The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation: A case-crossover analysis

Pieter C. Goeminne; Bianca Cox; Simon Finch; Michael Loebinger; Pallavi Bedi; Adam T. Hill; Thomas Fardon; Kees de Hoogh; Tim S. Nawrot; James Chalmers

doi:10.1183/13993003.02557-2017

The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation: A case-crossover analysis

Pieter C. Goeminne (Lead / Corresponding author), Bianca Cox, Simon Finch, Michael Loebinger, Pallavi Bedi, Adam T. Hill, Thomas Fardon, Kees de Hoogh, Tim S. Nawrot, James Chalmers

Undergraduate Medicine

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Abstract

Introduction: In bronchiectasis, exacerbations are believed to be triggered by infectious agents, but often no pathogen can be identified. We aimed to establish the effect of acute air pollution fluctuations on bronchiectasis exacerbations.

Methods: We combined a case-crossover design with distributed lag models in an observational record linkage study. Patients were recruited at Ninewells Hospital, Dundee, UK.

Results: We recruited 432 patients with HRCT diagnosed and clinically confirmed bronchiectasis. After excluding days with missing air pollution data, the final model for PM10 was based on 6741 exacerbations from 430 patients and for NO2 it included 6248 exacerbations from 426 patients. For each 10µg/m³ increase in PM10 and NO2, the risk of having an exacerbation that same day increased significantly by 4.5% (95%CI: 0.9-8.3) and 3.2% (95%CI: 0.7-5.8) respectively. The overall increase in the risk of exacerbation for a 10μg/m3 increase in air pollutant concentration was 11.2% (95%CI: 6.0-16.8) for PM10 and 4.7% (95%CI: 0.1-9.5) for NO2. Subanalysis showed significant higher relative risks during spring (PM10 1.198, 95%CI 1.102-1.303; NO2 1.146, 95%CI 1.035-1.268) and summer (PM10 2.142, 95%CI 1.785-2.570; NO2 1.352, 95%CI 1.140-1.602).

Conclusions: Acute air pollution fluctuations are associated with increased exacerbation risk in bronchiectasis.

Original language	English
Article number	1702557
Journal	European Respiratory Journal
Volume	52
Issue number	1
Early online date	14 Jun 2018
DOIs	https://doi.org/10.1183/13993003.02557-2017
Publication status	Published - 27 Jul 2018

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Chalmers, James
- Respiratory Medicine and Gastroenterology - Clinical Professor (Teaching and Research) of Respiratory Research
Person: Academic

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title = "The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation: A case-crossover analysis",

abstract = "Introduction: In bronchiectasis, exacerbations are believed to be triggered by infectious agents, but often no pathogen can be identified. We aimed to establish the effect of acute air pollution fluctuations on bronchiectasis exacerbations.Methods: We combined a case-crossover design with distributed lag models in an observational record linkage study. Patients were recruited at Ninewells Hospital, Dundee, UK.Results: We recruited 432 patients with HRCT diagnosed and clinically confirmed bronchiectasis. After excluding days with missing air pollution data, the final model for PM10 was based on 6741 exacerbations from 430 patients and for NO2 it included 6248 exacerbations from 426 patients. For each 10µg/m³ increase in PM10 and NO2, the risk of having an exacerbation that same day increased significantly by 4.5% (95%CI: 0.9-8.3) and 3.2% (95%CI: 0.7-5.8) respectively. The overall increase in the risk of exacerbation for a 10μg/m3 increase in air pollutant concentration was 11.2% (95%CI: 6.0-16.8) for PM10 and 4.7% (95%CI: 0.1-9.5) for NO2. Subanalysis showed significant higher relative risks during spring (PM10 1.198, 95%CI 1.102-1.303; NO2 1.146, 95%CI 1.035-1.268) and summer (PM10 2.142, 95%CI 1.785-2.570; NO2 1.352, 95%CI 1.140-1.602).Conclusions: Acute air pollution fluctuations are associated with increased exacerbation risk in bronchiectasis.",

author = "Goeminne, {Pieter C.} and Bianca Cox and Simon Finch and Michael Loebinger and Pallavi Bedi and Hill, {Adam T.} and Thomas Fardon and {de Hoogh}, Kees and Nawrot, {Tim S.} and James Chalmers",

note = "Funded by the British Lung Foundation through the GSK/British Lung Foundation Chair of Respiratory Research to JDC and by the European Respiratory Society through the EMBARC (European Multicentre Audit and Research Collaboration) Project. We acknowledge the support of the Health Informatics Centre (HIC), University of Dundee and the Farr Institute Scotland for managing and supplying the anonymised data and NHS Tayside, the original data source.",

year = "2018",

month = jul,

day = "27",

doi = "10.1183/13993003.02557-2017",

language = "English",

volume = "52",

journal = "European Respiratory Journal",

issn = "0903-1936",

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TY - JOUR

T1 - The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation

T2 - A case-crossover analysis

AU - Goeminne, Pieter C.

AU - Cox, Bianca

AU - Finch, Simon

AU - Loebinger, Michael

AU - Bedi, Pallavi

AU - Hill, Adam T.

AU - Fardon, Thomas

AU - de Hoogh, Kees

AU - Nawrot, Tim S.

AU - Chalmers, James

N1 - Funded by the British Lung Foundation through the GSK/British Lung Foundation Chair of Respiratory Research to JDC and by the European Respiratory Society through the EMBARC (European Multicentre Audit and Research Collaboration) Project. We acknowledge the support of the Health Informatics Centre (HIC), University of Dundee and the Farr Institute Scotland for managing and supplying the anonymised data and NHS Tayside, the original data source.

PY - 2018/7/27

Y1 - 2018/7/27

N2 - Introduction: In bronchiectasis, exacerbations are believed to be triggered by infectious agents, but often no pathogen can be identified. We aimed to establish the effect of acute air pollution fluctuations on bronchiectasis exacerbations.Methods: We combined a case-crossover design with distributed lag models in an observational record linkage study. Patients were recruited at Ninewells Hospital, Dundee, UK.Results: We recruited 432 patients with HRCT diagnosed and clinically confirmed bronchiectasis. After excluding days with missing air pollution data, the final model for PM10 was based on 6741 exacerbations from 430 patients and for NO2 it included 6248 exacerbations from 426 patients. For each 10µg/m³ increase in PM10 and NO2, the risk of having an exacerbation that same day increased significantly by 4.5% (95%CI: 0.9-8.3) and 3.2% (95%CI: 0.7-5.8) respectively. The overall increase in the risk of exacerbation for a 10μg/m3 increase in air pollutant concentration was 11.2% (95%CI: 6.0-16.8) for PM10 and 4.7% (95%CI: 0.1-9.5) for NO2. Subanalysis showed significant higher relative risks during spring (PM10 1.198, 95%CI 1.102-1.303; NO2 1.146, 95%CI 1.035-1.268) and summer (PM10 2.142, 95%CI 1.785-2.570; NO2 1.352, 95%CI 1.140-1.602).Conclusions: Acute air pollution fluctuations are associated with increased exacerbation risk in bronchiectasis.

AB - Introduction: In bronchiectasis, exacerbations are believed to be triggered by infectious agents, but often no pathogen can be identified. We aimed to establish the effect of acute air pollution fluctuations on bronchiectasis exacerbations.Methods: We combined a case-crossover design with distributed lag models in an observational record linkage study. Patients were recruited at Ninewells Hospital, Dundee, UK.Results: We recruited 432 patients with HRCT diagnosed and clinically confirmed bronchiectasis. After excluding days with missing air pollution data, the final model for PM10 was based on 6741 exacerbations from 430 patients and for NO2 it included 6248 exacerbations from 426 patients. For each 10µg/m³ increase in PM10 and NO2, the risk of having an exacerbation that same day increased significantly by 4.5% (95%CI: 0.9-8.3) and 3.2% (95%CI: 0.7-5.8) respectively. The overall increase in the risk of exacerbation for a 10μg/m3 increase in air pollutant concentration was 11.2% (95%CI: 6.0-16.8) for PM10 and 4.7% (95%CI: 0.1-9.5) for NO2. Subanalysis showed significant higher relative risks during spring (PM10 1.198, 95%CI 1.102-1.303; NO2 1.146, 95%CI 1.035-1.268) and summer (PM10 2.142, 95%CI 1.785-2.570; NO2 1.352, 95%CI 1.140-1.602).Conclusions: Acute air pollution fluctuations are associated with increased exacerbation risk in bronchiectasis.

U2 - 10.1183/13993003.02557-2017

DO - 10.1183/13993003.02557-2017

M3 - Article

C2 - 29903857

SN - 0903-1936

VL - 52

JO - European Respiratory Journal

JF - European Respiratory Journal

IS - 1

M1 - 1702557

ER -

The impact of acute air pollution fluctuations on bronchiectasis pulmonary exacerbation: A case-crossover analysis

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Chalmers, James

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