Effects of air pollution on acute exacerbation of chronic obstructive pulmonary disease: a descriptive retrospective study (pol-AECOPD)

Abstract

Purpose

Acute exacerbation of COPD (AECOPD) is among the most frequent causes for hospital admission, causing morbidity and mortality. Infection is the most frequent cause, and studies on pollution have shown higher hospital admission and mortality with inconsistent results. The objective was to identify if there is a change in levels of particulate matter (PM) during the days leading up to the symptom onset.

Patients and methods

A retrospective study was carried out on medical records of patients with AECOPD from a University Hospital. PM values of the consultation day, onset symptoms, and up to three previous days were recorded. Moreover, clinical presentation, laboratory findings, treatments, and hospital outcomes were recorded.

Results

A total of 250 medical records were included, mean age of 77 years, hospital stay mean of 6.7 days, 26.8% with no previous exposure was identified, coexistence with asthma was 5%, Obstructive Sleep Apnea Syndrome 15%, Pulmonary Hypertension 34%, antibiotic use 62%, ICU admission of 14% with non-invasive mechanical ventilation of 68%, and in-patient mortality of 2.4%. PM 2.5 of 48 hrs before onset symptoms median was 20.1 μg/m³ versus 15 and 16.5 for the day of symptoms and 3 days prior to onset symptoms (p<0.001). PM 10 of 46.65 μg/m³, versus 39 and 35.6, respectively (p<0.001). Expectoration OR 4.74; Purulence OR 6.58; Pleuritic pain OR 3.62; Antibiotic use OR 2.87, and corticoids use OR 2.62, all with p<0.05.

Conclusions

Patients with AECOPD have a higher median of particulate matter 48 hrs prior to symptomatic onset, as well as greater use of antibiotics and corticosteroids.

Keywords:

• pulmonary disease
• chronic obstructive
• particulate matter
• air pollutants

Acknowledgments

The authors thank the Hospital Universitario Nacional de Colombia and its directors for allowing us to carry out the study and access the patients’ medical records, to Dr Alfredo Saavedra, pulmonologist, for his contribution in the discussion of this study, and to my wife Angie Ortiz. All of this work’s costs were covered by the authors.

Responsibility for data

For efficacy data: Dr Jairo Morantes-Caballero has personally reviewed the efficacy data, understands the statistical methods employed for efficacy analysis, and confirms an understanding of this analysis, that the methods are clearly described, and that they are a fair way to report the results. For safety data: Dr Jairo Morantes-Caballero has personally reviewed the safety data. He understands the statistical methods employed for safety analysis and confirms that he understands this analysis, that the methods are clearly described, and that they are a fair way to report the results. For study design: Dr Jairo Morantes-Caballero confirms that the study objectives and procedures are honestly disclosed. Moreover, he has reviewed study execution data and confirms that procedures were followed to an extent that convinces all authors, that the results are valid and generalizable to a population similar to that enrolled in this study.

Author contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.