Personal exposure to air pollution and respiratory health of COPD patients in London

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Abstract

Previous studies have investigated the effects of air pollution on chronic obstructive pulmonary disease (COPD) patients using either fixed-site measurements or a limited number of personal measurements, usually for one pollutant and a short time period. These limitations may introduce bias and distort the epidemiological associations as they do not account for all the potential sources or the temporal variability of pollution.

We used detailed information on individuals’ exposure to various pollutants measured at fine spatiotemporal scale to obtain more reliable effect estimates. A panel of 115 patients was followed up for an average continuous period of 128 days carrying a personal monitor specifically designed for this project that measured temperature, nitrogen dioxide (NO ₂), ozone (O ₃), nitric oxide (NO), carbon monoxide (CO), and particulate matter with aerodynamic diameter <2.5 and <10 μm at 1-min time resolution. Each patient recorded daily information on respiratory symptoms and measured peak expiratory flow (PEF). A pulmonologist combined related data to define a binary variable denoting an “exacerbation”. The exposure–response associations were assessed with mixed effects models.

We found that gaseous pollutants were associated with a deterioration in patients’ health. We observed an increase of 16.4% (95% CI 8.6–24.6%), 9.4% (95% CI 5.4–13.6%) and 7.6% (95% CI 3.0–12.4%) in the odds of exacerbation for an interquartile range increase in NO ₂, NO and CO, respectively. Similar results were obtained for cough and sputum. O ₃ was found to have adverse associations with PEF and breathlessness. No association was observed between particulate matter and any outcome.

Our findings suggest that, when considering total personal exposure to air pollutants, mainly the gaseous pollutants affect COPD patients’ health.

Abstract

Significant adverse associations were found between the respiratory health of COPD patients and their personal exposure to gaseous pollutants measured using portable sensors over 6 months. No significant associations were found for particulate pollutants. https://bit.ly/3aqMT6O

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Most cited references 39

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Exposure measurement error in time-series studies of air pollution: concepts and consequences.

S Zeger, Owen D Thomas, F Dominici … (2000)

Misclassification of exposure is a well-recognized inherent limitation of epidemiologic studies of disease and the environment. For many agents of interest, exposures take place over time and in multiple locations; accurately estimating the relevant exposures for an individual participant in epidemiologic studies is often daunting, particularly within the limits set by feasibility, participant burden, and cost. Researchers have taken steps to deal with the consequences of measurement error by limiting the degree of error through a study's design, estimating the degree of error using a nested validation study, and by adjusting for measurement error in statistical analyses. In this paper, we address measurement error in observational studies of air pollution and health. Because measurement error may have substantial implications for interpreting epidemiologic studies on air pollution, particularly the time-series analyses, we developed a systematic conceptual formulation of the problem of measurement error in epidemiologic studies of air pollution and then considered the consequences within this formulation. When possible, we used available relevant data to make simple estimates of measurement error effects. This paper provides an overview of measurement errors in linear regression, distinguishing two extremes of a continuum-Berkson from classical type errors, and the univariate from the multivariate predictor case. We then propose one conceptual framework for the evaluation of measurement errors in the log-linear regression used for time-series studies of particulate air pollution and mortality and identify three main components of error. We present new simple analyses of data on exposures of particulate matter < 10 microm in aerodynamic diameter from the Particle Total Exposure Assessment Methodology Study. Finally, we summarize open questions regarding measurement error and suggest the kind of additional data necessary to address them. Images Figure 1 Figure 2 Figure 3

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Global burden of COPD.

José Luis López-Campos, Pui-Wan Tan, Joan B Soriano (2016)

It is estimated that the world population will reach a record 7.3 billion in 2015, and the high burden of chronic conditions associated with ageing and smoking will increase further. Respiratory diseases in general receive little attention and funding in comparison with other major causes of global morbidity and mortality. In particular, chronic obstructive pulmonary disease (COPD) has been a major public health problem and will remain a challenge for clinicians within the 21st century. Worldwide, COPD is in the spotlight, since its high prevalence, morbidity and mortality create formidable challenges for health-care systems. This review emphasizes the magnitude of the COPD problem from a clinician's standpoint by drawing extensively from the new findings of the Global Burden of Disease study. Updated, distilled information on the population distribution of COPD is useful for the clinician to help provide an appreciation of the relative impact of COPD in daily practice compared with other chronic conditions, and to allocate minimum resources in anticipation of future needs in care. Despite recent trends in reduction of COPD standardized mortality rates and some recent successes in anti-smoking efforts in a number of Western countries, the overarching demographic impact of ageing in an ever-expanding world population, joined with other factors such as high rates of smoking and air pollution in Asia, will ensure that COPD will continue to pose an ever-increasing problem well into the 21st century.

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COPD exacerbations: defining their cause and prevention

Jadwiga Wedzicha, Terence AR Seemungal (2007)

Summary Exacerbations of chronic obstructive pulmonary disease (COPD) are episodes of worsening of symptoms, leading to substantial morbidity and mortality. COPD exacerbations are associated with increased airway and systemic inflammation and physiological changes, especially the development of hyperinflation. They are triggered mainly by respiratory viruses and bacteria, which infect the lower airway and increase airway inflammation. Some patients are particularly susceptible to exacerbations, and show worse health status and faster disease progression than those who have infrequent exacerbations. Several pharmacological interventions are effective for the reduction of exacerbation frequency and severity in COPD such as inhaled steroids, long-acting bronchodilators, and their combinations. Non-pharmacological therapies such as pulmonary rehabilitation, self-management, and home ventilatory support are becoming increasingly important, but still need to be studied in controlled trials. The future of exacerbation prevention is in assessment of optimum combinations of pharmacological and non-pharmacological therapies that will result in improvement of health status, and reduction of hospital admission and mortality associated with COPD.

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Author and article information

Journal

Journal ID (nlm-ta): Eur Respir J

Journal ID (iso-abbrev): Eur Respir J

Journal ID (publisher-id): ERJ

Journal ID (hwp): erj

Title: The European Respiratory Journal

Publisher: European Respiratory Society

ISSN (Print): 0903-1936

ISSN (Electronic): 1399-3003

Publication date Collection: July 2021

Publication date (Electronic): 15 July 2021

Volume: 58

Issue: 1

Electronic Location Identifier: 2003432

Affiliations

[1 ]Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK

[2 ]National Institute for Health Research Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK

[3 ]Centre for Atmospheric Science, Dept of Chemistry, University of Cambridge, Cambridge, UK

[4 ]Dept of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece

[5 ]National Heart and Lung Institute, Imperial College London, London, UK

Author notes

Benjamin Barratt ( b.barratt@ 123456imperial.ac.uk )

Author information

Dimitris Evangelopoulos https://orcid.org/0000-0002-1071-6892

Jennifer K. Quint https://orcid.org/0000-0003-0149-4869

Article

Publisher ID: ERJ-03432-2020

DOI: 10.1183/13993003.03432-2020

PMC ID: 8290182

PubMed ID: 33542053

SO-VID: 3c980f40-8f56-4220-9062-c64d12eb2a04

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This version is distributed under the terms of the Creative Commons Attribution Licence 4.0.

History

Date received : 8 September 2020

Date accepted : 12 December 2020

Funding

Funded by: NIHR Health Protection Research Unit in Environmental Exposures and Health

Funded by: Medical Research Council, open-funder-registry 10.13039/501100000265;

Personal exposure to air pollution and respiratory health of COPD patients in London

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European Respiratory Society: COVID-19

Most cited references 39

Exposure measurement error in time-series studies of air pollution: concepts and consequences.

Global burden of COPD.

COPD exacerbations: defining their cause and prevention

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