Understanding the relationships between environmental factors and exacerbations of COPD

ABSTRACT

Introduction

Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant health burden both for patients and healthcare systems. Exposure to various environmental factors increases the risk of exacerbations.

Areas covered

We searched PubMed and assessed literature published within the last 10 years to include epidemiological evidence on the relationships between air pollution, temperature and COPD exacerbation risk as well as the implications of extreme weather events on exacerbations.

Expert opinion

Ongoing climate change is expected to increase air pollution levels, global temperature and the frequency and severity of extreme weather events, all of which are associated with COPD exacerbations. Further research is needed using patient-focused methodological approaches to better understand and quantify these relationships, so that effective mitigation strategies that decrease the risk of exacerbations can be developed.

KEYWORDS:

• COPD
• exacerbation
• air pollution
• environment
• climate

Article highlights

• Several environmental factors increase the risk of exacerbations in patients with COPD, likely by increasing inflammation and susceptibility to infections. These pathways should be targeted in future research

• Air pollution levels are high and management strategies are needed for patients at highest exposure to mitigate exacerbation risk

• Seasonality in exacerbations rates are proven, during winter months there is a need to increase awareness among patient groups at high risk

• Prevention of respiratory infections through effective vaccination programmes will help reduce exacerbation peaks in winter months

• In periods of extreme heat, more care and focus is needed on patients with comorbid cardiovascular conditions

• As climate change increases the risk of extreme phenomenon, adaptive management strategies for COPD patients who are likely to be adversely affected are needed.

Declaration of interest

A Gayle is a current employee of AstraZeneca. E Fuertes is supported by an Imperial College Research Fellowship (2019–2023). J Quint reports personal fees from AZ, GSK, Chiesi, Teva and BI for Advisory board participation or travel, outside the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.