PT  - JOURNAL ARTICLE
AU  - Elizabeth Moore
AU  - Lia Chatzidiakou
AU  - Moyosore-Oluwa Kuku
AU  - Roderic Jones
AU  - Liam Smeeth
AU  - Sean Beevers
AU  - Frank Kelly
AU  - Benjamin Barratt
AU  - Jennifer Quint
TI  - Global associations between air pollutants and chronic obstructive pulmonary disease (COPD) exacerbations: A systematic review
AID  - 10.1183/13993003.congress-2016.PA1126
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA1126
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA1126.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA1126.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Background: COPD exacerbations (AECOPD) affect lung function decline and quality of life. The effect of exposure to different air pollutants on AECOPD is unclear.Aim: We systematically reviewed the literature examining associations between air pollutants and hospital admissions for AECOPD.Methods: MEDLINE, EMBASE, BIOSIS & Science Citation Index were searched until September 2015. Inclusion criteria focused on studies presenting solely a COPD outcome defined by hospital admissions, and a measure of gaseous air pollutants and particle fractions. The association between each pollutant with COPD admissions was investigated in meta-analyses using random-effects models. Analyses were stratified by geographical clusters to investigate the evidence worldwide.Results: 46 studies were included and results showed marginal positive associations. The number of included studies was small with high heterogeneity between them and there was evidence of small-study bias. Geographical clustering of the effects of pollution on COPD hospital admissions was evident and reduced heterogeneity significantly. The most consistent association was between a 1mg/m3 increase in carbon monoxide levels with COPD related admissions; Odds Ratio: 1.2 (95%CI: 1.01-1.03).Conclusions: There is mixed evidence on the effects of pollution on AECOPD. Limitations of previous studies include the low spatio-temporal resolution of pollutants, inadequate control for confounding factors, and the use of aggregated health data that ignore personal characteristics. The need for personal exposure monitoring in a large number of geographical locations is evident.