Exacerbations of Chronic Obstructive Pulmonary Disease (COPD): An Ecological Study in the Basque Country, Spain (2000–2011)

Abstract

Chronic obstructive pulmonary disease (COPD) is a prevalent condition in adults aged ≥40 years characterized by progressive airflow limitation associated with chronic inflammatory response to noxious particles in the airways and lungs. Smoking, genetics, air pollution, nutrition and other factors may influence COPD development. Most hospitalizations and deaths for COPD are caused by its acute exacerbations, which greatly affect the health and quality of life of COPD patients and pose a high burden on health services. The aims of this project were to identify trends, geographic patterns and risk factors for COPD exacerbations, as revealed by hospitalizations and deaths, in the Basque Country, Spain, over a period of 12 years (2000-2011). Hospitalization and mortality rates for COPD were 262 and 18 per 100,000 population, respectively, with clusters around the biggest cities. Hospital mortality was 7.4%. Most hospitalized patients were male (77.4%) and accounted for 72.1% of hospital mortality. Hospitalizations decreased during the study period, except for 50-64 year-old women, peaking significantly. Using a multivariate modeling approach it was shown that hospitalizations were positively correlated with increased atmospheric concentrations of NO, CO, PM, and SO, and increased influenza incidence, but were negatively associated with increased temperatures and atmospheric O concentration. COPD exacerbations decreased in the Basque Country during 2000-2011, but not among 50-64-year-old women, reflecting the high smoking prevalence among Spanish women during the 1970-1990s. The main metropolitan areas were those with the highest risk for COPD exacerbations, calling attention to the role of heavy car traffic. Influenza virus, cold temperatures, and increased atmospheric NO, CO, PM, and SO (but decreased O) concentrations were identified as potential contributors to the burden of COPD exacerbations in the community. These findings are important for both the understanding of the disease process and in providing potential targets for COPD-reducing initiatives and new avenues for research.

Correlation Between Occurrence and Deterioration of Respiratory Diseases and Air Pollution Within the Legally Permissible Limits

“…Several studies report on O 3 to be associated with asthma 22,23,25,34,38 , acute and chronic bronchitis 39 , URTI 22 , and all respiratory visits 27,29,30,38 . Tamayo-Uria et al report that O 3 is negatively associated with COPD 28 . We found the number of patients with asthma to correlate with O 3 concentrations.…”

“…Particulate matter particles cause respiratory morbidity and mortality by inducing oxidative stress and infl ammation that lead to pulmonary anatomic and physiologic remodeling 19 . Association with PM 10 has been reported for asthma [20][21][22][23][24][25] , URTI and pneumonia 22 , COPD exacerbations [24][25][26][27][28] , as well as for all respiratory visits 20,29,30 . In our study, the number of patients with respiratory diseases (except for asthma) correlated with higher PM 10 concentrations, confi rming its role as the most powerful air pollutant generated by burning of fossil fuels in vehicles and other causes.…”

Environmental triggers of COPD symptoms: a case cross-over study

“…This allows the study considerable power to detect short-term variable exposures like air pollution that might be associated with the onset of an exacerbation. 36–39 While other studies demonstrate this association in emergency room and hospitalisation data, our evidence may be stronger because of the greater sensitivity of the case cross-over that includes not only those exacerbations that progress to emergency room or inpatient care.…”

Influence of Particulate Matter Air Pollution on Exacerbation of Chronic Obstructive Pulmonary Disease Depending on Aerodynamic Diameter and the Time of Exposure in the Selected Population with Coexistent Cardiovascular Diseases

“…It has been proven that there is a relation between exposure to PM, the drop of spirometric values [7][8], increase of dyspnoea, wheezes in patients with asthma and COPD [9]. It entailed higher consumption of inhalation medications applied in the treatment of COPD [10] and a bigger number of hospitalisations due to COPD exacerbation [11][12][13]. Simultaneously, the fundamental symptom of the COPD exacerbation -intensified dyspnoea above the normal variability -occurs in the course of exacerbation of congestive heart failure (CHF) and other cardiovascular diseases.…”