Urban air pollution and chronic obstructive pulmonary disease: a review

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Abstract
There is consistency in the findings that relate the acute increases in urban air pollution (mainly the particulate matter) and the short-term health effects (i.e. mortality and hospital admissions) on patients suffering from chronic obstructive pulmonary disease (COPD). Beyond the acute effects, a relevant public health and scientific question is to what extent chronic exposure to air pollution is related with lung function impairment and development of COPD. The few cross-sectional studies showed an increase of self-reported diagnosis of chronic bronchitis and emphysema, breathlessness and mucus hypersecretion and lower levels of lung function in the more polluted areas. The two cohort studies in children have found a retardation of pulmonary function growth, and the only cohort in adults a faster decline of lung function. Given the intrinsic limitations of cross-sectional studies to separate the timing between exposure and effects, and the weaknesses of the cohorts (i.e. few areas, short follow-up, only one retest, lack of individual weighting of air pollution measure) there is a need for new prospective studies. These should be performed in a large number of geographical areas and with a long follow-up to asses the impact of long-term air pollution on lung function growth and decline, and on incidence, duration, severity and survival of chronic obstructive pulmonary disease.