Association between ambient air pollution, meteorological conditions and exacerbations of asthma and chronic obstructive pulmonary disease in adult citizens of the town of Smederevo

  • Ivan Miodrag Stevanovic Department of Internal Medicine, General Hospital Smederevo, Smederevo, Serbia
  • Milena Jovašević-Stojanović Vinča Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
  • Jamina Jović-Stošić National Poison Control Center, Military Medical Academy, Belgrade, Serbia; §Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Keywords: air pollution, particle size, weather, disease progression, risk factors, pulmonary disease, chronic obstructive, asthma,

Abstract


Introduction. Smederevo is the only town in Serbia with a steel factory, whose exhausts contribute to air pollution. Therefore, the city conducts continuous monitoring of air quality. In recent years, high levels of particulate matter (PM), including coarse (PM10) and fine (PM2.5) particles in the air have frequently been recorded. The aim of this study was to assess association between exacerbation of asthma or chronic obstructive pulmonary disease (COPD) in adults and air pollution or meteorological conditions. Methods. The study was conducted in the secondary care General Hospital in Smederevo covering approximately 81, 000 inhabitants living in the area of about 7 km around the automatic station for air quality monitoring from which the verified data were collected. Data on patients were obtained from medical records. The correlation between the incidence of diseases exacerbation and the number of days with exceedance of air pollutants limit level per month, as well as meteorological conditions, was tested with parametric Pearson bivariate correlation test in program SPSS. Results. The study population consisted of adults registered as asthma or COPD suffering patients (n = 1,624) with 570 episodes of remarkable exacerbations (moderate or severe) of the disease in 2011. Asthma exacerbation was significantly more frequent in women than in men. The number of days with high levels of PM2.5 per month was statistically significantly associated with the total number of exacerbation (moderate and severe of both asthma and COPD) episodes among the female patients. There was also a statistically significant association between the number of days with PM2.5 exceedance and the number of moderate exacerbations in the subgroups of non-smokers and obese patients. A significant correlation of the number of days with the exceedance of PM10 limit level was shown only for the subgroup of obese, non-smoking patients with moderate exacerbation. A significant negative association with the average ambient temperature was proven for the obese female patients and obese non-smoking patients with moderate asthma exacerbations. The number of COPD exacerbation was in positive correlation with the average air pressure for the subgroup of female smokers, but the connection with air pollution was not proven. Conclusion. Exposure to airborne particles in the town of Smederevo, mainly to PM2.5, and to low temperature may trigger asthma exacerbation requiring emergency care. The most vulnerable may be women and obese patients.

 

 


Author Biography

Ivan Miodrag Stevanovic, Department of Internal Medicine, General Hospital Smederevo, Smederevo, Serbia
PhD candidate, clinical and experimental pharmacology, Medical faculty, University of Kragujevac

References

Katsouyanni K. Ambient air pollution and health. Br Med Bull 2003; 68(1): 143−56.

Halonen J, Lanki T, Yli-Tuomi T, Kulmala M, Tiittanen P, Pekkanen J. Urban air pollution, and asthma and COPD hospital emergency room visits. Thorax 2008; 63(7): 635−41.

Karakatsani A, Analitis A, Perifanou D, Ayres JG, Harrison RM, Kotronarou A, et al. Particulate matter air pollution and respira-tory symptoms in individuals having either asthma or chronic obstructive pulmonary disease: a European multicentre panel study. Environ Health 2012;11(1): 75.

Brunekreef B, Forsberg B. Epidemiological evidence of effects of coarse airborne particles on health. Eur Respir J 2005; 26(2): 309−18.

Peters A, Wichmann H, Tuch T, Heinrich J, Heyder J. Respiratory effects are associated with the number of ultrafine particles. Am J Respir Crit Care Med 1997; 155(4): 1376−83.

Vernon MK, Wiklund I, Bell JA, Dale P, Chapman KR. What do we know about asthma triggers? a review of the literature. J Asthma 2012; 49(10): 991−8.

Ko FW, Hui DS. Air pollution and chronic obstructive pulmo-nary disease. Respirology 2012; 17(3): 395−401.

Melgert BN, Ray A, Hylkema MN, Timens W, Postma DS. Are there reasons why adult asthma is more common in females. Curr Allergy Asthma Rep 2007; 7(2): 143−50.

Meng Y, Wilhelm M, Rull RP, English P, Ritz B. Traffic and out-door air pollution levels near residences and poorly controlled asthma in adults. Ann Allergy Asthma Immunol 2007; 98(5): 455−63.

Beuther DA, Sutherland E. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med 2007; 175(7): 661−6.

Assad N, Qualls C, Smith LJ, Arynchyn A, Thyagarajan B, Schuyler M, et al. Body mass index is a stronger predictor than the metabolic syndrome for future asthma in women The longitudinal CARDIA study. Am J Respir Crit Care Med 2013; 188(3): 319−26.

Mosen DM, Schatz M, Magid DJ, Camargo CA. The relationship between obesity and asthma severity and control in adults. J Allergy Clin Immunol 2008; 122(3): 507−11.

Schaub B, von Mutius E. Obesity and asthma, what are the links. Curr Opin Allergy Clin Immunol 2005; 5(2): 185−93.

Tsaroucha A, Daniil Z, Malli F, Georgoulias P, Minas M, Kostikas K, et al. Leptin, adiponectin, and ghrelin levels in female patients with asthma during stable and exacerbation periods. J Asthma 2013; 50(2): 188−97.

Brochu P, Bouchard M, Haddad S. Physiological daily inhalation rates for health risk assessment in overweight/obese children, adults, and elderly. Risk Anal 2014; 34(3): 567−82.

Rossi O, Kinnula V, Tienari J, Huhti E. Association of severe asthma attacks with weather, pollen, and air pollutants. Thorax 1993; 48(3): 244−8.

Abe T, Tokuda Y, Ohde S, Ishimatsu S, Nakamura T, Birrer RB. The relationship of short-term air pollution and weather to ED visits for asthma in Japan. Am J Emerg Med 2009; 27(2): 153−9.

Guo Y, Jiang F, Peng L, Zhang J, Geng F, Xu J, et al. The Associa-tion between Cold Spells and Pediatric Outpatient Visits for Asthma in Shanghai, China. PLoS ONE 2012; 7(7): e42232.

Atkinson R, Anderson H, Sunyer J, Ayres J, Baccini M, Vonk J, et al. Acute effects of particulate air pollution on respiratory ad-missions: results from APHEA 2 project Air Pollution and Health: a European Approach. Am J Respir Crit Care Med 2001; 164(10): 1860−6.

Schwartz J. Short term fluctuations in air pollution and hospital admissions of the elderly for respiratory disease. Thorax 1995; 50(5): 531−8.

Tseng C, Chen Y, Ou S, Hsiao Y, Li S, Wang S, et al. The effect of cold temperature on increased exacerbation of chronic ob-structive pulmonary disease: a nationwide study. PLoS ONE 2013; 8(3): e57066.

Ferrari U, Exner T, Wanka ER, Bergemann C, Meyer-Arnek J, Hildenbrand B, et al. Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany. Int J Biometeorol 2012; 56(1): 137−43.

Jenkins C, Celli B, Anderson J, Ferguson G, Jones P, Vestbo J, et al. Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study. Eur Respir J 2012; 39(1): 38−45

Published
2017/01/27
Section
Original Paper