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COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution

  • Susceptibility Factors in Environmental Health (B Ritz and Z Liew, Section Editors)
  • Published:
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Abstract

Purpose of Review

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide with no known cure and an increasing number of triggers that exacerbate symptoms and speed up progression. This review aims to summarize the evidence for COPD patients being more vulnerable to air pollution exposure assessed as acute effects.

Recent Findings

Several recent systematic reviews show consistently increased risks for COPD mortality and COPD hospital admission, ranging between 2 and 3% with increasing PM2.5 or PM10. Similar adverse impacts were shown for NO2. Also, adverse health effects among COPD patients were also found for other gaseous pollutants such as ozone and SO2; most of these studies could not be included in the meta-analysis we reviewed. Data from ten panel studies of COPD patients reported a small but statistically significant decline of FEV1 [− 3.38 mL (95% CI − 6.39 to − 0.37)] per increment of 10 μg/m3 PM10, supporting an impact on respiratory health with increasing PM10 exposure.

Summary

The combined information from systematic reviews and more recent findings lead us to conclude that COPD patients are more vulnerable to ambient air pollution than healthier people.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

  1. van Donkelaar A, Martin RV, Brauer M, Boys BL. Use of satellite observations for long-term exposure assessment of global concentrations of fine particulate matter. Environ Health Perspect. 2015;123(2):135–43. https://doi.org/10.1289/ehp.1408646.

    PubMed  Google Scholar 

  2. Hunt A, Abraham JL, Judson B, Berry CL. Toxicologic and epidemiologic clues from the characterization of the 1952 London smog fine particulate matter in archival autopsy lung tissues. Environ Health Perspect. 2003;111(9):1209–14. https://doi.org/10.1289/ehp.6114.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hogg JC. Pathophysiology of airflow limitation in chronic obstructive pulmonary disease. Lancet. 2004;364(9435):709–21. https://doi.org/10.1016/S0140-6736(04)16900-6.

    Article  PubMed  Google Scholar 

  4. Hogg JC, Chu F, Utokaparch S, Woods R, Elliott WM, Buzatu L, et al. The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(26):2645–53. https://doi.org/10.1056/NEJMoa032158.

    Article  CAS  PubMed  Google Scholar 

  5. Martinez FD. Early-life origins of chronic obstructive pulmonary disease. N Engl J Med. 2016;375(9):871–8. https://doi.org/10.1056/NEJMra1603287.

    Article  PubMed  Google Scholar 

  6. Wright RJ, Brunst KJ. Programming of respiratory health in childhood: influence of outdoor air pollution. Curr Opin Pediatr. 2013;25(2):232–9. https://doi.org/10.1097/MOP.0b013e32835e78cc.

    Article  CAS  PubMed  Google Scholar 

  7. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, et al. International variation in the prevalence of COPD (the BOLD study): a population-based prevalence study. Lancet. 2007;370(9589):741–50. https://doi.org/10.1016/S0140-6736(07)61377-4.

    Article  PubMed  Google Scholar 

  8. Zhong N, Wang C, Yao W, Chen P, Kang J, Huang S, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med. 2007;176(8):753–60. https://doi.org/10.1164/rccm.200612-1749OC.

    Article  PubMed  Google Scholar 

  9. Buist AS, Vollmer WM, McBurnie MA. Worldwide burden of COPD in high- and low-income countries. Part I. The burden of obstructive lung disease (BOLD) initiative. Int J Tuberc Lung Dis. 2008;12(7):703–8.

    CAS  PubMed  Google Scholar 

  10. Lopez-Campos JL, Tan W, Soriano JB. Global burden of COPD. Respirology. 2016;21(1):14–23. https://doi.org/10.1111/resp.12660.

    Article  PubMed  Google Scholar 

  11. Pauwels RA, Rabe KF. Burden and clinical features of chronic obstructive pulmonary disease (COPD). Lancet. 2004;364(9434):613–20. https://doi.org/10.1016/S0140-6736(04)16855-4.

    Article  PubMed  Google Scholar 

  12. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: global burden of disease study. Lancet. 1997;349(9061):1269–76. https://doi.org/10.1016/S0140-6736(96)07493-4.

    Article  CAS  PubMed  Google Scholar 

  13. Burney PG, Patel J, Newson R, Minelli C, Naghavi M. Global and regional trends in COPD mortality, 1990-2010. Eur Respir J. 2015;45(5):1239–47. https://doi.org/10.1183/09031936.00142414.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2007;4(7):502–6. https://doi.org/10.1513/pats.200701-001FM.

    Article  PubMed  Google Scholar 

  15. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. Mortality in COPD: role of comorbidities. Eur Respir J. 2006;28(6):1245–57. https://doi.org/10.1183/09031936.00133805.

    Article  CAS  PubMed  Google Scholar 

  16. Jayes L, Haslam PL, Gratziou CG, Powell P, Britton J, Vardavas C, et al. SmokeHaz: systematic reviews and meta-analyses of the effects of smoking on respiratory health. Chest. 2016;150(1):164–79. https://doi.org/10.1016/j.chest.2016.03.060.

    Article  PubMed  Google Scholar 

  17. • Atkinson RW, Kang S, Anderson HR, Mills IC, Walton HA. Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax. 2014;69(7):660–5. https://doi.org/10.1136/thoraxjnl-2013-204492. Although this is not the most recent systematic review, this paper offers a comprehensive review of studies on impact of ambient air pollution exposure on COPD outcomes in the general population.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. •• Bloemsma LD, Hoek G, Smit LA. Panel studies of air pollution in patients with COPD: systematic review and meta-analysis. Environ Res. 2016;151:458–68. https://doi.org/10.1016/j.envres.2016.08.018. This is one of the very recent systematic reviews on air pollution effects in COPD patients specifically.

    Article  CAS  PubMed  Google Scholar 

  19. Ko FW, Hui DS. Air pollution and chronic obstructive pulmonary disease. Respirology. 2012;17(3):395–401. https://doi.org/10.1111/j.1440-1843.2011.02112.x.

    Article  PubMed  Google Scholar 

  20. •• Li MH, Fan LC, Mao B, Yang JW, Choi AM, Cao WJ, et al. Short-term exposure to ambient fine particulate matter increases hospitalizations and mortality in COPD: a systematic review and meta-analysis. Chest. 2016a;149(2):447–58. https://doi.org/10.1378/chest.15-0513. This recent systematic review also included specifically studies published in Chinese language.

    Article  PubMed  Google Scholar 

  21. Schikowski T, Mills IC, Anderson HR, Cohen A, Hansell A, Kauffmann F, et al. Ambient air pollution: a cause of COPD? Eur Respir J. 2014a;43(1):250–63. https://doi.org/10.1183/09031936.00100112.

    Article  PubMed  Google Scholar 

  22. Schikowski T, Adam M, Marcon A, Cai Y, Vierkotter A, Carsin AE, et al. Association of ambient air pollution with the prevalence and incidence of COPD. Eur Respir J. 2014b;44(3):614–26. https://doi.org/10.1183/09031936.00132213.

    Article  CAS  PubMed  Google Scholar 

  23. Thurston GD, Kipen H, Annesi-Maesano I, Balmes J, Brook RD, Cromar K, et al. A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework. Eur Respir J. 2017;49(1):1600419. https://doi.org/10.1183/13993003.00419-2016.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Lelieveld J, Evans JS, Fnais M, Giannadaki D, Pozzer A. The contribution of outdoor air pollution sources to premature mortality on a global scale. Nature. 2015;525(7569):367–71. https://doi.org/10.1038/nature15371.

    Article  CAS  PubMed  Google Scholar 

  25. Stanek LW, Brown JS, Stanek J, Gift J, Costa DL. Air pollution toxicology—a brief review of the role of the science in shaping the current understanding of air pollution health risks. Toxicol Sci. 2011;120(Suppl 1):S8–27. https://doi.org/10.1093/toxsci/kfq367.

    Article  CAS  PubMed  Google Scholar 

  26. Kurt OK, Zhang J, Pinkerton KE. Pulmonary health effects of air pollution. Curr Opin Pulm Med. 2016;22(2):138–43. https://doi.org/10.1097/MCP.0000000000000248.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Hamra GB, Laden F, Cohen AJ, Raaschou-Nielsen O, Brauer M, Loomis D. Lung cancer and exposure to nitrogen dioxide and traffic: a systematic review and meta-analysis. Environ Health Perspect. 2015;123(11):1107–12. https://doi.org/10.1289/ehp.1408882.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Perez L, Rapp R, Kunzli N. The year of the lung: outdoor air pollution and lung health. Swiss Med Wkly. 2010;140:w13129. https://doi.org/10.4414/smw.2010.13129.

    PubMed  Google Scholar 

  29. Garshick E. Effects of short- and long-term exposures to ambient air pollution on COPD. Eur Respir J. 2014;44(3):558–61. https://doi.org/10.1183/09031936.00108814.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Faustini A, Stafoggia M, Cappai G, Forastiere F. Short-term effects of air pollution in a cohort of patients with chronic obstructive pulmonary disease. Epidemiology. 2012;23(6):861–79. https://doi.org/10.1097/EDE.0b013e31826767c2.

    Article  PubMed  Google Scholar 

  31. Garcia-Aymerich J, Tobias A, Anto JM, Sunyer J. Air pollution and mortality in a cohort of patients with chronic obstructive pulmonary disease: a time series analysis. J Epidemiol Community Health. 2000;54(1):73–4. https://doi.org/10.1136/jech.54.1.73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sunyer J, Basagana X. Particles, and not gases, are associated with the risk of death in patients with chronic obstructive pulmonary disease. Int J Epidemiol. 2001;30(5):1138–40. https://doi.org/10.1093/ije/30.5.1138.

    Article  CAS  PubMed  Google Scholar 

  33. 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. https://doi.org/10.1080/15412555.2016.1216956.

    Article  PubMed  Google Scholar 

  34. Li J, Sun S, Tang R, Qiu H, Huang Q, Mason TG, et al. Major air pollutants and risk of COPD exacerbations: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis. 2016b;11:3079–91. https://doi.org/10.2147/copd.s122282.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Samoli E, Stafoggia M, Rodopoulou S, Ostro B, Alessandrini E, Basagana X, et al. Which specific causes of death are associated with short term exposure to fine and coarse particles in Southern Europe? Results from the MED-PARTICLES project. Environ Int. 2014;67:54–61. https://doi.org/10.1016/j.envint.2014.02.013.

    Article  CAS  PubMed  Google Scholar 

  36. Chen R, Yin P, Meng X, Liu C, Wang L, Xu X, et al. Fine particulate air pollution and daily mortality. A Nationwide analysis in 272 Chinese cities. Am J Respir Crit Care Med. 2017;196(1):73–81. https://doi.org/10.1164/rccm.201609-1862OC.

    Article  PubMed  Google Scholar 

  37. Zhang S, Li G, Tian L, Guo Q, Pan X. Short-term exposure to air pollution and morbidity of COPD and asthma in East Asian area: a systematic review and meta-analysis. Environ Res. 2016;148:15–23. https://doi.org/10.1016/j.envres.2016.03.008.

    Article  CAS  PubMed  Google Scholar 

  38. Wu S, Ni Y, Li H, Pan L, Yang D, Baccarelli AA, et al. Short-term exposure to high ambient air pollution increases airway inflammation and respiratory symptoms in chronic obstructive pulmonary disease patients in Beijing, China. Environ Int. 2016;94:76–82. https://doi.org/10.2016/j.envint.2016.05.004.

    Article  CAS  PubMed  Google Scholar 

  39. Bell ML, Zanobetti A, Dominici F. Evidence on vulnerability and susceptibility to health risks associated with short-term exposure to particulate matter: a systematic review and meta-analysis. Am J Epidemiol. 2013;178(6):865–76. https://doi.org/10.1093/aje/kwt090.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Simoni M, Baldacci S, Maio S, Cerrai S, Sarno G, Viegi G. Adverse effects of outdoor pollution in the elderly. J Thorac Dis. 2015;7(1):34–45. https://doi.org/10.3978/j.issn.2072-1439.2014.12.10.

    PubMed  PubMed Central  Google Scholar 

  41. Brook RD, Rajagopalan S, Pope CA 3rd, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation. 2010;121(21):2331–78. https://doi.org/10.1161/CIR.0b013e3181dbece1.

    Article  CAS  PubMed  Google Scholar 

  42. Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. Environ Geochem Health. 2015;37(4):631–49. https://doi.org/10.1007/s10653-015-9720-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Ling SH, van Eeden SF. Particulate matter air pollution exposure: role in the development and exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2009;4:233–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Li XY, Gilmour PS, Donaldson K, MacNee W. Free radical activity and pro-inflammatory effects of particulate air pollution (PM10) in vivo and in vitro. Thorax. 1996;51(12):1216–22. https://doi.org/10.1136/thx.51.12.1216.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Abbey DE, Burchette RJ, Knutsen SF, McDonnell WF, Lebowitz MD, Enright PL. Long-term particulate and other air pollutants and lung function in nonsmokers. Am J Respir Crit Care Med. 1998;158(1):289–98. https://doi.org/10.1164/ajrccm.158.1.9710101.

    Article  CAS  PubMed  Google Scholar 

  46. Downs SH, Schindler C, Liu LJ, Keidel D, Bayer-Oglesby L, Brutsche MH, et al. Reduced exposure to PM10 and attenuated age-related decline in lung function. N Engl J Med. 2007;357(23):2338–47. https://doi.org/10.1056/NEJMoa073625.

    Article  CAS  PubMed  Google Scholar 

  47. Schikowski T, Ranft U, Sugiri D, Vierkotter A, Bruning T, Harth V, et al. Decline in air pollution and change in prevalence in respiratory symptoms and chronic obstructive pulmonary disease in elderly women. Respir Res. 2010;11(1):113. https://doi.org/10.1186/1465-9921-11-113.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We thank Dr. Carlana Ramlochansingh for the final editing of the manuscript.

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Authors and Affiliations

  1. Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Centre Munich, German Centre for Lung Research. (DZL), University Hospital Munich of Ludwig Maximillians University Munich, Munich, Germany

    Joachim Heinrich

  2. Institute of Epidemiology I, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany

    Joachim Heinrich

  3. Allergy and Lung Health Unit, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia

    Joachim Heinrich

  4. Leibniz Institute for Environmental Medicine, Düsseldorf, Germany

    Tamara Schikowski

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  1. Joachim Heinrich
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JH drafted the manuscript. TS added comments. Both authors critical interpreted the findings and derived the main conclusions.

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Joachim Heinrich and Tamara Schikowski declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Susceptibility Factors in Environmental Health

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Heinrich, J., Schikowski, T. COPD Patients as Vulnerable Subpopulation for Exposure to Ambient Air Pollution. Curr Envir Health Rpt 5, 70–76 (2018). https://doi.org/10.1007/s40572-018-0178-z

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