• Acting Director, CNR Institute of Biomedicine and Molecular Immunology

“Alberto Monroy”, Palermo, Italy

• Senior Consultant, Pulmonary Environmental Epidemiology Unit, CNR

Institute of Clinical Physiology, Pisa, Italy

• Professor of “Health Effects of Pollution”, School of Environmental

Sciences, University of Pisa, Italy

• 2006-07 Past-President, European Respiratory Society (ERS)

• 2015-17 Member of Planning Group, Global Alliance against chronic

Respiratory Diseases (GARD)

Outdoor air pollution

and COPD

G. Viegi, MD, FERS

Durata: 10’

Figure 1 Main respiratory health effects due to outdoor pollution exposure in the elderly. *Without further specifications. PM10 = particulate matter of 10 μm aerodiameter; NO2 = nitrogen dioxide; SO2 = sulphur dioxide; CO = carbon monoxide; O3 = ozone; COPD = chronic obstructive pulmonary disease; PM2.5 = particulate matter of aerodiameter 2.5μm.

Thurston, ERJ 2017

25/11/2017 5

2016

2016

Based on the modelled data, 92 % of the world population are exposed to PM2.5 air pollutionconcentrations that are above the annual mean WHO AQG levels of 10 μg/m3 .With the exception of the region of the Americas, all regions – both HIC and LMIC – have less than 20 % ofthe population living in places in compliance with the WHO AQG.

Schikowski, Respir Res 2005

50-64 years

COPDincidence

www.endseurope.com/docs/110302b.pdf

An accumulation of damage to airways resulting from these acute effects is a plausible basis for any link between air pollution and the development of COPD

FIGURE 2 Meta-analysis results summarising the centre-specific adjusted random-effect logistic regression model estimates of the effect of traffic variables on incidence of chronic obstructive pulmonary disease (COPD) (Global Initiative for Chronic Obstructive Lung Disease criteria all stages), in never-smokers, for increments in traffic intensity on the nearest road of 5000 vehicle?day-1 and in traffic load on major roads within a 100 m buffer of 500 000 vehicle?day-1?m in two categories. I-squared is the variation in estimate effect attributable to heterogeneity, and D+L the pooled random effects estimate of all studies. The logistic regression models were adjusted for sex at baseline, smoking at follow-up, maximal educational level, age at follow-up, age at follow-up squared, height at baseline, body mass index (BMI) at follow-up and BMI squared. ES: estimate.

Systematic review of the literature on the association between short-term exposures of particulate matter <2.5 microns (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) and COPD-related emergency department (ED) visits, hospital admissions (HA), and mortality.

An increase in PM2.5 of 10 ug/m3 was associated with a 2.5% (95% CI: 1.6–3.4%) increased risk of COPD-related ED and HA;

an increase of 10 ug/m3 in NO2 was associated with a 4.2% (2.5–6.0%) increase; and an increase of 10 ug/m3 in SO2 was associated with a 2.1% (0.7–3.5%) increase.

Similar pooled effects were estimated for each pollutant and COPD-related mortality. These results suggest an ongoing threat to the health of COPD patients from both outdoor particulates and gaseous pollutants. Ambient outdoor concentrations of PM2.5, NO2, and SO2

were significantly and positively associated with both COPD-related morbidity and mortality.

Assessment of health effects attributable to ground-level ozone (O3), including respiratory

mortality and hospital admissions for chronic obstructive pulmonary disease (HA-COPD)

using relative risk (RR) and baseline incidence (BI) as defined by WHO.

5.9% (95% CI: 2.3-9.4) of respiratory mortality, and 4.1% (CI: 2.5-6.1%) of the

HA-COPD were attributed to O3 concentrations higher than 10µg/m.

For each 10 µg/m3 increase in O3 concentration, the risk of respiratory mortality and HA-COPD increased by 1.25% and 0.86%, respectively.

EPIAIR 1

EPIAIR 1

respiratory natural-cause

EPIAIR 1

Hospital admissions forRespiratory diseases

Zona rurale Zona urbana

Epidemiological Studies of Po Delta and Pisa

Popolazione generale:fattore urbano

Maio, Chest 2009

Figure 2 Classification of subjects based on the distance of each home from the main road. Zoomed map representing the classification of subjects according to the distance of each home from the main road. Highly exposed subjects are those living in the buffer area 0-100 m from the road, moderately exposed subjects living in the buffer area 100-250 m and unexposed are those living between 250 and 800 m from the road.

Pisa Study

PI1(1985-88)

PI2(1991-93)

PI3(2009-11)

p-value(PI1 vs PI3)

p-value trend

Asma 6,7 7,1 7,8 n.s. n.s.

Attacchi d’asma correnti 3,4 3,4 7,2 <0,001 <0,001

Sintomi/diagnosi di rinite allergica 16,2 20,2 37,4 <0,001 <0,001

Tosse usuale 11,4 14,4 16,5 <0,001 <0,001

Espettorato usuale 8,7 12,0 19,5 <0,001 <0,001

BPCO 2,1 2,6 6,8 <0,001 <0,001

Ostruzione delle vie aeree* --- 10,8 21,1 <0,001 <0,001

Prevalence of respiratory

symptoms/diseases is still increasing:

Pisa general population sample followed

for 25 years

Fig. 2. a. Adjusted prevalence of asthma and allergic rhinitis

symptoms/ diagnosis in the three Surveys of the Pisa study. b.

Adjusted prevalence of COPD symptoms/ diagnosis and airway

obstruction in the three surveys of the Pisa study. # Lower Limit of

Normal (LLN) according to ATS/ERS;

*** p-value < 0.001 among the three surveys, by chi square test.

^^^ p-value < 0.001 by chi-square test for trend.

www.ersnet.org

“Many thanks for the invitation and for

the attention”.

Giovanni Viegi