THE EFFECT OF AIR POLLUTION ON CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the greatest global public health challenges, emerging as the third leading cause of death by 2030. Acute exacerbations of COPD (AECOPD) contribute to the accelerated deterioration of lung function, reduced quality of life and higher hospitalizations and mortality rates. The cause of exacerbation is usually an infectious agent, but the impact of exposure to environmental factors is being studied more thoroughly. Among them, atmospheric pollutants emerged as the most important ones. Multiple studies showed that elevated concentrations of particulate matter (PM), sulphur dioxide (SO2), nitric dioxide (NO2) and ozone (O3) in the atmosphere, have the most significant negative effect on patients with COPD, increasing hospitalisations and mortality rates due to COPD. While examining their effect on AECOPD, it is important to consider the mutual interactions of different air pollutants, as well as interactions with meteorological factors. In order to decrease the burden of COPD, it is necessary to implement all strategies that will reduce the incidence of COPD, including global reduction of air pollution. That will require the support of the world's most developed economies, a significant renewal of the necessary resources and, finally, radical social change.
References
Vukoja M, Kopitovic I, Lazic Z, Milenkovic B, Stankovic I, Zvezdin B, et al. Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement. Int J Chron Obstruct Pulmon Dis 2019; 14:1993–2002.
Zhao Q, Li S, Coelho MDSZS, Saldiva PHN, Xu R, Huxley RR, et al. Ambient heat and hospitalisation for COPD in Brazil: a nationwide case-crossover study. Thorax 2019;74(11):1031-6.
Burden of COPD (homepage on the Internet). Genève: WHO; c2020 (cited 2020 Apr 11). Available on URL: http://www.who.int/respiratory/copd/burden/en/
Lin MT, Kor CT, Chang CC, Chai WH, Soon MS, Ciou YS, et al. Association of meteorological factors and air NO2 and O3 concentrations with acute exacerbation of elderly chronic obstructive pulmonary disease. Sci Rep 2018; 8(1):1-9.
GBD 2013 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioral, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386(10010):2287-323.
WHO Factsheet: Ambient (outdoor) air quality and health (homepage on the Internet). Genève: WHO; c2020 (cited 03.07.2020.). Available at: https://www. who.int/news-room/fact-sheets/detail/ambient(outdoor)-air-quality-and-health 7. Burney PG, Patel J, Newson R, Minelli C, Naghavi M. Global and regional trends in COPD mortality, 19902010. Eur Respir J 2015; 45(5):1239-47.
Schikowski T, Mills IC, Anderson HR, Cohen A, Hansell A, Kauffmann F, et al. Ambient air pollution: a cause of COPD?. Eur Respir J 2014; 43:250-63.
Heinrich J, Schikowski T. COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution. Curr Environ Health Rep 2018; 5(1):70-6.
Olmo NR, Saldiva PH, Braga AL, Lin CA, Santos Ude P, Pereira LA. A review of low-level air pollution and adverse effects on human health: implications for epidemiological studies and public policy. Clinics (Sao Paulo) 2011; 66(4):681-90.
Qiu H, Tan K, Long F, Wang L, Yu H, Deng R, et al. The burden of COPD morbidity attributable to the interaction between ambient air pollution and temperature in Chengdu, China. Int J Environ Res Public Health 2018; 15(3):492-507. 12. Van Eden SF, Tan WC, Suwa T, Mukae H, Terashima T, Fujii T, et al. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med 2001; 164:826-30.
Anderson RH, Atkinson RW, Peacock JL, Marston L, Konstantinou K. Meta-analysis of time-series studies and panel studies of particulate matter (PM) and ozone (O3). Report of a WHO task group. Copenhagen: WHO Regional Office for Europe; 2004. Available at: https:// apps.who.int/iris/handle/10665/107557
Schikowski T, Sugiri D, Ranft U, Gehring U, Heinrich J, Wichmann HE, et al. Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respir Res 2005;6:152.
Dominici F, Peng RD, Bell ML, Pham L, McDermott A, Zeger SL, et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA 2006; 295(10):1127–34.
Liu S, Zhou Y, Wang X, Wang D, Lu J, Zheng J, et al. Biomass fuels are the probable risk factor for chronic obstructive pulmonary disease in rural South China. Thorax 2007; 62(10):889–97.
Sint T, Donohue JF, Ghio AJ. Ambient air pollution particles and the acute exacerbation of chronic obstructive pulmonary disease. Inhal Toxicol 2008; 20(1):25–9.
DeVries R, Kriebel D, Sama S. Outdoor air pollution and COPD-related emergency department visits, hospital admissions, and mortality: a meta-analysis. COPD 2017; 14(1):113-21.
Sunyer J, Spix C, Quenel P, Ponce-de-Leon A, Ponka A, Barumandzadeh T, et al. Urban air pollution and emergency room admissions for asthma in four European cities: the APHEA project. Thorax 1997; 52:760–5.
Anderson HR, Spix C, Medina S, Schouten JP, Castellsague J, Rossi G, et al. Air pollution and daily admissions for chronic obstructive pulmonary disease in 6 European cities: results from the APHEA project. Eur Respir J 1997; 10:1064–71.
Katsouyanni K, Touloumi G, Spix C, Schwartz J, Balducci F, Medina S, et al. Short term effects of ambient sulphur dioxide and particulate matter on mortality in 12 European cities: results from time series data from the APHEA project. BMJ 1997; 314:1658.
Sunyer J, Atkinson R, Ballester F, Le Tertre A, Ayres JG, Forastiere F, et al. Respiratory effects of sulphur dioxide: a hierarchical multicity analysis in the APHEA 2 study. Occup Environ Med 2003; 60:2-6.
US Environmental Protection Agency. Integrated Science Assessment (ISA) for Oxides of Nitrogen – Health Criteria (Second External Review Draft, EPA/600/R-14/006). Washington: US EPA; 2015.
Yang Q, Chen Y, Krewski D, Burnett RT, Shi Y, McGrail KM. Effect of short-term exposure to low levels of gaseous pollutants on chronic obstructive pulmonary disease hospitalizations. Environ Res 2005; 99:99-105.
World Health Organization. Health risks of ozone from long-range transboundary air pollution. Denmark: WHO, Regional Office for Europe; 2008. Available at: https:// apps.who.int/iris/handle/10665/326496
Stieb DM, Szyszkowicz M, Rowe BH, Leech JA. Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis. Environ Health 2009; 8:25.
Schwartz J. PM10, ozone, and hospital admissions for the elderly in Minneapolis-St. Paul, Minnesota. Arch Environ Health 1994; 49:366-374.
Goudarzi G, Zallaghi E, Neissi A, Ahmadi AK, Saki A, Babaei AA. Cardiopulmonary mortalities and chronic obstructive pulmonary disease attributed to ozone air pollution. Arch Hyg Sci 2013;2(2):62-72.