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Urban air pollution and chronic obstructive pulmonary disease-related emergency department visits
  1. M A Arbex1,2,
  2. G M de Souza Conceição1,
  3. S P Cendon1,
  4. F F Arbex1,
  5. A C Lopes1,
  6. E P Moysés1,
  7. S L Santiago1,
  8. P H N Saldiva2,
  9. L A A Pereira2,3,
  10. A L F Braga2,3,4
  1. 1
    Internal Medicine Post-Graduate Programme, São Paulo Federal University, Medical School, São Paulo, Brazil
  2. 2
    Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, University of São Paulo Faculty of Medical Sciences, São Paulo, Brazil
  3. 3
    Environmental Exposure and Risk Analysis Group, Public Health Post-Graduate Programme, Catholic University of Santos, Santos, Brazil
  4. 4
    Community Health Department, ABC Faculty of Medicine, Santo André, São Paulo, Brazil
  1. Correspondence to Dr M A Arbex, Rua Pedro de Toledo, 980, 11° Andar, Cj. 116, Vila Clementino, 04039-002, São Paulo, SP, Brazil; arbexma{at}


Background: Patients with chronic obstructive pulmonary disease (COPD) can have 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 department visits and the daily environmental air concentrations of PM10, SO2, NO2, CO and O3 in the City of São Paulo, Brazil.

Methods: The 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 department 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 women was observed at lag 0, and among the elderly the lag period was noted to be longer. Increases in 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 affects 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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  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.