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Effect of air-pollutants and environmental factors on COPD exacerbations: time series analysis stratified by age and concentration of pollutants
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  • Jong Seung Kim,
  • Hyu Seok Shin,
  • Eun Jung Lee,
  • Min Gul Kim,
  • Sang Woo Yeom,
  • Sam Hyun Kwon,
  • Min Hee Lee ,
  • Doo Hwan Kim,
  • Sang Jae Noh
Jong Seung Kim
Chonbuk National University Hospital
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Hyu Seok Shin
Chonbuk National University Hospital
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Eun Jung Lee
Chonbuk National University Hospital
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Min Gul Kim
Chonbuk National University Hospital
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Sang Woo Yeom
Chonbuk National University Hospital
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Sam Hyun Kwon
Chonbuk National University Hospital
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Min Hee Lee
Presbyterian Medical Center
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Doo Hwan Kim
National Health Insurance Service
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Sang Jae Noh
Chonbuk National University Hospital
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Abstract

Background: Chronic obstructive pulmonary disease (COPD) exacerbation (CE) is characterized by the rapid deterioration of respiratory symptoms caused by air pollution, but there have been no comprehensive studies with regard to the age-stratified effect of air pollution. We investigate the short-term effects of air pollution and environmental factors on CE. Methods: By merging the individualized environmental data and Korea’s National Health Insurance cohort, we conducted Quasi-Poisson analysis to evaluate the effects of air pollutants and environmental factors on CE. Results: From January 2007 to December 2012, a total of 15110 CE events occurred, which showed seasonal dynamics in CE events, air pollutants (particulate matter less than 10 µm (PM10), NO2, SO2) and environmental factors (wind speed (WS), solar sunshine (SS)). The only factor affecting CE was PM10, and this occurred on lag days 4, 5, and 6 and had a peak hazard ratio (HR) of 1.0404 on lag day 5. PM10 also had a lag-cumulative effect on CE risk from lag day 6 to lag day 10. In subgroup analysis on age and level of parameters, each factor had a different significant effect on CE on different lag days. Conclusions: PM10 uniquely affects CE at lag-specific day 5 (from lag day 4 to lag day 6). PM10 also had a lag-cumulative effect on CE risk which showed a pattern proportional to the concentration of PM10. Considering the subgroup analysis, we need to devise different strategies for air pollutants and age for patients with COPD exacerbation.