Association of PM2.5 and PM10 with Acute Exacerbation of Chronic Obstructive Pulmonary Disease at lag0 to lag7: A Systematic Review and Meta-Analysis

Abstract

This study aimed to conduct a meta-analysis to investigate whether short-term exposure to fine (PM_2.5) and coarse (PM₁₀) particulate matter was associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) hospitalization, emergency room visit, and outpatient visit at different lag values. PubMed, Embase, and the Cochrane Library were searched for relevant papers published up to March 2021. For studies reporting results per 1-µg/m³ increase in PM_2.5, the results were recalculated as per 10-µg/m³ increase. We manually calculated the RRs for these two studies and transferred the RRs to estimate 10 µg/m³ increases in PM_2.5. Automation tools were initially used to remove ineligible studies. Two reviewers independently screened the remaining records and retrieved reports. Twenty-six studies (28 datasets; 7,018,419 patients) were included. There was a significant association between PM_2.5 and AECOPD events on lag0 (ES = 1.01, 95%CI: 1.01-1.02, p < 0.001; I²=88.6%, P_{heterogeneity}<0.001), lag1 (ES = 1.00, 95%CI: 1.00-1.01, p < 0.001; I²=82.5%, P_{heterogeneity}<0.001), lag2 (ES = 1.01, 95%CI: 1.01-1.01, p < 0.001; I²=90.6%, P_{heterogeneity}<0.001), lag3 (ES = 1.01, 95%CI: 1.00-1.01, p < 0.001; I²=88.9%, P_{heterogeneity}<0.001), lag4 (ES = 1.00, 95%CI: 1.00-1.01, p < 0.001; I²=83.7%, P_{heterogeneity}<0.001), and lag7 (ES = 1.00, 95%CI: 1.00-1.00, p < 0.001; I²=0.0%, P_{heterogeneity}=0.743). The subgroup analyses showed that PM_2.5 influenced the rates of hospitalization, emergency room visits, and outpatient visits. Similar trends were observed with PM₁₀. The risk of AECOPD events (hospitalization, emergency room visit, and outpatient visit) was significantly increased with a 10-µg/m³ increment in PM_2.5 and PM₁₀ from lag0 to lag7.

List Of Abbreviations: particulate matter (PM_2.5 and PM₁₀); acute exacerbation of chronic obstructive pulmonary disease (AECOPD); Chronic obstructive pulmonary disease (COPD); Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); Effect sizes [48]; confidence intervals (CIs)

Keywords:

• Fine particulate matter
• acute exacerbation of chronic obstructive pulmonary disease
• hospitalization
• emergency room
• outpatient

Relevance to clinical practice

Short-term exposure to PM_2.5 and PM₁₀ were reported to increase the burden of AECOPD significantly. Therefore, this study aimed to conduct a meta-analysis to explore whether PM_2.5 and PM₁₀ were associated with AECOPD hospitalization, emergency room visit, and outpatient visit. The results showed that the risk of AECOPD events (hospitalization, emergency room visit, and outpatient visit) was significantly increased with an increment of 10 µg/m³ in PM_2.5 and PM₁₀ from lag0 to lag7.

Impact statement

What does this paper contribute to the wider global clinical community?

The results showed that an increment of 10 µg/m³ in particulate matter PM_2.5 and PM₁₀ from lag0 to lag7 might significantly increase the AECOPD events, including hospitalization, emergency room, and outpatient visits.

Author contributions

Niuniu Li and Liyun Wang carried out the studies, participated in collecting data, and drafted the manuscript. Niuniu Li and Liyun Wang performed the statistical analysis and participated in its design. Kun Ji and Jianling Ma participated in the acquisition, analysis, or interpretation of data and drafted the manuscript. All authors read and approved the final manuscript.

Declaration of interest

The authors report no conflict of interest.

Statement

Manuscripts have been read and approved by all authors to meet the authorship requirements of this journal, and each author believes that the manuscript represents honest work if that information is not provided in another form.

Health and safety

This study does not involve any experimental operations, so there are no risks that might be involved in experiments or procedures, or that might involve instructions, materials, or formulas. This article complies with the relevant rules.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (No.81373588) and Beijing University of Chinese Medicine (2018-JYbZZ-JS144).