symptom burden varied substantially across provinces. DN and HR participants had significantly poorer SF-12 physical and mental health scores than LR participants (P<0.001).</span><br><strong><span lang="EN-US">Conclusion: </span></strong><span lang="EN-US">A substantial proportion of Iranian adults are at high risk for COPD, indicating an important burden of potentially undiagnosed disease. Targeted screening, smoking-cessation initiatives, and earlier primary-care intervention may improve COPD detection and prevention.</span> https://www.tanaffosjournal.ir/article_739076_941c7f3a468ace5aabf28d4ff8aaf273.pdf