Relationship of air-pollution with the acute exacerbation of chronic obstructive pulmonary disease

Background Kutahya is among the cities in Turkey where air pollution is heavy. Chronic obstructive pulmonary disease (COPD) being the most affected disease from environmental factors such as air pollution. The purpose of the study is to evaluate the relationship of air-pollution with admissions to the emergency unit with the acute exacerbation of COPD. Method Time-series analysis was performed in order to identify the relationship between Kutahya province pollution indicators and the number of admissions to Dumlupınar University Hospital Emergency Department with acute COPD exacerbation between the dates 1 January 2013 and 31 January 2014 (for a total of 734 days). The diagnoses of acute COPD exacerbations according to the ICD-10 were retrieved from the electronic registration system. The daily average SO2, NO2, and O3 and particulate matter and average temperature and relative humidity values were obtained from Air Quality Monitoring Station. For the time-series design, generalized gradual linear method (GAM) was used. In the GAM, the potential confounding effects were calculated. Acute COPD exacerbations were taken as the dependent variable which was converted to normal distribution by taking the linear logarithm. Results There were 11 109 admissions to the emergency department with acute exacerbation of COPD. Daily mean(SD) and median number of acute COPD exacerbation were 15(14) and 12, respectively. Of the air pollution indicators, mean(SD) PM was 66.5(36), SO2 was 11.3(8.6), NO2 was 39.3(11.2) and O3 was 47.2(24.7). Mean daily temperature was 11.6(7.7) and humidity was 64.9(13.3). In multivariate linear regression analysis, the variables affecting the admissions to acute COPD exacerbations were weekends, days of the week, daily mean temperature, daily humidity, NO2 and O3 (R2 : 0.592; F : 70.636; p < 0.001). Conclusions The air pollution in Kutahya is in near the danger limits. Acute COPD exacerbations increase in certain days of the week and with increased humidity rate and NO2 and decreased O3. Key message To evaluate the relationship of air-pollution with health effects is so important.