Objectives: To carry out a prospective combined quantitative analysis of the associations between all cause mortality and ambient particulate matter and sulphur dioxide.

We investigated the short-term effects of air pollution on hospital admissions for chronic obstructive pulmonary disease (COPD) in Europe.As part of a European project (Air Pollution and Health, a European Approach (APHEA)), we analysed data from the cities of Amsterdam, Barcelona, London, Milan, Paris and Rotterdam, using a standardized approach to data eligibility and statistical analysis. Relative risks for daily COPD admissions were obtained using Poisson regression, controlling for: seasonal and other cycles; influenza epidemics; day of the week; temperature; humidity and autocorrelation. Summary effects for each pollutant were estimated as the mean of each city's regression coefficients weighted by the inverse of the variance, allowing for additional between-cities variance, as necessary.For all ages, the relative risks (95% confidence limits (95% CL)) for a 50 µg·m -3 increase in daily mean level of pollutant (lagged 1-3 days) were (95% CL): sulphur dioxide 1.02 (0.98, 1.06); black smoke 1.04 (1.01, 1.06); total suspended particulates 1.02 (1.00, 1.05), nitrogen dioxide 1.02 (1.00, 1.05) and ozone (8 h) 1.04 (1.02, 1.07).The results confirm that air pollution is associated with daily admissions for chronic obstructive pulmonary disease in European cities with widely varying climates. The results for particles and ozone are broadly consistent with those from North America, though the coefficients for particles are substantially smaller. Overall, the evidence points to a causal relationship but the mechanisms of action, exposure response relationships and pollutant interactions remain unclear.

The relationship of airway responsiveness to respiratory symptom prevalence has been studied in a cross-sectional analysis of a random subpopulation from a large-scale population study on chronic obstructive pulmonary disease (COPD) being conducted in the Netherlands. In 1,905 subjects with complete data on age, sex, area of residence, smoking habits, and respiratory symptom prevalence, airway responsiveness was assessed by a histamine challenge test. Subjects with a decrease in FEV1 of greater than or equal to 10% at a histamine concentration of less than or equal to 16 mg/ml were considered to be responders. Bronchial hyperresponsiveness appeared to be age dependent, with the proportion of responders increasing from 13% in those 14 to 24 yr of age to 40% in those 55 to 64 yr of age (p less than 0.001). Respiratory symptom outcomes included chronic cough, chronic phlegm, dyspnea, bronchitic episodes, persistent wheeze, and asthmatic attacks. Respiratory symptom prevalence rates were significantly higher in responders (p less than 0.001 for all symptoms). Cigarette smoking is known to be related to respiratory symptom prevalence and possibly to bronchial responsiveness. Because of these associations, we examined the relationship of bronchial responsiveness to respiratory symptoms within cigarette smoking categories. For all respiratory symptoms, it was found that, regardless of smoking category, responders were more likely to be symptomatic than were nonresponders. Odds ratios ranged from 1.7 for chronic cough to 4.4 for asthmatic attacks.(ABSTRACT TRUNCATED AT 250 WORDS)

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Study objective -To assess the short term relationship between air pollution and the daily number of emergency hospital admissions for respiratory disease. Design -Data were analysed using autoregressive Poisson regression allowing for overdispersion and controlling for possible confounding factors such as seasonal and other chronological variables, meteorological factors, and influenza epidemics. Setting -The two major cities in The Netherlands -Amsterdam (694 700 inhabitants) and Rotterdam (576 200 inhabitants). Participants and measurements -Emergency hospital admissions for respiratory diseases, registered on a daily basis by the National Medical Registration, for the period 1977-89 were used. ICD-9 codes included were: respiratory (460-519), chronic obstructive pulmonary disease (490-492, 494, 496), and asthma (493). The mean (range) of the total daily number of admissions for these three classifications were as follows: 6-70 (0-23), 1-74 (0-9)