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. 2024 Nov 14;79(12):1116-1123.
doi: 10.1136/thorax-2024-221874.

Air pollution and respiratory health in patients with COPD: should we focus on indoor or outdoor sources?

Dimitris Evangelopoulos  1   2 , Hanbin Zhang  1   2   3 , Lia Chatzidiakou  4 , Heather Walton  1   2 , Klea Katsouyanni  1   2   5 , Roderic L Jones  4 , Jennifer K Quint  6   7 , Benjamin Barratt  8   2
Affiliations

Air pollution and respiratory health in patients with COPD: should we focus on indoor or outdoor sources?

Dimitris Evangelopoulos et al. Thorax. .

Abstract

Introduction: While associations between ambient air pollution and respiratory health in chronic obstructive pulmonary disease (COPD) patients are well studied, little is known about individuals' personal exposure to pollution and associated health effects by source.

Aim: To separate measured total personal exposure into indoor-generated and outdoor-generated pollution and use these improved metrics in health models for establishing more reliable associations with exacerbations and respiratory symptoms.

Methods: We enrolled a panel of 76 patients with COPD and continuously measured their personal exposure to particles and gaseous pollutants and location with portable monitors for 134 days on average. We collected daily health information related to respiratory symptoms through diary cards and peak expiratory flow (PEF). Mixed-effects models were applied to quantify the relationship between total, indoor-generated and outdoor-generated personal exposures to pollutants with exacerbation and symptoms occurrence and PEF.

Results: Exposure to nitrogen dioxide from both indoor and outdoor sources was associated with exacerbations and respiratory symptoms. We observed an increase of 33% (22%-45%), 19% (12%-18%) and 12% (5%-20%) in the odds of exacerbation for an IQR increase in total, indoor-generated and outdoor-generated exposures. For carbon monoxide, health effects were mainly attributed to indoor-generated pollution. While no associations were observed for particulate matter2.5 with COPD exacerbations, indoor-generated particles were associated with a significant decrease in PEF.

Conclusions: Indoor-generated and outdoor-generated pollution can deteriorate COPD patients' health. Policy-makers, physicians and patients with COPD should note the importance of decreasing exposure equally to both source types to decrease risk of exacerbation.

Keywords: COPD Exacerbations; COPD epidemiology; Respiratory Measurement.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. OR with 95% CI for the occurrence of exacerbation associated with an IQR increase on the same day (lag0) for each air pollutant and exposure variable. Random intercept models adjusted for age, sex, COPD severity, Index of Multiple Deprivation Score, inhaled corticosteroids medication use, temperature and time. COPD, chronic obstructive pulmonary disease; NO2, nitrogen dioxide; PeIG, personal exposure to indoor generated pollution; PeOG, personal exposure to outdoor generated pollution.
Figure 2
Figure 2. OR with 95% CI for the occurrence of respiratory symptoms associated with an IQR increase on the same day (lag0) for each air pollutant and exposure variable. Random intercept models adjusted for age, sex, COPD severity, Index of Multiple Deprivation rank, inhaled corticosteroids medication use, temperature and time. COPD, chronic obstructive pulmonary disease; NO2, nitrogen dioxide; PeIG, personal exposure to indoor generated pollution; PeOG, personal exposure to outdoor generated pollution.
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References

    1. Bloemsma LD, Hoek G, Smit LAM. Panel studies of air pollution in patients with COPD: Systematic review and meta-analysis. Environ Res. 2016;151:458–68. doi: 10.1016/j.envres.2016.08.018. - DOI - PubMed
    1. Peacock JL, Anderson HR, Bremner SA, et al. Outdoor air pollution and respiratory health in patients with COPD. Thorax. 2011;66:591–6. doi: 10.1136/thx.2010.155358. - DOI - PubMed
    1. de Hartog JJ, Ayres JG, Karakatsani A, et al. Lung function and indicators of exposure to indoor and outdoor particulate matter among asthma and COPD patients. Occup Environ Med. 2010;67:2–10. doi: 10.1136/oem.2008.040857. - DOI - PubMed
    1. Cortez-Lugo M, Ramírez-Aguilar M, Pérez-Padilla R, et al. Effect of Personal Exposure to PM2.5 on Respiratory Health in a Mexican Panel of Patients with COPD. Int J Environ Res Public Health. 2015;12:10635–47. doi: 10.3390/ijerph120910635. - DOI - PMC - PubMed
    1. Wilson WE, Brauer M. Estimation of ambient and non-ambient components of particulate matter exposure from a personal monitoring panel study. J Expo Sci Environ Epidemiol. 2006;16:264–74. doi: 10.1038/sj.jes.7500483. - DOI - PubMed

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