Environmental Science and Pollution Research

, Volume 22, Issue 4, pp 2817–2823 | Cite as

Effect of exposure to O3, NO2, and SO2 on chronic obstructive pulmonary disease hospitalizations in Tabriz, Iran

  • Mohammad Ghanbari Ghozikali
  • Mohammad Mosaferi
  • Gholam Hossein Safari
  • Jalil JaafariEmail author
Research Article


Air pollution in cities is a serious environmental problem especially in the developing countries. We examined the associations between gaseous pollutants and hospitalizations for chronic obstructive pulmonary diseases (COPD) among people living in Tabriz, a city in north western of Iran. We used the approach proposed by the World Health Organization (WHO) using the AirQ 2.2.3 software developed by the WHO European Center for Environment and Health, Bilthoven Division. To assess human exposure and health effect, data were used for ozone as a1h average; for nitrogen dioxide and sulfur dioxide as daily average concentrations. The association between air pollution and chronic obstructive pulmonary disease (COPD) was assessed using AirQ 2.2.3 model. The results of this study showed that 3 % (95 % CI 1.2–4.8 %) of HA COPD were attributed to O3 concentrations over 10 μg/m3. Also, 0.9 % (95 % CI 0.1–2.2 %) and 0.4 % (95 % CI 0–1.1 %) of HA COPD were attributed to NO2 and SO2 concentrations over 10 μg/m3, respectively. For every 10 μg/m3 increase in O3, NO2, and SO2 concentrations, the risk of HA COPD increase to about 0.58, 0.38, and 0.44 %, respectively. We found significant positive associations between the levels of all air pollution and hospital admissions COPD. Otherwise, O3, NO2, and SO2 have a significant impact on COPD hospitalization.


Chronic obstructive pulmonary disease (COPD) Ozone (O3Nitrogen dioxide (NO2Sulfur dioxide (SO2Hospitalization 


  1. Andersen ZJ, Hvidberg M, Jensen SS, Ketzel M, Loft S, Sørensen M, Tjønneland A, Overvad K, Raaschou-Nielsen O (2011) Chronic obstructive pulmonary disease and long-term exposure to traffic-related air pollution: a cohort study. Am J Respir Crit Care Med 183:455–461CrossRefGoogle Scholar
  2. Barnes PJ (2011): Targeting Histone Deacetylases in Chronic Obstructive Pulmonary Disease, Epigenetic Aspects of Chronic Diseases. Springer, pp. 205–215Google Scholar
  3. Bayram H, Sapsford RJ, Abdelaziz MM, Khair OA (2001) Effect of ozone and nitrogen dioxide on the release of proinflammatory mediators from bronchial epithelial cells of nonatopic nonasthmatic subjects and atopic asthmatic patients in vitro. J Allergy Clin Immunol 107:287–294CrossRefGoogle Scholar
  4. Budinger GS, McKell JL, Urich D, Foiles N, Weiss I, Chiarella SE, Gonzalez A, Soberanes S, Ghio AJ, Nigdelioglu R (2011) Particulate matter-induced lung inflammation increases systemic levels of PAI-1 and activates coagulation through distinct mechanisms. PLoS One 6:e18525CrossRefGoogle Scholar
  5. Corradi M, Alinovi R, Goldoni M, Vettori MV, Folesani G, Mozzoni P, Cavazzini S, Bergamaschi E, Rossi L, Mutti A (2002) Biomarkers of oxidative stress after controlled human exposure to ozone. Toxicol Lett 134:219–225CrossRefGoogle Scholar
  6. Fattore E, Paiano V, Borgini A, Tittarelli A, Bertoldi M, Crosignani P, Fanelli R (2011) Human health risk in relation to air quality in two municipalities in an industrialized area of Northern Italy. Environ Res 111:1321–1327CrossRefGoogle Scholar
  7. Foster WM, Brown RH, Macri K, Mitchell CS (2000) Bronchial reactivity of healthy subjects: 18–20 h postexposure to ozone. J Appl Physiol 89:1804–1810Google Scholar
  8. Gilmour PS, Rahman I, Donaldson K, MacNee W (2003) Histone acetylation regulates epithelial IL-8 release mediated by oxidative stress from environmental particles. Am J Physiol-Lung Cell Mole Physiol 284:L533–L540Google Scholar
  9. Goudarzi G, Zallaghi E, Neissi A, Ankali KA, Saki A, Babaei AA, Alavi N, Mohammadi MJ (2013): Cardiopulmonary Mortalities and Chronic Obstructive Pulmonary Disease Attributed to Ozone Air Pollution. Archives of Hygiene Sciences 2Google Scholar
  10. Happo M, Salonen R, Hälinen A, Jalava P, Pennanen A, Dormans J, Gerlofs-Nijland M, Cassee F, Kosma V-M, Sillanpää M (2010) Inflammation and tissue damage in mouse lung by single and repeated dosing of urban air coarse and fine particles collected from six European cities. Inhal Toxicol 22:402–416CrossRefGoogle Scholar
  11. Kamani H, Hoseini M, Seyedsalehi M, Mahdavi Y, Jaafari J, Safari GH (2014) Concentration and characterization of airborne particles in Tehran’s subway system. Environ Sci Poll Res. 1–10Google Scholar
  12. Killian KJ, Leblanc P, Martin DH, Summers E, Jones NL, Campbell EM (1992) Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. Am Rev Respir Dis 146:935–940CrossRefGoogle Scholar
  13. Ko FW, Tam W, Wong TW, Chan DP, Tung AH, Lai CK, Hui DS (2007) Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong. Thorax 62:780–785CrossRefGoogle Scholar
  14. Ko FW, Hui DS (2012) Air pollution and chronic obstructive pulmonary disease. Respirology 17:395–401CrossRefGoogle Scholar
  15. Krzyzanowski M (1997) Methods for assessing the extent of exposure and effects of air pollution. Occup Environ Med 54:145–151CrossRefGoogle Scholar
  16. Liu Y, Lee K, Perez-Padilla R, Hudson N, Mannino DM (2008) Outdoor and indoor air pollution and COPD-related diseases in high-and low-income countries [State of the Art Series. Chronic obstructive pulmonary disease in high-and low-income countries. Edited by G. Marks and M. Chan-Yeung. Number 2 in the series]. Int J Tuberc Lung Dis 12:115–127Google Scholar
  17. Lopez AD, Murray C (1998) The global burden of disease. Nat Med 4:1241–1243CrossRefGoogle Scholar
  18. MacNee W, Donaldson K (2000) Exacerbations of COPD environmental mechanisms. CHEST J 117:390S–397SCrossRefGoogle Scholar
  19. Mannino DM (2003) Chronic obstructive pulmonary disease: definition and epidemiology. Respir Care 48:1185–1193Google Scholar
  20. Mannino DM, Buist AS (2007) Global burden of COPD: risk factors, prevalence, and future trends. Lancet 370:765–773CrossRefGoogle Scholar
  21. Oh SM, Kim HR, Park YJ, Lee SY, Chung KH (2011) Organic extracts of urban air pollution particulate matter (PM2. 5)-induced genotoxicity and oxidative stress in human lung bronchial epithelial cells (BEAS-2B cells). Mutat Res/Gene Toxicol Environ Mutagen 723:142–151CrossRefGoogle Scholar
  22. Organization WH (2000) Air quality guidelines for EuropeGoogle Scholar
  23. Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS (2012) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 163Google Scholar
  24. Schikowski T, Sugiri D, Ranft U, Gehring U, Heinrich J, Wichmann H-E, Kramer U (2005) Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respir Res 6:152CrossRefGoogle Scholar
  25. Stieb DM, Szyszkowicz M, Rowe BH, Leech JA (2009) Air pollution and emergency department visits for cardiac and respiratory conditions: a multi-city time-series analysis. Environ Health 8:10.1186CrossRefGoogle Scholar
  26. Viegi G, Maio S, Pistelli F, Baldacci S, Carrozzi L (2006) Epidemiology of chronic obstructive pulmonary disease: health effects of air pollution. Respirology 11:523–532CrossRefGoogle Scholar
  27. Welte T, Groneberg DA (2006) Asthma and COPD. Exp Toxicol Pathol 57:35–40CrossRefGoogle Scholar
  28. Wong C, Thach T, Chau P, Chan E, Chung R, Ou C, Yang L, Peiris J, Thomas G, Lam T (2010) Part 4. Interaction between air pollution and respiratory viruses: time-series study of daily mortality and hospital admissions in Hong Kong. Research report (Health Effects Institute), 283–362Google Scholar
  29. Yang Q, Chen Y, Krewski D, Burnett RT, Shi Y, McGrail KM (2005) Effect of short-term exposure to low levels of gaseous pollutants on chronic obstructive pulmonary disease hospitalizations. Environ Res 99:99–105CrossRefGoogle Scholar
  30. Goudarzi G, Naddaf K, Mesdaghinia AR (2009) Quantifying the health effects of air pollution in Tehran and determines the third axis of the comprehensive plan to reduce air pollution in Tehran. [PhD Thesis]. Tehran: Tehran University of Medical SciencesGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Mohammad Ghanbari Ghozikali
    • 1
  • Mohammad Mosaferi
    • 2
  • Gholam Hossein Safari
    • 3
  • Jalil Jaafari
    • 3
    Email author
  1. 1.Environmental Health Department of East Azerbaijan Province Health CenterTabriz University of Medical SciencesTabrizIran
  2. 2.Tabriz Health Services Management Research Center, Department of Environmental Health EngineeringTabriz University of Medical SciencesTabrizIran
  3. 3.Department of Environmental Health Engineering, School of Public HealthTehran University of Medical SciencesTehranIran

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