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Urban Air Pollution and COPD-related Emergency Room Visits
  1. Marcos Abdo Arbex1,
  2. Gleice Margarete de Souza Conceição1,
  3. Sonia Perez Cendon1,
  4. Flavio Ferlin Arbex1,
  5. Antonio Carlos Lopes1,
  6. Elisangela Providello Moyses1,
  7. Silvia Leticia Santiago1,
  8. Paulo Hilario Nascimento Saldiva2,
  9. Luiz Alberto Amador Pereira3,
  10. Alfésio Luis Ferreira Braga3
  1. 1 São Paulo Federal University, Medical School, Brazil;
  2. 2 University of São Paulo, Faculty of Medical Sciences, Brazil;
  3. 3 Catholic University of Santos, Brazil
  1. E-mail: arbexma{at}


Background: Chronic obstructive pulmonary disease patients may suffer from recurrent disease exacerbations triggered by several factors, including air pollution. Visits to the Emergency Respiratory Department can be a direct result of short-term exposure to air pollution. The aim of this study was to investigate the relationship between the daily number of COPD emergency room visits and the daily environmental air concentrations of PM10, SO2, NO2, CO and O3 in the City of São Paulo, Brazil.

Methods: Our sample data were collected between 2001 and 2003 and are categorised by gender and age. Generalised linear Poisson regression models were adopted to control for both short and long-term seasonal changes as well as for temperature and relative humidity. The non-linear dependencies were controlled using a natural cubic spline function. Third-degree polynomial distributed lag models were adopted to estimate both lag structures and the cumulative effects of air pollutants.

Results: PM10 and SO2 readings showed both acute and lagged effects on COPD emergency room visits. Interquartile range increases in their concentration (28.3 μg/m3 and 7.8 μg/m3, respectively) were associated with a cumulative 6 day increase of 19% and 16% in COPD admissions, respectively. An effect on females was observed at lag 0, and among the elderly the lag period was noted to be longer. Increases of CO concentration showed impacts in the female and elderly groups. NO2 and O3 presented mild effects on the elderly and in women, respectively.

Conclusion: These results indicate that air pollution impacts health in a gender- and age-specific manner and should be considered a relevant risk factor that exacerbates COPD in urban environments.

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